d</label>
															<input class="form-control" id="card_name" type="text">
														</div>
													</div>
													<div class="col-md-6">
														<div class="form-group card-label">
															<label for="card_number">Card Number</label>
															<input class="form-control" id="card_number" placeholder="1234  5678  9876  5432" type="text">
														</div>
													</div>
													<div class="col-md-4">
														<div class="form-group card-label">
							