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              <form accept-charset="UTF-8" action="#" class="pro-form" id="pro-form" method="post">

  <h1>Progress Form</h1>

  <div class="progress-wrap">
<progress max="100" value="0" id="progress"></progress>
    <div class="progress-message" id="progress-message">The form, it wants you.</div>
</div>

  <input id="subscription_plan_id" name="subscription[plan_id]" type="hidden" value="1">

  <input id="subscription_stripe_card_token" name="subscription[stripe_card_token]" type="hidden">

    <div class="field">
      <label for="card_name">Name on Card</label>
      <br>
      <input id="card_name" required="required" type="text">
    </div>

    <div class="field">
      <label for="card_address_1">Street Address</label>
      <br>
      <input id="card_address_1" required="required" type="text">
      <input id="card_address_2" type="text">
    </div>

    <div class="field">
      <label for="card_zip">Zip Code</label>
      <br>
      <input id="card_zip" maxlength="10" pattern="[0-9]*" required="required" type="text">
    </div>

    <div class="field">
      <label for="card_number">Credit Card Number</label>
      <br>
      <input id="card_number" pattern="[0-9]*" required="required" type="number">
    </div>

    <div class="field">
      <label for="card_code">Security Code on Card (CVV)</label>
      <br>
      <input id="card_code" required="required" type="text">
    </div>

    <div class="field">
      <label for="card_month">Card Expiration</label>
      <br>
      <select id="card_month">
<option value="1">1 - January</option>
<option value="2">2 - February</option>
<option value="3">3 - March</option>
<option value="4">4 - April</option>
<option value="5">5 - May</option>
<option value="6">6 - June</option>
<option value="7">7 - July</option>
<option value="8">8 - August</option>
<option value="9">9 - September</option>
<option value="10">10 - October</option>
<option value="11">11 - November</option>
<option value="12">12 - December</option>
</select>

      <select id="card_year">
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
</select>

    </div>

  <div class="actions">

      <input name="commit" type="submit" value="Subscribe" class="button">
  </div>

</form>
            
          
!
            
              @import "compass/css3";

* { @include box-sizing(border-box); }
body { 
  background: #333;
  font-family: "Lucida Grande", "Lucida Sans Unicode", Tahoma, Sans-Serif;
  font-size: 14px;
  line-height: 1.4;
  padding: 20px;
}
h1, h2 {
  font-family: Sans-Serif; 
}

.pro-form {
  width: 350px;
  border-radius: 20px;
  @include background(linear-gradient(#268ad0, #59c1d4));
  padding: 2px 20px 20px 20px;
  .field {
    margin: 0 0 10px 0;
    input[type=text], input[type=number] {
      width: 100%;
    }
  }
}
#card_zip {
  width: 50%;
}
#card_code {
  width: 30%;
}
#card_address_2 {
  margin-top: 3px;
}

.actions {
  margin-top: 25px;
  .button {
    display: block;
    width: 100%;
    float: none;
    text-align: center;
    font-size: 120%;
  }
}

input[type=number]::-webkit-inner-spin-button,
input[type=number]::-webkit-outer-spin-button {
  -webkit-appearance: none;
  margin: 0;
}

input[type='text'],
input[type='number'], {
  -webkit-appearance: none;
  @include background(linear-gradient(#ccc, #fff));
  padding: 4px 20px 4px 5px;
  outline: 0;
  border: 0;
  box-shadow: inset 1px 1px 1px rgba(black, 0.3);
  &:focus {
    background: white;
  }
}

.button {
  float: left;
  border: 0;
  padding: 12px 16px;
  @include background(linear-gradient(#323232, #272727));
  box-shadow: inset 0 1px 0 #3c3c3c;
  border-radius: 5px;
  border: 1px solid #111;
  color: white !important;
  font-size: 16px;
  text-shadow: 0 1px 1px rgba(0,0,0,0.8);
  text-overflow: ellipsis;
  cursor: pointer;
  &:hover, &:focus, &.gsc-cursor-current-page {
    background: #333;
    text-decoration: none !important;
    @include box-shadow((0 2px 3px -2px rgba(0, 0, 0, 0.5)));
    strong {
      background: #999;
      color: black;
    }
  }
  &:active {
    position: relative;
    top: 1px;
    box-shadow: none;
  }
  &.active {
    background: black;
  }
  a {
    color: white;
  }
}

.progress-wrap {
  text-align: center;
  font-size: 10px;
  color: white;
  margin: 0 0 20px 0;
  progress {
    width: 100%;
    margin: 0 0 5px 0;
  }
}
            
          
!
            
              $("#pro-form input").keyup(function() {
  
var numValid = 0;
$("#pro-form input[required]").each(function() {
    if (this.validity.valid) {
        numValid++;
    }
});

var progress = $("#progress"),
    progressMessage = $("#progress-message");

if (numValid == 0) {
    progress.attr("value", "0");
    progressMessage.text("The form, it wants you.");
}
if (numValid == 1) {
    progress.attr("value", "20");
    progressMessage.text("There you go, great start!");
}
if (numValid == 2) {
    progress.attr("value", "40");
    progressMessage.text("Nothing can stop you now.");
}
if (numValid == 3) {
    progress.attr("value", "60");
    progressMessage.text("You're basically a hero, right?");
}
if (numValid == 4) {
    progress.attr("value", "80");
    progressMessage.text("They are going to write songs about you.");
}
if (numValid == 5) {
    progress.attr("value", "95");
    progressMessage.text("SO CLOSE. PRESS THE THING.");
}
  
});
            
          
!
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