1 <HTML><HEAD><TITLE><%= $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : '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><%= $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : 'ISP' ) %> Signup form</FONT><BR><BR>
16 <FONT SIZE="+1" COLOR="#ff0000"><%= $error %></FONT>
17 <FORM NAME="OneTrueForm" ACTION="<%= $self_url %>" METHOD=POST onSubmit="document.OneTrueForm.signup.disabled=true">
18 <INPUT TYPE="hidden" NAME="session" VALUE="<%= $session_id %>">
19 <INPUT TYPE="hidden" NAME="action" VALUE="process_signup">
20 <INPUT TYPE="hidden" NAME="referral_custnum" VALUE="<%= $referral_custnum %>">
21 <INPUT TYPE="hidden" NAME="ss" VALUE="">
22 <input type="hidden" name="payby" />
24 $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);
28 $OUT = join("\n", map { qq|<input type="hidden" name="$_" />| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum countrycode phonenum sip_password pin / );
31 Where did you hear about our service? <SELECT NAME="refnum">
33 $OUT .= '<OPTION VALUE="">' unless $refnum;
34 foreach my $part_referral ( @part_referral ) {
35 $OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
36 $OUT .= ' SELECTED' if $part_referral->{'refnum'} eq $refnum;
37 $OUT .= '>'. $part_referral->{'referral'};
42 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
44 <TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH>
45 <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>">,
46 <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>"></TD>
49 <TD ALIGN="right">Company</TD>
50 <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>"></TD>
53 <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
54 <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>"></TD>
57 <TD ALIGN="right"> </TD>
58 <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>"></TD>
61 <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
62 <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>"></TD>
63 <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
66 ($county_html, $state_html, $country_html) =
68 selected_county => $county,
69 selected_state => $state,
70 selected_country => $country,
71 default_state => $statedefault,
72 default_country => $countrydefault,
73 locales => \@cust_main_county,
76 "$county_html $state_html";
79 <TH><font color="#ff0000">*</font>Zip</TH>
80 <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>"></TD>
83 <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
84 <TD><%= $country_html %></TD>
86 <TD ALIGN="right">Day Phone</TD>
87 <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18></TD>
90 <TD ALIGN="right">Night Phone</TD>
91 <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18></TD>
94 <TD ALIGN="right">Fax</TD>
95 <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12></TD>
99 if ( $stateid_enabled ) {
100 my ($county_html, $state_html, $country_html) =
102 prefix => 'stateid_',
103 default_state => $statedefault,
104 default_country => $countrydefault,
105 locales => \@cust_main_county,
107 $OUT .= qq!<TR><TD ALIGN="right">!. $label{stateid}.'</TD>';
108 $OUT .= qq!<TD><INPUT TYPE="text" NAME="stateid" VALUE="$stateid" SIZE=12></TD>!;
109 $OUT .= qq!<TD ALIGN="right">!. $label{stateid_state} .'</TD>';
110 $OUT .="<TD COLSPAN=3>$county_html $state_html</TD></TR>";
113 </TABLE><font color="#ff0000">*</font> required fields<BR>
114 <BR>Billing information<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
119 unless ( $emailinvoiceonly ) {
120 $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
121 my @invoicing_list = split(', ', $invoicing_list );
123 if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
124 $OUT .= '> Postal mail invoice'; }
129 <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 ) ) %>">
131 <%= ( scalar(@payby) > 1 or 1 ) ? '<TR><TD>Billing type ' : '' %>
133 <TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
138 my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
139 foreach ( keys %card_types ) {
140 $selected = $CARD_type eq $card_types{$_} ? 'SELECTED' : '';
141 $cardselect .= qq!<OPTION $selected VALUE="$card_types{$_}">$_</OPTION>!;
143 $cardselect .= '</SELECT>';
146 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
147 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
148 'CHEK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="">!,
149 'DCHK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
150 'LECB' => qq!Phone bill billing<BR>${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="">!,
151 '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">!,
152 '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"),
153 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
156 if ( $cvv_enabled ) {
157 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
158 $payby{$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>!;
161 if ( $paystate_enabled ) {
162 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
163 my ($county_html, $state_html, $country_html) =
165 prefix => "${payby}_pay",
166 default_state => $statedefault,
167 default_country => $countrydefault,
168 locales => \@cust_main_county,
170 $payby{$payby} .= "<BR>${r}Bank state $county_html $state_html";
174 my( $account, $aba ) = split('@', $payinfo);
176 'CARD' => qq!<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%"><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card type</TD><TD>$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>!,
177 '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">!,
178 '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">!,
179 '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
180 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="$payinfo" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!,
