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Code Editor : billing.html
<!doctype html> <html lang="en"> <head><meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta name="description" content="Billing details for Health Care Startup coaching program orders." /> <title>Billing | Health Care Startup</title> <link rel="preconnect" href="https://fonts.googleapis.com" /> <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin /> <link href="https://fonts.googleapis.com/css2?family=Cinzel:wght@600;700&family=Inter:wght@400;500;600;700;800&display=swap" rel="stylesheet" /> <link rel="icon" href="assets/favicon.ico" sizes="any" /> <link rel="stylesheet" href="styles.css?v=reference-photo" /> <script src="https://unpkg.com/lucide@latest/dist/umd/lucide.min.js" defer></script> <script src="content-data.js" defer></script> <script src="script.js" defer></script> </head> <body class="page-coaching page-billing"> <a class="skip-link" href="#main">Skip to content</a> <header class="site-header" data-header> <div class="container header-inner"> <a class="brand" href="/" aria-label="Health Care Startup home"><span>Health Care Startup</span></a> <nav class="desktop-nav" aria-label="Primary navigation"> <a href="/about">About Us</a> <a href="/coaching-programs" aria-current="page">Coaching Programs</a> <a href="/policy-and-procedure-manuals">Policy & Procedure Manuals</a> <a href="/licensing-startup">Licensing & Startup</a> <a href="/accreditation">Accreditation</a> <a href="/training">Training</a> <a href="/blogs">Blogs</a> </nav> <div class="header-actions"> <a class="button button-call" href="tel:+11234567890"><i data-lucide="phone-call"></i><span>Call Us Now</span></a> <button class="menu-toggle" type="button" aria-expanded="false" aria-controls="mobile-menu" data-menu-toggle> <span class="sr-only">Open menu</span> <i data-lucide="menu"></i> </button> </div> </div> <div class="mobile-panel" id="mobile-menu" data-mobile-menu> <nav class="mobile-nav" aria-label="Mobile navigation"> <a href="/about">About Us</a> <a href="/coaching-programs" aria-current="page">Coaching Programs</a> <a href="/policy-and-procedure-manuals">Policy & Procedure Manuals</a> <a href="/licensing-startup">Licensing & Startup</a> <a href="/accreditation">Accreditation</a> <a href="/training">Training</a> <a href="/blogs">Blogs</a> <a class="button button-call mobile-call" href="tel:+11234567890"><i data-lucide="phone-call"></i><span>Call Us Now</span></a> </nav> </div> </header> <main id="main" data-billing-page> <section class="page-hero section-reveal" aria-labelledby="billing-title"> <div class="container page-hero-inner"> <div class="page-hero-copy"> <p class="section-kicker">Billing</p> <h1 id="billing-title">Complete your billing details.</h1> <p> Confirm the selected product and agency state, then enter your billing contact information so the order can be prepared. </p> </div> <aside class="order-summary-card" aria-labelledby="summary-title"> <div class="summary-heading"> <span class="summary-icon"><i data-lucide="shopping-bag"></i></span> <div> <p>Checkout</p> <h2 id="summary-title">Order Summary</h2> </div> </div> <ul class="order-items" data-billing-items></ul> <div class="summary-total"> <span>Total</span> <strong data-billing-price>$0</strong> </div> <div class="summary-meta"> <span data-billing-state-label>Agency state: Not selected</span> <span data-billing-count>1 product selected</span> </div> <form class="add-product-form" data-add-product-form> <label for="additional-product"> <span>More products</span> <small data-add-product-help>Add another product to this order</small> </label> <div class="add-product-row"> <select id="additional-product" data-add-product-select> <option value="">Add another product</option> </select> <button class="button button-light" type="submit"> <i data-lucide="plus"></i> <span>Add</span> </button> </div> </form> <a class="summary-change-link" data-billing-change-link href="/coaching-programs">Back to catalog</a> </aside> </div> </section> <section class="section section-reveal" aria-labelledby="billing-form-title"> <div class="container billing-layout"> <form class="contact-form-card billing-form checkout-form" action="billing.html" method="post" data-billing-form> <div class="form-status" data-billing-status role="status" aria-live="polite"></div> <fieldset class="checkout-fieldset"> <legend id="billing-form-title">Contact information</legend> <div class="form-row"> <label class="sr-only" for="billing-email">Email address</label> <input id="billing-email" name="email" type="email" autocomplete="email" placeholder="Email address" required /> <p class="checkout-helper">You are currently checking out as a guest.