1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
4 <TITLE><%= $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : 'ISP' ) %> Signup form</TITLE>
7 <BODY BGCOLOR="<%= $body_bgcolor || '#e8e8e8' %>" onUnload="myclose()">
9 <script type="text/javascript">
11 function myopen(filename,windowname,properties) {
13 mywindow = window.open(filename,windowname,properties);
22 <%= $OUT .= $body_header
24 ( $agent || ( $signup_service eq 'svc_phone' ? 'ITSP' : 'ISP' ) ).
25 ' Signup form</FONT><BR><BR>';
28 <FONT SIZE="+1" COLOR="#ff0000"><%= $error %></FONT>
30 <FORM NAME="OneTrueForm" ACTION="<%= $self_url %>" METHOD=POST onSubmit="document.OneTrueForm.signup.disabled=true">
31 <INPUT TYPE="hidden" NAME="session" VALUE="<%= $session_id %>">
32 <INPUT TYPE="hidden" NAME="action" VALUE="process_signup">
33 <INPUT TYPE="hidden" NAME="referral_custnum" VALUE="<%= $referral_custnum %>">
34 <INPUT TYPE="hidden" NAME="ss" VALUE="">
35 <input type="hidden" name="payby">
37 $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);
41 $OUT = join("\n", map { qq|<input type="hidden" name="$_" />| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum mac_addr countrycode phonenum sip_password pin / );
44 Where did you hear about our service? <SELECT NAME="refnum">
46 $OUT .= '<OPTION VALUE="">' unless $refnum;
47 foreach my $part_referral ( @part_referral ) {
48 $OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
49 $OUT .= ' SELECTED' if $part_referral->{'refnum'} == $refnum;
50 $OUT .= '>'. $part_referral->{'referral'};
55 <TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
57 <TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH>
58 <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>">,
59 <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>"></TD>
62 <TD ALIGN="right">Company</TD>
63 <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>"></TD>
66 <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
67 <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>"></TD>
70 <TD ALIGN="right"> </TD>
71 <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>"></TD>
74 <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
75 <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>"></TD>
76 <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
79 ($county_html, $state_html, $country_html) =
81 selected_county => $county,
82 selected_state => $state,
83 selected_country => $country,
84 default_state => $statedefault,
85 default_country => $countrydefault,
86 locales => \@cust_main_county,
89 "$county_html $state_html";
92 <TH><font color="#ff0000">*</font>Zip</TH>
93 <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>"></TD>
96 <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
97 <TD><%= $country_html %></TD>
99 <TD ALIGN="right">Day Phone</TD>
100 <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18></TD>
103 <TD ALIGN="right">Night Phone</TD>
104 <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18></TD>
107 <TD ALIGN="right">Fax</TD>
108 <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12></TD>
112 if ( $stateid_enabled ) {
113 my ($county_html, $state_html, $country_html) =
115 prefix => 'stateid_',
116 default_state => $statedefault,
117 default_country => $countrydefault,
118 locales => \@cust_main_county,
120 $OUT .= qq!<TR><TD ALIGN="right">!. $label{stateid}.'</TD>';
121 $OUT .= qq!<TD><INPUT TYPE="text" NAME="stateid" VALUE="$stateid" SIZE=12></TD>!;
122 $OUT .= qq!<TD ALIGN="right">!. $label{stateid_state} .'</TD>';
123 $OUT .="<TD COLSPAN=3>$county_html $state_html</TD></TR>";
126 </TABLE><font color="#ff0000">*</font> required fields<BR>
127 <BR>Billing information<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
132 unless ( $emailinvoiceonly ) {
133 $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
134 my @invoicing_list = split(', ', $invoicing_list );
136 if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
137 $OUT .= '> Postal mail invoice'; }
142 <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 ) ) %>">
144 <%= ( scalar(@payby) > 1 or 1 ) ? '<TR><TD>Billing type ' : '' %>
146 <TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
151 my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
152 foreach ( keys %card_types ) {
