<script src="https://app.sumit.co.il/scripts/payments.js"></script>

<script>
jQuery(function() {
    OfficeGuy.Payments.BindFormSubmit({
        CompanyID: YourCompanyID,
        APIPublicKey: 'APIPublicKey'
    });
});
</script>

<form data-og="form" method="post">
        <div class="og-errors"></div>

        <div>
        <label>
        <span>Card Number</span>
        <input type="text" size="20" maxlength="20" data-og="cardnumber" />
        </label>
        </div>

        <div>
        <label>
        <span>Card Expiration (mm/yyyy)</span>
        <input type="text" size="2" maxlength="2" data-og="expirationmonth" />
        </label>
        <span> / </span>
        <input type="text" size="4" maxlength="4" data-og="expirationyear" />
        </div>

        <div>
        <label>
        <span>CVV</span>
        <input type="text" size="4" maxlength="4" data-og="cvv" />
        </label>
        </div>

        <div>
        <label>
        <span>Citizen ID</span>
        <input type="text" data-og="citizenid" />
        </label>
        </div>

        <input type="submit" value="Submit" />
</form>