1 <HTML><HEAD><TITLE>ISP Signup form</TITLE></HEAD>
2 <BODY BGCOLOR="#e8e8e8" onUnload="myclose()">
3 <script language="JavaScript"><!--
5 function myopen(filename,windowname,properties) {
7 mywindow = window.open(filename,windowname,properties);
15 <FONT SIZE=7>ISP Signup form</FONT><BR><BR>
16 <FONT SIZE="+1" COLOR="#ff0000"><%= $error %></FONT>
17 <FORM ACTION="<%= $self_url %>" METHOD=POST>
18 <INPUT TYPE="hidden" NAME="magic" VALUE="process">
19 <INPUT TYPE="hidden" NAME="ref" VALUE="<%= $referral_custnum %>">
20 <INPUT TYPE="hidden" NAME="ss" VALUE="">
22 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
24 <TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH>
25 <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>">,
26 <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>"></TD>
29 <TD ALIGN="right">Company</TD>
30 <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>"></TD>
33 <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
34 <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>"></TD>
37 <TD ALIGN="right"> </TD>
38 <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>"></TD>
41 <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
42 <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>"></TD>
43 <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
46 ($county_html, $state_html, $country_html) =
47 regionselector( $county, $state, $country );
49 "$county_html $state_html";
52 <TH><font color="#ff0000">*</font>Zip</TH>
53 <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>"></TD>
56 <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
57 <TD><%= $country_html %></TD>
59 <TD ALIGN="right">Day Phone</TD>
60 <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18></TD>
63 <TD ALIGN="right">Night Phone</TD>
64 <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18></TD>
67 <TD ALIGN="right">Fax</TD>
68 <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12></TD>
70 </TABLE><font color="#ff0000">*</font> required fields<BR>
71 <BR>Billing information<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
75 $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
76 my @invoicing_list = split(', ', $invoicing_list );
78 if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
84 <TR><TD>Email invoice <INPUT TYPE="text" NAME="invoicing_list" VALUE="<%= join(', ', grep { $_ ne 'POST' } split(', ', $invoicing_list ) ) %>">
86 <%= scalar(@payby) > 1 ? '<TR><TD>Billing type</TD></TR>' : '' %>
88 <TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
93 my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
95 'VISA' => 'VISA card',
96 'MasterCard' => 'MasterCard',
97 'Discover' => 'Discover card',
98 'American Express' => 'American Express card',
100 foreach ( keys %types ) {
101 $selected = $cgi->param('CARD_type') eq $types{$_} ? 'SELECTED' : '';
102 $cardselect .= qq!<OPTION $selected VALUE="$types{$_}">$_</OPTION>!;
104 $cardselect .= '</SELECT>';
107 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
108 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
109 'CHEK' => qq!Electronic check<BR>${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="">!,
110 '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
111 'LECB' => qq!Phone bill billing<BR>${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="">!,
112 '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">!,
113 '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"),
114 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
117 if ( $init_data->{'cvv_enabled'} ) {
118 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
119 $payby{$payby} .= qq!<BR>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>) <INPUT TYPE="text" NAME=${payby}_paycvv VALUE="" SIZE=4 MAXLENGTH=4>!;
123 my( $account, $aba ) = split('@', $payinfo);
125 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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">!,
126 '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">!,
127 '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">!,
128 '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">!,
129 '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="">!,
130 '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">!,
131 '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", $paydate),
132 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
135 if ( $init_data->{'cvv_enabled'} ) {
136 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
137 $paybychecked{$payby} .= qq!<BR>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>) <INPUT TYPE="text" NAME=${payby}_paycvv VALUE="$paycvv" SIZE=4 MAXLENGTH=4>!;
142 if ( scalar(@payby) == 1) {
143 $OUT .= '<TD VALIGN=TOP>'.
144 qq!<INPUT TYPE="hidden" NAME="payby" VALUE="$_">!.
145 "$paybychecked{$_}</TD>";
147 $OUT .= qq!<TD VALIGN=TOP><INPUT TYPE="radio" NAME="payby" VALUE="$_"!;
149 $OUT .= qq! CHECKED> $paybychecked{$_}</TD>!;
151 $OUT .= qq!> $payby{$_}</TD>!;
158 </TR></TABLE><font color="#ff0000">*</font> required fields for each billing type
159 <BR><BR>First package
160 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
162 <TD COLSPAN=2><SELECT NAME="pkgpart"><OPTION VALUE="">(none)
165 foreach my $package ( @{$packages} ) {
166 $OUT .= '<OPTION VALUE="'. $package->{'pkgpart'}. '"';
167 $OUT .= ' SELECTED' if $pkgpart && $package->{'pkgpart'} == $pkgpart;
168 $OUT .= '>'. $package->{'pkg'};
175 <TD ALIGN="right">Username</TD>
176 <TD><INPUT TYPE="text" NAME="username" VALUE="<%= $username %>"></TD>
179 <TD ALIGN="right">Password</TD>
180 <TD><INPUT TYPE="password" NAME="_password" VALUE="<%= $password %>"></TD>
183 <TD ALIGN="right">Re-enter Password</TD>
184 <TD><INPUT TYPE="password" NAME="_password2" VALUE="<%= $password2 %>"></TD>
187 if ( $init_data->{'security_phrase'} ) {
190 <TD ALIGN="right">Security Phrase</TD>
191 <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
196 $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
200 if ( scalar(@$pops) ) {
201 $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
202 popselector($popnum). '</TD></TR>';
204 $OUT .= popselector($popnum);
208 <BR><BR>Enter up to ten external accounts from which to retrieve email
209 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
211 <TH ALIGN="left">Mail server</TH>
212 <TH ALIGN="left">Username</TH>
213 <TH ALIGN="left">Password</TH>
216 for my $num ( 1..10 ) {
218 $OUT .= qq!<TR><TD><INPUT TYPE="text" NAME="snarf_machine$num" VALUE="${"snarf_machine$num"}"></TD>!.
219 qq!<INPUT TYPE="hidden" NAME="snarf_protocol$num" VALUE="pop3">!.
220 qq!<TD><INPUT TYPE="text" NAME="snarf_username$num" VALUE="${"snarf_username$num"}"></TD>!.
221 qq!<TD><INPUT TYPE="password" NAME="snarf_password$num" VALUE="${"snarf_password$num"}"></TD>!.
227 <BR><BR><INPUT TYPE="submit" VALUE="Signup">
228 </FORM></BODY></HTML>