<FONT SIZE="+1" COLOR="#ff0000"><%= $error %></FONT>
<FORM NAME="OneTrueForm" ACTION="<%= $self_url %>" METHOD=POST onSubmit="document.OneTrueForm.signup.disabled=true">
+<INPUT TYPE="hidden" NAME="prepaid_shortform" VALUE="<%= $prepaid_shortform %>">
<INPUT TYPE="hidden" NAME="session" VALUE="<%= $session_id %>">
<INPUT TYPE="hidden" NAME="action" VALUE="process_signup">
<INPUT TYPE="hidden" NAME="agentnum" VALUE="<%= $agentnum %>">
$OUT = join("\n", map { qq|<input type="hidden" name="$_" />| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum mac_addr countrycode phonenum sip_password pin / );
%>
+<%=
+ if ($override_ban_warn) {
+ $OUT .= 'Are you sure you want to sign up again? <SELECT NAME="override_ban_warn"><OPTION VALUE="0">No<OPTION VALUE="1">Yes</SELECT><BR><BR>';
+ } else {
+ $OUT .= '';
+ }
+%>
+
Where did you hear about our service? <SELECT NAME="refnum">
<%=
$OUT .= '<OPTION VALUE="">' unless $refnum;
}
%>
</SELECT><BR><BR>
+
+<%= unless ( $prepaid_template_custnum && $prepaid_shortform ) {
+
+my $bgcolor = $box_bgcolor || '#c0c0c0';
+$OUT .= qq!
Contact Information
-<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
+<TABLE BGCOLOR="$bgcolor" BORDER=0 CELLSPACING=0 WIDTH="100%">
<TR>
<TH ALIGN="right"><font color="#ff0000">*</font>Contact name<BR>(last, first)</TH>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>">,
- <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>"></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="$last">,
+ <INPUT TYPE="text" NAME="first" VALUE="$first"></TD>
</TR>
<TR>
<TD ALIGN="right">Company</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>"></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="$company"></TD>
</TR>
<TR>
<TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>"></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="$address1"></TD>
</TR>
<TR>
<TD ALIGN="right"> </TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>"></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="$address2"></TD>
</TR>
<TR>
<TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
- <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>"></TD>
- <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
- <TD>
- <%=
- ($county_html, $state_html, $country_html) =
+ <TD><INPUT TYPE="text" NAME="city" VALUE="$city"></TD> !;
+
+ my ($county_html, $state_html, $country_html) =
regionselector( {
selected_county => $county,
selected_state => $state,
locales => \@cust_main_county,
} );
- "$county_html $state_html";
- %>
+$county_out = ($county_html =~ /SELECT/) ? 'County/State' : 'State';
+$OUT .= qq!<TH ALIGN="right"><font color="#ff0000">*</font> $county_out </TH>
+ <TD>
+ $county_html $state_html
</TD>
<TH><font color="#ff0000">*</font>Zip</TH>
- <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>"></TD>
+ <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="$zip"></TD>
</TR>
<TR>
<TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
- <TD><%= $country_html %></TD>
+ <TD>$country_html</TD>
<TR>
<TD ALIGN="right">Day Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="$daytime" SIZE=18></TD>
</TR>
<TR>
<TD ALIGN="right">Night Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="$night" SIZE=18></TD>
</TR>
<TR>
<TD ALIGN="right">Fax</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12></TD>
+ <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="$fax" SIZE=12></TD>
</TR>
-<%=
- $OUT = '';
+!;
if ( $stateid_enabled ) {
my ($county_html, $state_html, $country_html) =
regionselector( {
$OUT .= qq!<TD ALIGN="right">!. $label{stateid_state} .'</TD>';
$OUT .="<TD COLSPAN=3>$county_html $state_html</TD></TR>";
}
-%>
+$OUT .= qq!
</TABLE><font color="#ff0000">*</font> required fields<BR>
+!;
+
+}
+else {
+ @payby = ('PREPAY');
+}
+%>
+
<BR>Billing information<TABLE BGCOLOR="<%= $box_bgcolor || '#c0c0c0' %>" BORDER=0 CELLSPACING=0 WIDTH="100%">
<TR><TD>