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Diffstat (limited to 'fs_selfservice/FS-SelfService/cgi/signup-agentselect.html')
| -rwxr-xr-x | fs_selfservice/FS-SelfService/cgi/signup-agentselect.html | 195 |
1 files changed, 195 insertions, 0 deletions
diff --git a/fs_selfservice/FS-SelfService/cgi/signup-agentselect.html b/fs_selfservice/FS-SelfService/cgi/signup-agentselect.html new file mode 100755 index 000000000..7851c5601 --- /dev/null +++ b/fs_selfservice/FS-SelfService/cgi/signup-agentselect.html @@ -0,0 +1,195 @@ +<HTML><HEAD><TITLE>ISP Signup form</TITLE></HEAD> +<BODY BGCOLOR="#e8e8e8"><FONT SIZE=7>ISP Signup form</FONT><BR><BR> +<FONT SIZE="+1" COLOR="#ff0000"><%= $error %></FONT> +<FORM NAME="OneTrueForm" ACTION="<%= $self_url %>" METHOD=POST onSubmit="document.OneTrueForm.signup.disabled=true"> +<INPUT TYPE="hidden" NAME="magic" VALUE="process"> +<INPUT TYPE="hidden" NAME="ref" VALUE="<%= $referral_custnum %>"> +<INPUT TYPE="hidden" NAME="ss" VALUE=""> +Agent <SELECT NAME="agentnum"> +<%= + warn $init_data; + warn $init_data->{'agent'}; + foreach my $agent ( @{$init_data->{'agent'}} ) { + $OUT .= '<OPTION VALUE="'. $agent->{'agentnum'}. '"'; + $OUT .= ' SELECTED' if $agent->{'agentnum'} eq $agentnum; + $OUT .= '>'. $agent->{'agent'}; + } +%> +</SELECT><BR><BR> +Contact Information +<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%"> +<TR> + <TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH> + <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>">, + <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>"></TD> +</TR> +<TR> + <TD ALIGN="right">Company</TD> + <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>"></TD> +</TR> +<TR> + <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH> + <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>"></TD> +</TR> +<TR> + <TD ALIGN="right"> </TD> + <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>"></TD> +</TR> +<TR> + <TH ALIGN="right"><font color="#ff0000">*</font>City</TH> + <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>"></TD> + <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH> + <TD> + <%= + ($county_html, $state_html, $country_html) = + regionselector( $county, $state, $country ); + + "$county_html $state_html"; + %> + </TD> + <TH><font color="#ff0000">*</font>Zip</TH> + <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>"></TD> +</TR> +<TR> + <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH> + <TD><%= $country_html %></TD> +<TR> + <TD ALIGN="right">Day Phone</TD> + <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18></TD> +</TR> +<TR> + <TD ALIGN="right">Night Phone</TD> + <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18></TD> +</TR> +<TR> + <TD ALIGN="right">Fax</TD> + <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12></TD> +</TR> +</TABLE><font color="#ff0000">*</font> required fields<BR> +<BR>Billing information<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%"> +<TR><TD> + + <%= + $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"'; + my @invoicing_list = split(', ', $invoicing_list ); + $OUT .= ' CHECKED' + if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list; + $OUT .= '>'; + %> + + Postal mail invoice +</TD></TR> +<TR><TD>Email invoice <INPUT TYPE="text" NAME="invoicing_list" VALUE="<%= join(', ', grep { $_ ne 'POST' } split(', ', $invoicing_list ) ) %>"> +</TD></TR> +<%= scalar(@payby) > 1 ? '<TR><TD>Billing type</TD></TR>' : '' %> +</TABLE> +<TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%"> +<TR> + + <%= + + my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>'; + my %types = ( + 'VISA' => 'VISA card', + 'MasterCard' => 'MasterCard', + 'Discover' => 'Discover card', + 'American Express' => 'American Express card', + ); + foreach ( keys %types ) { + $selected = $cgi->param('CARD_type') eq $types{$_} ? 'SELECTED' : ''; + $cardselect .= qq!<OPTION $selected VALUE="$types{$_}">$_</OPTION>!; + } + $cardselect .= '</SELECT>'; + + my %payby = ( + 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="CARD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("CARD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="CARD_payname" VALUE="">!, + 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!, + 'CHEK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="CHEK_payinfo1" VALUE="" MAXLENGTH=10><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="CHEK_payinfo2" VALUE="" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="CHEK_month" VALUE="12"><INPUT TYPE="hidden" NAME="CHEK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="">!, + 'DCHK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="DCHK_payinfo1" VALUE="" MAXLENGTH=10><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="DCHK_payinfo2" VALUE="" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="DCHK_month" VALUE="12"><INPUT TYPE="hidden" NAME="DCHK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!, + 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!, + 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE=""><BR><font color="#ff0000">*</font>Exp !. expselect("BILL", "12-2037"). qq!