<div class="form-group col-sm-12" id="">
    <div class="form-group col-sm-10" id=""style="background-color: #cccccc;">
        <div class="form-group col-sm-10" id=""style="background-color: #cccccc;">
            <div class="form-group col-sm-5">
                <label for="credit_card_type">Credit Card type:</label><br>
                <input data-errormessage-value-missing="Credit Card type is required!" 
                       class=" validate[required] text-input"
                       type="radio"
                       name="credit_card_type"
                       value="1"
                       id="credit_card_type">Master
                <input data-errormessage-value-missing="Credit Card type is required!" 
                       class=" validate[required] text-input" 
                       type="radio" 
                       name="credit_card_type" 
                       value="2" 
                       id="credit_card_type">Visa
            </div>
            <script>
            
            </script>
            <div class="form-group col-sm-5">
                <label for="credit_card_number">Card Card Number:</label>
                <input data-errormessage-value-missing="Card Card Number is required!" 
                       class="form-control validate[required, custom[validCreditCard]] text-input" 
                       type="text" 
                       name="credit_card_number" 
                       id="credit_card_number" 
                       value="<?php echo set_value('credit_card_number'); ?>">
            </div>
            <div class="form-group col-sm-5">
                <label for="credit_card_expiry_date">Card Expiry Date:</label>
                <input data-errormessage-value-missing="Card Expiry Date is required!" 
                       class="form-control validate[required] text-input" 
                       type="date" 
                       name="credit_card_expiry_date" 
                       maxlength="16" 
                       aid="credit_card_expiry_date" 
                       value="<?php echo set_value('credit_card_expiry_date'); ?>"
                       >
            </div>
            <div class="form-group col-sm-4">
                <label for="credit_card_verification_number">Verification Number:</label>
                <input data-errormessage-value-missing="Verification Number is required!" 
                       class="form-control validate[required] text-input"
                       type="text" 
                       name="credit_card_verification_number" 
                       maxlength="4" 
                       id="credit_card_verification_number" 
                       value="<?php echo set_value('credit_card_expiry_date'); ?>"
                       >
            </div>
        </div>
    </div>
</div>