181 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE="$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">!,
182 '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", $paydate),
183 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
186 if ( $cvv_enabled ) {
187 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
188 $paybychecked{$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>!;
191 if ( $paystate_enabled ) {
192 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
193 my ($county_html, $state_html, $country_html) =
195 prefix => "${payby}_pay",
196 selected_county => $county,
197 selected_state => $state,
198 selected_country => $country,
199 default_state => $statedefault,
200 default_country => $countrydefault,
201 locales => \@cust_main_county,
203 $paybychecked{$payby} .= "<BR>${r}Bank state $county_html $state_html";
208 use HTML::Widgets::SelectLayers;
210 my %payby_index = ( 'CARD' => qq/Credit Card/,
211 'DCRD' => qq/Credit Card/,
214 'LECB' => qq/Phone Bill Billing/,
215 'BILL' => qq/Billing/,
216 'COMP' => qq/Complimentary/,
217 'PREPAY' => qq/Prepaid Card/,
221 tie my %options, 'Tie::IxHash', ();
223 foreach my $payby_option ( @payby ) {
224 $options{$payby_option} = $payby_index{$payby_option};
227 HTML::Widgets::SelectLayers->new(
228 options => \%options,
229 selected_layer => 'CARD',
230 form_name => 'dummy',
231 html_between => '</td></tr></table>',
232 form_action => 'dummy.cgi',
233 layer_callback => sub { my $layer = shift; return $paybychecked{$layer}. '</TABLE>'; },
239 </TR></TABLE><font color="#ff0000">*</font> required fields
240 <FORM name="signup_form" action="<%= $self_url %>" METHOD="POST" onsubmit="return fixup_form();"><BR><BR>First package
241 <INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $promo_code %>">
242 <INPUT TYPE="hidden" NAME="reg_code" VALUE="<%= $reg_code %>">
243 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
245 <TD COLSPAN=2><SELECT NAME="pkgpart">
248 $OUT .= '<OPTION VALUE="">(none)'
249 unless scalar(@part_pkg) == 1 or $default_pkgpart;
250 foreach my $part_pkg ( @part_pkg ) {
251 $OUT .= '<OPTION VALUE="'. $part_pkg->{'pkgpart'}. '"';
252 $OUT .= ' SELECTED' if $pkgpart && $part_pkg->{'pkgpart'} == $pkgpart;
253 $OUT .= '>'. $part_pkg->{'pkg'};
260 if ( $signup_service eq 'svc_phone' ) {
262 $OUT .= '<TR><TD ALIGN="right">Phone number</TD><TD>'.
263 didselector( 'field' => 'phonenum',
264 'svcpart' => $default_svcpart,
270 <TD ALIGN="right">Voicemail PIN</TD>
271 <TD><INPUT TYPE="pin" NAME="pin" VALUE="$pin"></TD>
279 <TD ALIGN="right">Username</TD>
280 <TD><INPUT TYPE="text" NAME="username" VALUE="$username"></TD>
283 <TD ALIGN="right">Password</TD>
284 <TD><INPUT TYPE="password" NAME="_password" VALUE="$_password"></TD>
287 <TD ALIGN="right">Re-enter Password</TD>
288 <TD><INPUT TYPE="password" NAME="_password2" VALUE="$_password2"></TD>
292 if ( $security_phrase ) {
295 <TD ALIGN="right">Security Phrase</TD>
296 <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
301 $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
306 if ( @svc_acct_pop ) {
307 $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
308 popselector( 'popnum' => $popnum,
309 'pops' => \@svc_acct_pop,
310 'init_popstate' => $init_popstate,
312 'acstate' => $acstate,
316 $OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop);
324 if ( @optional_packages ) {
326 foreach my $ii ( 0 .. $#optional_packages) {
327 my $friendly_index = $ii + 1;
328 if ($optional_packages[$ii]) {
329 push @html, qq|<BR>Optional Package #$friendly_index <br />|,'<table bgcolor="#c0c0c0"><tr><td>';
331 push @html, qq|<select name="optional_package${ii}">|;
332 push @html, qq|<option value="none"></option>|;
333 push @html, map { qq|<option value="$_->{pkgpart}">$_->{pkg}</option>| } @{$optional_packages[$ii]};
334 push @html, q|</select>|;
336 push @html, '</td></tr></table>';
338 $OUT = join("\n", @html);
345 <BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
346 <script language="JavaScript">
348 function fixup_form() {
350 // copy payment method data up to OneTrueForm
352 var payment_method_elements = new Array( 'payinfo', 'payinfo1', 'payinfo2', 'payname', 'paycvv' , 'paystate', 'paytype', 'month', 'year','type' );
353 var payment_method_form_name = document.OneTrueForm.select.options[document.OneTrueForm.select.selectedIndex].value;
354 document.OneTrueForm.elements['payby'].value = payment_method_form_name;
355 var payment_method_form = document.forms[payment_method_form_name];
357 for ( ii = 0 ; ii < payment_method_elements.length ; ii++ ) {
358 var true_element_name = payment_method_form_name + '_' + payment_method_elements[ii];
359 copyelement ( payment_method_form.elements[true_element_name],
360 document.OneTrueForm.elements[true_element_name] );
363 // Copy signup details to OneTrueForm
365 var signup_elements = new Array (
366 'promo_code', 'reg_code', 'pkgpart',
367 'username', '_password', '_password2', 'sec_phrase', 'popnum',
368 'countrycode', 'phonenum', 'sip_password', 'pin'
371 for ( ii = 0 ; ii < signup_elements.length ; ii ++ ) {
372 copyelement ( document.signup_form.elements[signup_elements[ii]],
373 document.OneTrueForm.elements[signup_elements[ii]]);
376 document.OneTrueForm.submit();
380 function copyelement(from, to) {
381 // alert ( from + ' ' + to );
383 if ( from == undefined ) {
386 if ( from.type == 'select-one' ) {
387 to.value = from.options[from.selectedIndex].value;
388 } else if ( from.type == 'checkbox' ) {
389 if ( from.checked ) {
390 to.value = from.value;
395 if ( from.value == undefined ) {
398 to.value = from.value;
401 // alert(from.name + " (" + from.type + "): " + to.name + " => " + to.value);
406 </FORM></BODY></HTML>