Stripe authorisation page

Job ID: 35356919

Budget: $30 – $250 AUD

I want a HTML webpage I can upload into wordpress with a form that contains the following mandatory fields:

Customer name
Customer email
Customer ID type and number
Credit card authorisation amount
Credit card number
Credit card expiry
Credit card ccv

When the form is actioned I want the following to occur:

1) Customer profile created in my stripe account.
Form field 'customer name' = stripe field 'name'.
Form field 'customer email' = stripe field 'account email'.
Form field 'ID type and number' = stripe field 'description'.
2) Customer's credit card details saved within the customer profile within my account so it can be charged again later.
3) A hold for the amount specified in the form to be placed on the card for a period of 28 days (not the usual 7 days).
4) A message to display after actioning the form to let the user know if the authorisation was successful or not.

https://stripe.com/docs/terminal/features/extended-authorizations

I want a white background, a black title and a place for my logo.
Related categories: HTML Stripe