1 <HTML><HEAD><TITLE><%= $agent || '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 || '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 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 / );
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>
97 </TABLE><font color="#ff0000">*</font> required fields<BR>
98 <BR>Billing information<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
103 unless ( $emailinvoiceonly ) {
104 $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
105 my @invoicing_list = split(', ', $invoicing_list );
107 if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
108 $OUT .= '> Postal mail invoice'; }
113 <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 ) ) %>">
115 <%= ( scalar(@payby) > 1 or 1 ) ? '<TR><TD>Billing type ' : '' %>
117 <TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
122 my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
124 'VISA' => 'VISA card',
125 'MasterCard' => 'MasterCard',
126 'Discover' => 'Discover card',
127 'American Express' => 'American Express card',
129 foreach ( keys %types ) {
130 $selected = $CARD_type eq $types{$_} ? 'SELECTED' : '';
131 $cardselect .= qq!<OPTION $selected VALUE="$types{$_}">$_</OPTION>!;
133 $cardselect .= '</SELECT>';
136 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
137 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
138 'CHEK' => qq!Electronic check<BR>${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="">!,
139 '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
140 'LECB' => qq!Phone bill billing<BR>${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="">!,
141 '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">!,
142 '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"),
143 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
146 if ( $cvv_enabled ) {
147 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
148 $payby{$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>!;
152 my( $account, $aba ) = split('@', $payinfo);
154 'CARD' => qq!<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%"><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card type</TD><TD>$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>!,
155 '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">!,
156 '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">!,
157 '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">!,
158 '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="">!,
159 '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">!,
160 '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", $paydate),
161 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
164 if ( $cvv_enabled ) {
165 foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
166 $paybychecked{$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>!;
170 use HTML::Widgets::SelectLayers;
172 my %payby_index = ( 'CARD' => qq/Credit Card/,
173 'DCRD' => qq/Credit Card/,
176 'LECB' => qq/Phone Bill Billing/,
177 'BILL' => qq/Billing/,
178 'COMP' => qq/Complimentary/,
179 'PREPAY' => qq/Prepaid Card/,
183 tie my %options, 'Tie::IxHash', ();
185 foreach my $payby_option ( @payby ) {
186 $options{$payby_option} = $payby_index{$payby_option};
189 HTML::Widgets::SelectLayers->new(
190 options => \%options,
191 selected_layer => 'CARD',
192 form_name => 'dummy',
193 html_between => '</td></tr></table>',
194 form_action => 'dummy.cgi',
195 layer_callback => sub { my $layer = shift; return $paybychecked{$layer}. '</TABLE>'; },
201 </TR></TABLE><font color="#ff0000">*</font> required fields
202 <FORM name="signup_form" action="<%= $self_url %>" METHOD="POST" onsubmit="return fixup_form();"><BR><BR>First package
203 <INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $promo_code %>">
204 <INPUT TYPE="hidden" NAME="reg_code" VALUE="<%= $reg_code %>">
205 <TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
207 <TD COLSPAN=2><SELECT NAME="pkgpart">
210 $OUT .= '<OPTION VALUE="">(none)'
211 unless scalar(@part_pkg) == 1 or $default_pkgpart;
212 foreach my $part_pkg ( @part_pkg ) {
213 $OUT .= '<OPTION VALUE="'. $part_pkg->{'pkgpart'}. '"';
214 $OUT .= ' SELECTED' if $pkgpart && $part_pkg->{'pkgpart'} == $pkgpart;
215 $OUT .= '>'. $part_pkg->{'pkg'};
222 <TD ALIGN="right">Username</TD>
223 <TD><INPUT TYPE="text" NAME="username" VALUE="<%= $username %>"></TD>
226 <TD ALIGN="right">Password</TD>
227 <TD><INPUT TYPE="password" NAME="_password" VALUE="<%= $_password %>"></TD>
230 <TD ALIGN="right">Re-enter Password</TD>
231 <TD><INPUT TYPE="password" NAME="_password2" VALUE="<%= $_password2 %>"></TD>
234 if ( $security_phrase ) {
237 <TD ALIGN="right">Security Phrase</TD>
238 <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
243 $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
247 if ( @svc_acct_pop ) {
248 $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
249 popselector( 'popnum' => $popnum,
250 'pops' => \@svc_acct_pop,
251 'init_popstate' => $init_popstate,
253 'acstate' => $acstate,
257 $OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop);
263 if ( @optional_packages ) {
265 foreach my $ii ( 0 .. $#optional_packages) {
266 my $friendly_index = $ii + 1;
267 if ($optional_packages[$ii]) {
268 push @html, qq|<BR>Optional Package #$friendly_index <br />|,'<table bgcolor="#c0c0c0"><tr><td>';
270 push @html, qq|<select name="optional_package${ii}">|;
271 push @html, qq|<option value="none"></option>|;
272 push @html, map { qq|<option value="$_->{pkgpart}">$_->{pkg}</option>| } @{$optional_packages[$ii]};
273 push @html, q|</select>|;
275 push @html, '</td></tr></table>';
277 $OUT = join("\n", @html);
284 <BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
285 <script language="JavaScript">
287 function fixup_form() {
289 // copy payment method data up to OneTrueForm
291 var payment_method_elements = new Array( 'payinfo', 'payinfo1', 'payinfo2', 'payname', 'paycvv' , 'month', 'year','type' );
292 var payment_method_form_name = document.OneTrueForm.select.options[document.OneTrueForm.select.selectedIndex].value;
293 document.OneTrueForm.elements['payby'].value = payment_method_form_name;
294 var payment_method_form = document.forms[payment_method_form_name];
296 for ( ii = 0 ; ii < payment_method_elements.length ; ii++ ) {
297 var true_element_name = payment_method_form_name + '_' + payment_method_elements[ii];
298 copyelement ( payment_method_form.elements[true_element_name],
299 document.OneTrueForm.elements[true_element_name] );
302 // Copy signup details to OneTrueForm
304 var signup_elements = new Array ( 'promo_code', 'reg_code',
305 'pkgpart', 'username',
306 '_password', '_password2',
307 'sec_phrase', 'popnum' );
309 for ( ii = 0 ; ii < signup_elements.length ; ii ++ ) {
310 copyelement ( document.signup_form.elements[signup_elements[ii]],
311 document.OneTrueForm.elements[signup_elements[ii]]);
314 document.OneTrueForm.submit();
318 function copyelement(from, to) {
319 // alert ( from + ' ' + to );
321 if ( from == undefined ) {
324 if ( from.type == 'select-one' ) {
325 to.value = from.options[from.selectedIndex].value;
326 } else if ( from.type == 'checkbox' ) {
327 if ( from.checked ) {
328 to.value = from.value;
333 if ( from.value == undefined ) {
336 to.value = from.value;
339 // alert(from.name + " (" + from.type + "): " + to.name + " => " + to.value);
344 </FORM></BODY></HTML>