ISP Signup form
<%= $error %>
Contact Information
*
Contact name
(last, first)
,
Company
*
Address
*
City
*
State/Country
<%= foreach ( @{$locales} ) { $OUT .= '
{'state'} && $county eq $_->{'county'} && $country eq $_->{'country'} ); $OUT .= '>'. $_->{'state'}; $OUT .= ' ('. $_->{'county'}. ')' if $_->{'county'}; $OUT .= ' / '. $_->{'country'}; } %>
*
Zip
Day Phone
Night Phone
Fax
*
required fields
Billing information
<%= $OUT .= '
Postal mail invoice
Email invoice
Billing type
<%= my %payby = ( 'CARD' => qq!Credit card
*
*
Exp !. expselect("CARD"). qq!
*
Name on card
!, 'BILL' => qq!Billing
P.O.
*
Exp !. expselect("BILL", "12-2037"). qq!
*
Attention
!, 'COMP' => qq!Complimentary
*
Approved by
*
Exp !. expselect("COMP"), 'PREPAY' => qq!Prepaid card
*
!, ); my %paybychecked = ( 'CARD' => qq!Credit card
*
*
Exp !. expselect("CARD", $paydate). qq!
*
Name on card
!, 'BILL' => qq!Billing
P.O.
*
Exp !. expselect("BILL", $paydate). qq!
*
Attention
!, 'COMP' => qq!Complimentary
*
Approved by
*
Exp !. expselect("COMP", $paydate), 'PREPAY' => qq!Prepaid card
*
!, ); for (@payby) { $OUT .= qq!
$paybychecked{$_}
!; } else { $OUT .= qq!> $payby{$_}!; } } %>
*
required fields for each billing type
First package
(none) <%= foreach my $package ( @{$packages} ) { $OUT .= '
{'pkgpart'} == $pkgpart; $OUT .= '>'. $package->{'pkg'}; } %>
Username
Password
(blank to generate)
POP
<%= foreach my $pop ( @{$pops} ) { $OUT .= '
{'popnum'} == $popnum; $OUT .= '>'. $pop->{'popnum'}. ': '. $pop->{'city'}. ', '. $pop->{'state'}. ' ('. $pop->{'ac'}. ')/'. $pop->{'exch'}. "\n"; } %>