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|
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML>
<HEAD>
<TITLE><%= $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : 'ISP' ) %> Signup form</TITLE>
<%= $head %>
</HEAD>
<BODY BGCOLOR="<%= $body_bgcolor || '#e8e8e8' %>" onUnload="myclose()">
<script type="text/javascript">
var mywindow = -1;
function myopen(filename,windowname,properties) {
myclose();
mywindow = window.open(filename,windowname,properties);
}
function myclose() {
if ( mywindow != -1 )
mywindow.close();
mywindow = -1
}
</script>
<%= $OUT .= $body_header
|| '<FONT SIZE=7>'.
( $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : '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="session" VALUE="<%= $session_id %>">
<INPUT TYPE="hidden" NAME="action" VALUE="process_signup">
<INPUT TYPE="hidden" NAME="referral_custnum" VALUE="<%= $referral_custnum %>">
<INPUT TYPE="hidden" NAME="ss" VALUE="">
<input type="hidden" name="payby">
<%=
$OUT = join("\n",map { my $method = $_ ; map { qq|<input type="hidden" name="${method}_$_" />| } qw / payinfo payinfo1 payinfo2 payname paystate paytype paycvv month year type / } @payby);
%>
<%=
$OUT = join("\n", map { qq|<input type="hidden" name="$_" />| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum countrycode phonenum sip_password pin / );
%>
Where did you hear about our service? <SELECT NAME="refnum">
<%=
$OUT .= '<OPTION VALUE="">' unless $refnum;
foreach my $part_referral ( @part_referral ) {
$OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
$OUT .= ' SELECTED' if $part_referral->{'refnum'} eq $refnum;
$OUT .= '>'. $part_referral->{'referral'};
}
%>
</SELECT><BR><BR>
Contact Information
<TABLE BGCOLOR="<%= $box_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( {
selected_county => $county,
selected_state => $state,
selected_country => $country,
default_state => $statedefault,
default_country => $countrydefault,
locales => \@cust_main_county,
} );
"$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>
<%=
$OUT = '';
if ( $stateid_enabled ) {
my ($county_html, $state_html, $country_html) =
regionselector( {
prefix => 'stateid_',
default_state => $statedefault,
default_country => $countrydefault,
locales => \@cust_main_county,
} );
$OUT .= qq!<TR><TD ALIGN="right">!. $label{stateid}.'</TD>';
$OUT .= qq!<TD><INPUT TYPE="text" NAME="stateid" VALUE="$stateid" SIZE=12></TD>!;
$OUT .= qq!<TD ALIGN="right">!. $label{stateid_state} .'</TD>';
$OUT .="<TD COLSPAN=3>$county_html $state_html</TD></TR>";
}
%>
</TABLE><font color="#ff0000">*</font> required fields<BR>
<BR>Billing information<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
<TR><TD>
<%=
$OUT ='';
unless ( $emailinvoiceonly ) {
$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><%= $OUT = ( $emailinvoiceonly ? q|<font color="#ff0000">*</font>| : q|| ) %> Email invoice <INPUT TYPE="text" NAME="invoicing_list" VALUE="<%= join(', ', grep { $_ ne 'POST' } split(', ', $invoicing_list ) ) %>">
</TD></TR>
<%= ( scalar(@payby) > 1 or 1 ) ? '<TR><TD>Billing type ' : '' %>
<!--</TABLE>
<TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
<TR>-->
<%=
my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
foreach ( keys %card_types ) {
$selected = $CARD_type eq $card_types{$_} ? 'SELECTED' : '';
$cardselect .= qq!<OPTION $selected VALUE="$card_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>${r}ABA/Routing code <INPUT TYPE="text" NAME="CHEK_payinfo2" VALUE="" SIZE=10 MAXLENGTH=9> Type <SELECT NAME="CHEK_paytype">!. join('', map {qq!<OPTION VALUE="$_">$_</OPTION>!} @paytypes). qq!</SELECT><BR>{$r}Bank State <INPUT TYPE="text" NAME="CHEK_paystate" VALUE="" SIZE=5 MAXLENGTH=4><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> Type <SELECT NAME="DCHK_paytype">!. join('', map {qq!<OPTION VALUE="$_">$_</OPTION>!} @paytypes). qq!</SELECT><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="DCHK_payinfo2" VALUE="" SIZE=10 MAXLENGTH=9><BR>{$r}Bank State <INPUT TYPE="text" NAME="DCHK_paystate" VALUE="" SIZE=5 MAXLENGTH=4><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" NAME="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><INPUT TYPE="hidden" NAME="BILL_month" VALUE="12"><INPUT TYPE="hidden" NAME="BILL_year" VALUE="2037">Attention<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>!,
);
if ( $cvv_enabled ) {
foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
$payby{$payby} .= qq!<TR><TD ALIGN="right">CVV2 (<A HREF="javascript:myopen('cvv2.html','cvv2','toolbar=no,location=no,directories=no,status=no,menubar=no,scrollbars=no,resizable=yes,copyhistory=no,width=480,height=288')">help</A>)</TD><TD><INPUT TYPE="text" NAME=${payby}_paycvv VALUE="" SIZE=4 MAXLENGTH=4></TD></TR>!;
}
}
if ( $paystate_enabled ) {
foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
my ($county_html, $state_html, $country_html) =
regionselector( {
prefix => "${payby}_pay",
default_state => $statedefault,
default_country => $countrydefault,
locales => \@cust_main_county,
} );
$payby{$payby} .= "<BR>${r}Bank state $county_html $state_html";
}
}
my( $account, $aba ) = split('@', $payinfo);
my %paybychecked = (
'CARD' => '<TABLE BGCOLOR="'. ( $box_bgcolor || '#c0c0c0' ). qq!" BORDER=0 CELLSPACING=0 WIDTH="100%"><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card type</TD><TD>$cardselect</TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card number</TD><TD><INPUT TYPE="text" NAME="CARD_payinfo" VALUE="$payinfo" MAXLENGTH=19></TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Expration</TD><TD>!. expselect("CARD", $paydate). qq!</TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Name on card</TD><TD><INPUT TYPE="text" NAME="CARD_payname" VALUE="$payname"></TD></TR>!,
'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> Type <SELECT NAME="CHEK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><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> Type <SELECT NAME="DCHK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
'LECB' => qq!Phone bill billing<BR>${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><INPUT TYPE="hidden" NAME="BILL_month" VALUE="12"><INPUT TYPE="hidden" NAME="BILL_year" VALUE="2037">Attention<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>!,
);
if ( $cvv_enabled ) {
foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
$paybychecked{$payby} .= qq!<TR><TD ALIGN="right">CVV2 (<A HREF="javascript:myopen('cvv2.html','cvv2','toolbar=no,location=no,directories=no,status=no,menubar=no,scrollbars=no,resizable=yes,copyhistory=no,width=480,height=288')">help</A>)</TD><TD><INPUT TYPE="text" NAME=${payby}_paycvv VALUE="$paycvv" SIZE=4 MAXLENGTH=4></TD></TR>!;
}
}
if ( $paystate_enabled ) {
foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
my ($county_html, $state_html, $country_html) =
regionselector( {
prefix => "${payby}_pay",
selected_county => $county,
selected_state => $state,
selected_country => $country,
default_state => $statedefault,
default_country => $countrydefault,
locales => \@cust_main_county,
} );
$paybychecked{$payby} .= "<BR>${r}Bank state $county_html $state_html";
}
}
use Tie::IxHash;
use HTML::Widgets::SelectLayers;
my %payby_index = ( 'CARD' => qq/Credit Card/,
'DCRD' => qq/Credit Card/,
'CHEK' => qq/Check/,
'DCHK' => qq/Check/,
'LECB' => qq/Phone Bill Billing/,
'BILL' => qq/Billing/,
'COMP' => qq/Complimentary/,
'PREPAY' => qq/Prepaid Card/,
);
tie my %options, 'Tie::IxHash', ();
foreach my $payby_option ( @payby ) {
$options{$payby_option} = $payby_index{$payby_option};
}
my $selected_layer = ( grep { $_ eq 'CARD' } @payby ) ? 'CARD' : $payby[0];
HTML::Widgets::SelectLayers->new(
options => \%options,
selected_layer => $selected_layer,
form_name => 'dummy',
html_between => '</td></tr></table>',
form_action => 'dummy.cgi',
layer_callback => sub { my $layer = shift; return $paybychecked{$layer}. '</TABLE>'; },
)->html;
%>
</TR></TABLE><font color="#ff0000">*</font> required fields
<FORM name="signup_form" action="<%= $self_url %>" METHOD="POST" onsubmit="return fixup_form();"><BR><BR>First package
<INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $promo_code %>">
<INPUT TYPE="hidden" NAME="reg_code" VALUE="<%= $reg_code %>">
<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
<TR>
<TD COLSPAN=2><SELECT NAME="pkgpart">
<%=
$OUT .= '<OPTION VALUE="">(none)'
unless scalar(@part_pkg) == 1 or $default_pkgpart;
foreach my $part_pkg ( @part_pkg ) {
$OUT .= '<OPTION VALUE="'. $part_pkg->{'pkgpart'}. '"';
$OUT .= ' SELECTED' if $pkgpart && $part_pkg->{'pkgpart'} == $pkgpart;
$OUT .= '>'. $part_pkg->{'pkg'};
}
%>
</SELECT></TD>
</TR>
<%=
if ( $signup_service eq 'svc_phone' ) {
$OUT .= '<TR><TD ALIGN="right">Phone number</TD><TD>'.
