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="prepaid_shortform" VALUE="<%= $prepaid_shortform %>">
32 <INPUT TYPE="hidden" NAME="session" VALUE="<%= $session_id %>">
33 <INPUT TYPE="hidden" NAME="action" VALUE="process_signup">
34 <INPUT TYPE="hidden" NAME="agentnum" VALUE="<%= $agentnum %>">
35 <INPUT TYPE="hidden" NAME="referral_custnum" VALUE="<%= $referral_custnum %>">
36 <INPUT TYPE="hidden" NAME="ss" VALUE="">
37 <input type="hidden" name="payby">
39 $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);
43 $OUT = join("\n", map { qq|<input type="hidden" name="$_" />| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum mac_addr countrycode phonenum sip_password pin / );
46 Where did you hear about our service? <SELECT NAME="refnum">
48 $OUT .= '<OPTION VALUE="">' unless $refnum;
49 foreach my $part_referral ( @part_referral ) {
50 $OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
51 $OUT .= ' SELECTED' if $part_referral->{'refnum'} == $refnum;
52 $OUT .= '>'. $part_referral->{'referral'};
57 <%= unless ( $prepaid_template_custnum && $prepaid_shortform ) {
59 my $bgcolor = $box_bgcolor || '#c0c0c0';
62 <TABLE BGCOLOR="$bgcolor" BORDER=0 CELLSPACING=0 WIDTH="100%">
64 <TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH>
65 <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="$last">,
66 <INPUT TYPE="text" NAME="first" VALUE="$first"></TD>
69 <TD ALIGN="right">Company</TD>
70 <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="$company"></TD>
73 <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
74 <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="$address1"></TD>
77 <TD ALIGN="right"> </TD>
78 <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="$address2"></TD>
81 <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
82 <TD><INPUT TYPE="text" NAME="city" VALUE="$city"></TD> !;
84 my ($county_html, $state_html, $country_html) =
86 selected_county => $county,
87 selected_state => $state,
88 selected_country => $country,
89 default_state => $statedefault,
90 default_country => $countrydefault,
91 locales => \@cust_main_county,
94 $county_out = ($county_html =~ /SELECT/) ? 'County/State' : 'State';
95 $OUT .= qq!<TH ALIGN="right"><font color="#ff0000">*</font> $county_out </TH>
97 $county_html $state_html
99 <TH><font color="#ff0000">*</font>Zip</TH>
100 <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="$zip"></TD>
103 <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
104 <TD>$country_html</TD>
106 <TD ALIGN="right">Day Phone</TD>
107 <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="$daytime" SIZE=18></TD>
110 <TD ALIGN="right">Night Phone</TD>
111 <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="$night" SIZE=18></TD>
114 <TD ALIGN="right">Fax</TD>
115 <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="$fax" SIZE=12></TD>
118 if ( $stateid_enabled ) {
119 my ($county_html, $state_html, $country_html) =
121 prefix => 'stateid_',
122 default_state => $statedefault,
123 default_country => $countrydefault,
124 locales => \@cust_main_county,
126 $OUT .= qq!<TR><TD ALIGN="right">!. $label{stateid}.'</TD>';
127 $OUT .= qq!<TD><INPUT TYPE="text" NAME="stateid" VALUE="$stateid" SIZE=12></TD>!;
128 $OUT .= qq!<TD ALIGN="right">!. $label{stateid_state} .'</TD>';
129 $OUT .="<TD COLSPAN=3>$county_html $state_html</TD></TR>";
132 </TABLE><font color="#ff0000">*</font> required fields<BR>
141 <BR>Billing information<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
146 unless ( $emailinvoiceonly ) {
147 $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
148 my @invoicing_list = split(', ', $invoicing_list );
150 if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
151 $OUT .= '> Postal mail invoice'; }
156 <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 ) ) %>">
158 <%= ( scalar(@payby) > 1 or 1 ) ? '<TR><TD>Billing type ' : '' %>
160 <TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
165 my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
166 foreach ( keys %card_types ) {
167 $selected = $CARD_type eq $card_types{$_} ? 'SELECTED' : '';
168 $cardselect .= qq!<OPTION $selected VALUE="$card_types{$_}">$_</OPTION>!;