<BR><font color="#ff0000">*</font>Attention<BR><INPUT TYPE="text" NAME="BILL_payname" VALUE="Accounts Payable">!, + 'COMP' => qq!Complimentary<BR><font color="#ff0000">*</font>Approved by<INPUT TYPE="text" NAME="COMP_payinfo" VALUE=""><BR><font color="#ff0000">*</font>Exp !. expselect("COMP"), + 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!, + ); + + my( $account, $aba ) = split('@', $payinfo); + my %paybychecked = ( + 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="CARD_payinfo" VALUE="$payinfo" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("CARD", $paydate). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="CARD_payname" VALUE="$payname">!, + 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="$payinfo" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD", $paydate). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="$payname">!, + 'CHEK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="CHEK_payinfo1" VALUE="$account" MAXLENGTH=10><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="CHEK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="CHEK_month" VALUE="12"><INPUT TYPE="hidden" NAME="CHEK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="$payname">!, + 'DCHK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="DCHK_payinfo1" VALUE="$account" MAXLENGTH=10><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="DCHK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="DCHK_month" VALUE="12"><INPUT TYPE="hidden" NAME="DCHK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="$payname">!, + 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="$payinfo" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!, + 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE="$payinfo"><BR><font color="#ff0000">*</font>Exp !. expselect("BILL", $paydate). qq!<BR><font color="#ff0000">*</font>Attention<BR><INPUT TYPE="text" NAME="BILL_payname" VALUE="$payname">!, + 'COMP' => qq!Complimentary<BR><font color="#ff0000">*</font>Approved by<INPUT TYPE="text" NAME="COMP_payinfo" VALUE="$payinfo"><BR><font color="#ff0000">*</font>Exp !. expselect("COMP", $paydate), + 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!, + ); + + for (@payby) { + if ( scalar(@payby) == 1) { + $OUT .= '<TD VALIGN=TOP>'. + qq!<INPUT TYPE="hidden" NAME="payby" VALUE="$_">!. + "$paybychecked{$_}</TD>"; + } else { + $OUT .= qq!<TD VALIGN=TOP><INPUT TYPE="radio" NAME="payby" VALUE="$_"!; + if ($payby eq $_) { + $OUT .= qq! CHECKED> $paybychecked{$_}</TD>!; + } else { + $OUT .= qq!> $payby{$_}</TD>!; + } + + } + } + %> + +</TR></TABLE><font color="#ff0000">*</font> required fields for each billing type +<BR><BR>First package +<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%"> +<TR> + <TD COLSPAN=2><SELECT NAME="pkgpart"><OPTION VALUE="">(none) + + <%= + foreach my $package ( @{$packages} ) { + $OUT .= '<OPTION VALUE="'. $package->{'pkgpart'}. '"'; + $OUT .= ' SELECTED' if $pkgpart && $package->{'pkgpart'} == $pkgpart; + $OUT .= '>'. $package->{'pkg'}; + } + %> + + </SELECT></TD> +</TR> +<TR> + <TD ALIGN="right">Username</TD> + <TD><INPUT TYPE="text" NAME="username" VALUE="<%= $username %>"></TD> +</TR> +<TR> + <TD ALIGN="right">Password</TD> + <TD><INPUT TYPE="password" NAME="_password" VALUE="<%= $password %>"></TD> +</TR> +<TR> + <TD ALIGN="right">Re-enter Password</TD> + <TD><INPUT TYPE="password" NAME="_password2" VALUE="<%= $password2 %>"></TD> +</TR> +<%= + if ( $init_data->{'security_phrase'} ) { + $OUT .= <<ENDOUT; +<TR> + <TD ALIGN="right">Security Phrase</TD> + <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase"> + </TD> +</TR> +ENDOUT + } else { + $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">'; + } +%> +<%= + if ( scalar(@$pops) ) { + $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'. + popselector($popnum). '</TD></TR>'; + } else { + $OUT .= popselector($popnum); + } +%> +</TABLE> +<BR><BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup" > +</FORM></BODY></HTML> |