</p> </div> </fieldset> <fieldset class="checkout-fieldset"> <legend>Billing address</legend> <div class="form-row"> <label class="sr-only" for="billing-country">Country/Region</label> <select id="billing-country" name="country" required> <option value="United States (US)" selected>United States (US)</option> </select> </div> <div class="form-split"> <div class="form-row"> <label class="sr-only" for="billing-first-name">First name</label> <input id="billing-first-name" name="first-name" type="text" autocomplete="given-name" placeholder="First name" required /> </div> <div class="form-row"> <label class="sr-only" for="billing-last-name">Last name</label> <input id="billing-last-name" name="last-name" type="text" autocomplete="family-name" placeholder="Last name" required /> </div> </div> <div class="form-row"> <label class="sr-only" for="billing-address">Address</label> <input id="billing-address" name="address" type="text" autocomplete="street-address" placeholder="Address" required /> </div> <div class="form-row"> <label class="sr-only" for="billing-address-extra">Apartment, suite, etc.</label> <input id="billing-address-extra" name="address-extra" type="text" autocomplete="address-line2" placeholder="+ Add apartment, suite, etc." /> </div> <div class="form-split"> <div class="form-row"> <label class="sr-only" for="billing-city">City</label> <input id="billing-city" name="city" type="text" autocomplete="address-level2" placeholder="City" required /> </div> <div class="form-row"> <label class="sr-only" for="billing-state">State</label> <select id="billing-state" name="state" data-billing-state required> <option value="">State</option> </select> </div> </div> <div class="form-split"> <div class="form-row"> <label class="sr-only" for="billing-zip">ZIP Code</label> <input id="billing-zip" name="zip" type="text" autocomplete="postal-code" placeholder="ZIP Code" required /> </div> <div class="form-row"> <label class="sr-only" for="billing-phone">Phone</label> <input id="billing-phone" name="phone" type="tel" autocomplete="tel" placeholder="Phone (optional)" /> </div> </div> </fieldset> <fieldset class="checkout-fieldset"> <legend>Payment options</legend> <div class="payment-option-box"> <span class="payment-option-icon" aria-hidden="true"><i data-lucide="credit-card"></i></span> <div class="payment-option-copy"> <strong data-payment-option-title>Secure card checkout</strong> <span data-payment-option-description>Pay safely with encrypted checkout. Your card details stay protected.</span> <div class="payment-card-logos" data-payment-card-logos aria-label="Accepted card brands"> <span class="card-logo card-logo-visa">Visa</span> <span class="card-logo card-logo-mastercard">Mastercard</span> <span class="card-logo card-logo-amex">Amex</span> <span class="card-logo card-logo-discover">Discover</span> </div> </div> </div> </fieldset> <button class="button button-primary form-submit" data-billing-submit type="submit">Continue to secure checkout</button> </form> <article class="product-detail-card billing-note"> <p class="section-kicker">Quick Checkout</p> <h2>Multiple product order</h2> <p> Add extra products from the order summary before submitting. The product list, total, and selected state stay in the page URL so the order is easy to review. </p> <ul class="product-detail-list"> <li>Contact information captured</li> <li>Billing address included</li> <li>Stripe or manual orders supported</li> </ul> </article> </div> </section> </main> <footer class="footer" id="contact"> <div class="container footer-grid"> <div class="footer-copy"> <a class="brand footer-brand" href="/" aria-label="Health Care Startup home"> <span>Health Care Startup</span> </a> <p> Helping you launch your licensed home care, hospice, or healthcare staffing agency - without franchise fees. </p> </div> <nav class="footer-column" aria-labelledby="quick-links-title"> <h2 id="quick-links-title">Quick Links</h2> <ul class="footer-links"> <li><a href="/about">About Us</a></li> <li><a href="/coaching-programs">Coaching Programs</a></li> <li><a href="/policy-and-procedure-manuals">Policy & Procedure Manuals</a></li> <li><a href="/licensing-startup">Licensing & Startup</a></li> <li><a href="/accreditation">Accreditation</a></li> <li><a href="/training">Training</a></li> <li><a href="/blogs">Blogs</a></li> <li><a href="/contact">Contact Us</a></li> </ul> </nav> <div class="footer-column"> <h2>Contact Us</h2> <div class="footer-contact"> <a href="mailto:info@startuphomecare.org"> <i data-lucide="mail" aria-hidden="true"></i> info@startuphomecare.org </a> <a href="tel:+11234567890"> <i data-lucide="phone" aria-hidden="true"></i> (123) 456-7890 </a> <span><i data-lucide="map-pin" aria-hidden="true"></i> Location: Boston, MA</span> <a href="/contact"> <i data-lucide="send" aria-hidden="true"></i> Contact </a> </div> </div> <div class="footer-column"> <h2>Subscribe Our Newsletter</h2> <form class="newsletter-form" action="#"> <label for="newsletter-email">Email</label> <input id="newsletter-email" name="email" type="email" autocomplete="email" required /> <button class="button button-primary" type="submit">Subscribe</button> </form> </div> </div> <div class="container footer-bottom"> <p>© <span data-year></span> Health Care Startup. Home care startup consulting for compliant growth.</p> <a href="#">Back to top</a> </div> </footer> </body> </html>
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