170 $cardselect .= '</SELECT>';
173 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
174 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
175 'CHEK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="">!,
176 'DCHK' => qq!Electronic check<BR>${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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
177 'LECB' => qq!Phone bill billing<BR>${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="">!,
178 '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">!,
179 '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"),
180 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
183 if ( $cvv_enabled ) {
184 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
185 $payby{$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>!;
188 if ( $paystate_enabled ) {
189 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
190 my ($county_html, $state_html, $country_html) =
192 prefix => "${payby}_pay",
193 default_state => $statedefault,
194 default_country => $countrydefault,
195 locales => \@cust_main_county,
197 $payby{$payby} .= "<BR>${r}Bank state $county_html $state_html";
201 my( $account, $aba ) = split('@', $payinfo);
203 '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>!,
204 '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">!,
205 '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">!,
206 '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
207 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="$payinfo" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!,
208 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE="$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="$payname">!,
209 'COMP' => qq!Complimentary<BR><font color="#ff0000">*</font>Approved by<INPUT TYPE="text" NAME="COMP_payinfo" VALUE="$payinfo"><BR><font color="#ff0000">*</font>Exp !. expselect("COMP", $paydate),
210 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
213 if ( $cvv_enabled ) {
214 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
215 $paybychecked{$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>!;
218 if ( $paystate_enabled ) {
219 foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) {
220 my ($county_html, $state_html, $country_html) =
222 prefix => "${payby}_pay",
223 selected_county => $county,
224 selected_state => $state,
225 selected_country => $country,
226 default_state => $statedefault,
227 default_country => $countrydefault,
228 locales => \@cust_main_county,
230 $paybychecked{$payby} .= "<BR>${r}Bank state $county_html $state_html";
234 my %payby_index = ( 'CARD' => qq/Credit Card/,
235 'DCRD' => qq/Credit Card/,
238 'LECB' => qq/Phone Bill Billing/,
239 'BILL' => qq/Billing/,
240 'COMP' => qq/Complimentary/,
241 'PREPAY' => qq/Prepaid Card/,
245 tie my %options, 'Tie::IxHash', ();
247 foreach my $payby_option ( @payby ) {
248 $options{$payby_option} = $payby_index{$payby_option};
251 my $selected_layer = ( grep { $_ eq 'CARD' } @payby ) ? 'CARD' : $payby[0];
253 HTML::Widgets::SelectLayers->new(
254 options => \%options,
255 selected_layer => $selected_layer,
256 form_name => 'dummy',
257 html_between => '</td></tr></table>',
258 form_action => 'dummy.cgi',
259 layer_callback => sub { my $layer = shift; return ( shift @hide_payment_fields ? '' : $paybychecked{$layer} ) . '</TABLE>'; },
265 </TR></TABLE><font color="#ff0000">*</font> required fields
266 <FORM name="signup_form" action="<%= $self_url %>" METHOD="POST" onsubmit="return fixup_form();"><BR><BR>First package
267 <INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $promo_code %>">
268 <INPUT TYPE="hidden" NAME="reg_code" VALUE="<%= $reg_code %>">
269 <TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
271 <TD COLSPAN=2><SELECT NAME="pkgpart">
274 $OUT .= '<OPTION VALUE="">(none)'
275 unless scalar(@part_pkg) == 1 or $default_pkgpart;
276 foreach my $part_pkg ( @part_pkg ) {
277 $OUT .= '<OPTION VALUE="'. $part_pkg->{'pkgpart'}. '"';
278 $OUT .= ' SELECTED' if $pkgpart && $part_pkg->{'pkgpart'} == $pkgpart;
279 $OUT .= '>'. $part_pkg->{'pkg'};
286 if ( $signup_service eq 'svc_phone' ) {
288 $OUT .= '<TR><TD ALIGN="right">Phone number</TD><TD>'.
