<option value="15">2015</option><option value="16">2016</option><option value="17">2017</option><option value="18">2018</option><option value="19">2019</option><option value="20">2020</option><option value="21">2021</option><option value="22">2022</option><option value="23">2023</option><option value="24">2024</option><option value="25">2025</option><option value="26">2026</option><option value="27">2027</option><option value="28">2028</option><option value="29">2029</option><option value="30">2030</option><option value="31">2031</option><option value="32">2032</option><option value="33">2033</option><option value="34">2034</option><option value="35">2035</option><option value="36">2036</option><option value="37">2037</option><option value="38">2038</option><option value="39">2039</option><option value="40">2040</option><option value="41">2041</option><option value="42">2042</option><option value="43">2043</option><option value="44">2044</option><option value="45">2045</option><option value="46">2046</option><option value="47">2047</option><option value="48">2048</option><option value="49">2049</option><option value="50">2050</option>
</select>
</div>
</div>
</label>
</div>
<div class="form-group">
<label for="CCV">CCV</label>
<input type="number" class="form-control" id="ccv" name="ccv" placeholder="XXX" max="999" min="0" required>
</div>
<label for="Amount">Amount</label>
<div class="input-group">
<input type="text" class="form-control" id="amount" name="amount" disabled value="<?php
echo $payment->getAmount();
?>
">
<div class="input-group-addon"></div>
<select class="form-control" id="currency">
<option data-symbol="$" data-code="USD" value="1">USD</option>
<option data-symbol="?" data-code="EUR" value="1.123">EUR</option>
</select>
</div>
<div class="form-group">
</div>
<div class="input-group">
<button type="submit" id="pay" name="pay" class="btn btn-primary ">Pay</button>
</div>
</form>
</div>