didselector( 'field' => 'phonenum',
'svcpart' => $default_svcpart,
).
'</TD></TR>';
$OUT .= <<ENDOUT;
<TR>
<TD ALIGN="right">Voicemail PIN</TD>
<TD><INPUT TYPE="pin" NAME="pin" VALUE="$pin"></TD>
</TR>
ENDOUT
} else {
$OUT .= <<ENDOUT;
<TR>
<TD ALIGN="right">Username</TD>
<TD><INPUT TYPE="text" NAME="username" VALUE="$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>
ENDOUT
if ( $security_phrase ) {
$OUT .= <<SECPHRASE;
<TR>
<TD ALIGN="right">Security Phrase</TD>
<TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
</TD>
</TR>
SECPHRASE
} else {
$OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
}
}
if ( @svc_acct_pop ) {
$OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
popselector( 'popnum' => $popnum,
'pops' => \@svc_acct_pop,
'init_popstate' => $init_popstate,
'popac' => $popac,
'acstate' => $acstate,
).
'</TD></TR>';
} else {
$OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop);
}
%>
</TABLE>
<%=
if ( @optional_packages ) {
my @html;
foreach my $ii ( 0 .. $#optional_packages) {
my $friendly_index = $ii + 1;
if ($optional_packages[$ii]) {
push @html, qq|<BR>Optional Package #$friendly_index <br />|,'<table bgcolor="#c0c0c0"><tr><td>';
push @html, qq|<select name="optional_package${ii}">|;
push @html, qq|<option value="none"></option>|;
push @html, map { qq|<option value="$_->{pkgpart}">$_->{pkg}</option>| } @{$optional_packages[$ii]};
push @html, q|</select>|;
push @html, '</td></tr></table>';
}
$OUT = join("\n", @html);
}
} else {
$OUT = ''
}
%>
<BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
<script language="JavaScript">
function fixup_form() {
// copy payment method data up to OneTrueForm
var payment_method_elements = new Array( 'payinfo', 'payinfo1', 'payinfo2', 'payname', 'paycvv' , 'paystate', 'paytype', 'month', 'year','type' );
var payment_method_form_name = document.OneTrueForm.select.options[document.OneTrueForm.select.selectedIndex].value;
document.OneTrueForm.elements['payby'].value = payment_method_form_name;
var payment_method_form = document.forms[payment_method_form_name];
for ( ii = 0 ; ii < payment_method_elements.length ; ii++ ) {
var true_element_name = payment_method_form_name + '_' + payment_method_elements[ii];
copyelement ( payment_method_form.elements[true_element_name],
document.OneTrueForm.elements[true_element_name] );
}
// Copy signup details to OneTrueForm
var signup_elements = new Array (
'promo_code', 'reg_code', 'pkgpart',
'username', '_password', '_password2', 'sec_phrase', 'popnum',
'countrycode', 'phonenum', 'sip_password', 'pin'
);
for ( ii = 0 ; ii < signup_elements.length ; ii ++ ) {
copyelement ( document.signup_form.elements[signup_elements[ii]],
document.OneTrueForm.elements[signup_elements[ii]]);
}
document.OneTrueForm.submit();
return false;
}
function copyelement(from, to) {
// alert ( from + ' ' + to );
if ( from == undefined ) {
to.value = '';
} else {
if ( from.type == 'select-one' ) {
to.value = from.options[from.selectedIndex].value;
} else if ( from.type == 'checkbox' ) {
if ( from.checked ) {
to.value = from.value;
} else {
to.value = '';
}
} else {
if ( from.value == undefined ) {
to.value = '';
} else {
to.value = from.value;
}
}
// alert(from.name + " (" + from.type + "): " + to.name + " => " + to.value);
}
}
</script>
</FORM>
<%= $OUT .= $body_footer %>
</BODY>
</HTML>
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