289 didselector( 'field' => 'phonenum',
290 'svcpart' => $default_svcpart,
296 <TD ALIGN="right">Voicemail PIN</TD>
297 <TD><INPUT TYPE="pin" NAME="pin" VALUE="$pin"></TD>
305 <TD ALIGN="right">Username</TD>
306 <TD><INPUT TYPE="text" NAME="username" VALUE="$username"></TD>
309 <TD ALIGN="right">Password</TD>
310 <TD><INPUT TYPE="password" NAME="_password" VALUE="$_password"></TD>
313 <TD ALIGN="right">Re-enter Password</TD>
314 <TD><INPUT TYPE="password" NAME="_password2" VALUE="$_password2"></TD>
318 if ( $security_phrase ) {
321 <TD ALIGN="right">Security Phrase</TD>
322 <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
327 $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
337 <INPUT TYPE="hidden" NAME="mac_addr" VALUE="$mac_addr">
344 if ( @svc_acct_pop ) {
345 $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
346 popselector( 'popnum' => $popnum,
347 'pops' => \@svc_acct_pop,
348 'init_popstate' => $init_popstate,
350 'acstate' => $acstate,
354 $OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop);
362 if ( @optional_packages ) {
364 foreach my $ii ( 0 .. $#optional_packages) {
365 my $friendly_index = $ii + 1;
366 if ($optional_packages[$ii]) {
367 push @html, qq|<BR>Optional Package #$friendly_index <br />|,'<table bgcolor="#c0c0c0"><tr><td>';
369 push @html, qq|<select name="optional_package${ii}">|;
370 push @html, qq|<option value="none"></option>|;
371 push @html, map { qq|<option value="$_->{pkgpart}">$_->{pkg}</option>| } @{$optional_packages[$ii]};
372 push @html, q|</select>|;
374 push @html, '</td></tr></table>';
376 $OUT = join("\n", @html);
383 <BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
384 <script language="JavaScript">
386 function fixup_form() {
388 // copy payment method data up to OneTrueForm
390 var payment_method_elements = new Array( 'payinfo', 'payinfo1', 'payinfo2', 'payname', 'paycvv' , 'paystate', 'paytype', 'month', 'year','type' );
391 var payment_method_form_name = document.OneTrueForm.select.options[document.OneTrueForm.select.selectedIndex].value;
392 document.OneTrueForm.elements['payby'].value = payment_method_form_name;
393 var payment_method_form = document.forms[payment_method_form_name];
395 for ( ii = 0 ; ii < payment_method_elements.length ; ii++ ) {
396 var true_element_name = payment_method_form_name + '_' + payment_method_elements[ii];
397 copyelement ( payment_method_form.elements[true_element_name],
398 document.OneTrueForm.elements[true_element_name] );
401 // Copy signup details to OneTrueForm
403 var signup_elements = new Array (
404 'promo_code', 'reg_code', 'pkgpart',
405 'username', '_password', '_password2', 'sec_phrase', 'popnum',
407 'countrycode', 'phonenum', 'sip_password', 'pin'
410 for ( ii = 0 ; ii < signup_elements.length ; ii ++ ) {
411 copyelement ( document.signup_form.elements[signup_elements[ii]],
412 document.OneTrueForm.elements[signup_elements[ii]]);
415 document.OneTrueForm.submit();
419 function copyelement(from, to) {
420 // alert ( from + ' ' + to );
422 if ( from == undefined ) {
425 if ( from.type == 'select-one' ) {
426 to.value = from.options[from.selectedIndex].value;
427 } else if ( from.type == 'checkbox' ) {
428 if ( from.checked ) {
429 to.value = from.value;
434 if ( from.value == undefined ) {
437 to.value = from.value;
440 // alert(from.name + " (" + from.type + "): " + to.name + " => " + to.value);
446 <%= $OUT .= $body_footer %>