153 $selected = $CARD_type eq $card_types{$_} ? 'SELECTED' : '';
154 $cardselect .= qq!<OPTION $selected VALUE="$card_types{$_}">$_</OPTION>!;
156 $cardselect .= '</SELECT>';
159 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
160 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
161 'CHEK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="">!,
162 'DCHK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
163 'LECB' => qq!Phone bill billing<BR>${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="">!,
164 '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">!,
165 '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"),
166 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
169 if ( $cvv_enabled ) {
170 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
171 $payby{$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>!;
174 if ( $paystate_enabled ) {
175 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
176 my ($county_html, $state_html, $country_html) =
178 prefix => "${payby}_pay",
179 default_state => $statedefault,
180 default_country => $countrydefault,
181 locales => \@cust_main_county,
183 $payby{$payby} .= "<BR>${r}Bank state $county_html $state_html";
187 my( $account, $aba ) = split('@', $payinfo);
189 '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>!,
190 '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">!,
191 '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">!,
192 '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
193 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="$payinfo" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!,
194 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE="$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="$payname">!,
195 'COMP' => qq!Complimentary<BR><font color="#ff0000">*</font>Approved by<INPUT TYPE="text" NAME="COMP_payinfo" VALUE="$payinfo"><BR><font color="#ff0000">*</font>Exp !. expselect("COMP", $paydate),
196 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
199 if ( $cvv_enabled ) {
200 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
201 $paybychecked{$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>!;
204 if ( $paystate_enabled ) {
205 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
206 my ($county_html, $state_html, $country_html) =
208 prefix => "${payby}_pay",
209 selected_county => $county,
210 selected_state => $state,
211 selected_country => $country,
212 default_state => $statedefault,
213 default_country => $countrydefault,
214 locales => \@cust_main_county,
216 $paybychecked{$payby} .= "<BR>${r}Bank state $county_html $state_html";
221 use HTML::Widgets::SelectLayers;
223 my %payby_index = ( 'CARD' => qq/Credit Card/,
224 'DCRD' => qq/Credit Card/,
227 'LECB' => qq/Phone Bill Billing/,
228 'BILL' => qq/Billing/,
229 'COMP' => qq/Complimentary/,
230 'PREPAY' => qq/Prepaid Card/,
234 tie my %options, 'Tie::IxHash', ();
236 foreach my $payby_option ( @payby ) {
237 $options{$payby_option} = $payby_index{$payby_option};
240 my $selected_layer = ( grep { $_ eq 'CARD' } @payby ) ? 'CARD' : $payby[0];
242 HTML::Widgets::SelectLayers->new(
243 options => \%options,
244 selected_layer => $selected_layer,
245 form_name => 'dummy',
246 html_between => '</td></tr></table>',
247 form_action => 'dummy.cgi',
248 layer_callback => sub { my $layer = shift; return ( shift @hide_payment_fields ? '' : $paybychecked{$layer} ) . '</TABLE>'; },
254 </TR></TABLE><font color="#ff0000">*</font> required fields
255 <FORM name="signup_form" action="<%= $self_url %>" METHOD="POST" onsubmit="return fixup_form();"><BR><BR>First package
256 <INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $promo_code %>">
257 <INPUT TYPE="hidden" NAME="reg_code" VALUE="<%= $reg_code %>">
258 <TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
260 <TD COLSPAN=2><SELECT NAME="pkgpart">
263 $OUT .= '<OPTION VALUE="">(none)'
264 unless scalar(@part_pkg) == 1 or $default_pkgpart;
265 foreach my $part_pkg ( @part_pkg ) {
266 $OUT .= '<OPTION VALUE="'. $part_pkg->{'pkgpart'}. '"';
267 $OUT .= ' SELECTED' if $pkgpart && $part_pkg->{'pkgpart'} == $pkgpart;
268 $OUT .= '>'. $part_pkg->{'pkg'};
275 if ( $signup_service eq 'svc_phone' ) {
277 $OUT .= '<TR><TD ALIGN="right">Phone number</TD><TD>'.
