Create a form and popup carrying over shopping cart information -- 2

I have a new hotels reservation website that currently accepts credit cards.

I want to create a popup for OFFLINE payments (no integration with anything)

I want to add a new button "Pay with Bitcoin" and when the user clicks it it will open a POPUP with a form to collect some info from the client: Name, Last name, Street Address, City, Country, phone and email.

After user submits the form he gets to a popup with the:

- HOTEL NAME, DATE, ROOM TYPE

- the total price in local currency (R$) as carried from the area marked in the image attached (TOTAL PRICE)

- the price calculated in bitcoin

- check box saying client agrees with Terms & Conditions

- button "Finalize and Pay with Bitcoin"

PRICE CALCULATED IN BITCOIN:

- You will need to create a table that I can maintain with the current bitcoin price per (R$)

- The price showed in bitcoin will be the TOTAL PRICE divided by the current bitcoin price in the table above.

After client clicks finalize and pay with Bitcoin:

- There will be 5 hidden different bitcoin address codes and their respective QR codes (static image).

- The client will be shown a popup with one of the 5 codes and it is respective QR code

- An email needs te generated with the reservation and payment information.

- Client will click a button, to close popup and go back to home page.

MY WEBSITE IS: [login to view URL]

Thats pretty much it. Please take a look at the screenshot.

HTML HTML5 JavaScript MySQL PHP

Ταυτότητα Εργασίας: #8872650

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