bank card payment plug in wanted for javascript website

I need a simple, classic and sophisticated, symmetric and aligned international bank card plug in for my java script website for w w w . m e d n a c l i n i c . c o m to replace the bank account info, so it should be similar to the attached one that I got from [login to view URL] and I quite like it without the red text. please, include the softer version and price in your bid and send me a screen shot of the plug when you PM me. I am only interested in one time buy off of the program, so no need to include installation, thank you.