278 didselector( 'field' => 'phonenum',
279 'svcpart' => $default_svcpart,
285 <TD ALIGN="right">Voicemail PIN</TD>
286 <TD><INPUT TYPE="pin" NAME="pin" VALUE="$pin"></TD>
294 <TD ALIGN="right">Username</TD>
295 <TD><INPUT TYPE="text" NAME="username" VALUE="$username"></TD>
298 <TD ALIGN="right">Password</TD>
299 <TD><INPUT TYPE="password" NAME="_password" VALUE="$_password"></TD>
302 <TD ALIGN="right">Re-enter Password</TD>
303 <TD><INPUT TYPE="password" NAME="_password2" VALUE="$_password2"></TD>
307 if ( $security_phrase ) {
310 <TD ALIGN="right">Security Phrase</TD>
311 <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
316 $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
326 <INPUT TYPE="hidden" NAME="mac_addr" VALUE="$mac_addr">
333 if ( @svc_acct_pop ) {
334 $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
335 popselector( 'popnum' => $popnum,
336 'pops' => \@svc_acct_pop,
337 'init_popstate' => $init_popstate,
339 'acstate' => $acstate,
343 $OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop);
351 if ( @optional_packages ) {
353 foreach my $ii ( 0 .. $#optional_packages) {
354 my $friendly_index = $ii + 1;
355 if ($optional_packages[$ii]) {
356 push @html, qq|<BR>Optional Package #$friendly_index <br />|,'<table bgcolor="#c0c0c0"><tr><td>';
358 push @html, qq|<select name="optional_package${ii}">|;
359 push @html, qq|<option value="none"></option>|;
360 push @html, map { qq|<option value="$_->{pkgpart}">$_->{pkg}</option>| } @{$optional_packages[$ii]};
361 push @html, q|</select>|;
363 push @html, '</td></tr></table>';
365 $OUT = join("\n", @html);
372 <BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
373 <script language="JavaScript">
375 function fixup_form() {
377 // copy payment method data up to OneTrueForm
379 var payment_method_elements = new Array( 'payinfo', 'payinfo1', 'payinfo2', 'payname', 'paycvv' , 'paystate', 'paytype', 'month', 'year','type' );
380 var payment_method_form_name = document.OneTrueForm.select.options[document.OneTrueForm.select.selectedIndex].value;
381 document.OneTrueForm.elements['payby'].value = payment_method_form_name;
382 var payment_method_form = document.forms[payment_method_form_name];
384 for ( ii = 0 ; ii < payment_method_elements.length ; ii++ ) {
385 var true_element_name = payment_method_form_name + '_' + payment_method_elements[ii];
386 copyelement ( payment_method_form.elements[true_element_name],
387 document.OneTrueForm.elements[true_element_name] );
390 // Copy signup details to OneTrueForm
392 var signup_elements = new Array (
393 'promo_code', 'reg_code', 'pkgpart',
394 'username', '_password', '_password2', 'sec_phrase', 'popnum',
396 'countrycode', 'phonenum', 'sip_password', 'pin'
399 for ( ii = 0 ; ii < signup_elements.length ; ii ++ ) {
400 copyelement ( document.signup_form.elements[signup_elements[ii]],
401 document.OneTrueForm.elements[signup_elements[ii]]);
404 document.OneTrueForm.submit();
408 function copyelement(from, to) {
409 // alert ( from + ' ' + to );
411 if ( from == undefined ) {
414 if ( from.type == 'select-one' ) {
415 to.value = from.options[from.selectedIndex].value;
416 } else if ( from.type == 'checkbox' ) {
417 if ( from.checked ) {
418 to.value = from.value;
423 if ( from.value == undefined ) {
426 to.value = from.value;
429 // alert(from.name + " (" + from.type + "): " + to.name + " => " + to.value);
435 <%= $OUT .= $body_footer %>