{fld-amount class="form-control" placeholder="Amount*" }

{err-amount}

{fld-paymode class="form-control" placeholder="Amount*" }

{err-paymode}

{fld-transction_no class="form-control" placeholder="Transction No*" }

{err-transaction_no}

{fld-bank_name class="form-control" placeholder="Bank Name"}

{err-bank_name}

{fld-branch_name class="form-control" placeholder="Branch Name"}

{err-branch_name}

{fld-remarks class="form-control" placeholder="Remarks"}

{err-remarks}

{fld-txn_password class="form-control" placeholder="Transction Password"}

{err-txn_password}

Upload Scanned Copy

{fld-sb class="btn btn-primary"}

Note:-
1. After 5 PM Payment approve on next working day
2.There should be single bank transaction against a request.