self-xss, RT#81757
[freeside.git] / fs_selfservice / FS-SelfService / cgi / contact.html
1 <TABLE BGCOLOR="#cccccc" BORDER=0 CELLSPACING=0>
2
3 <TR>
4   <TH ALIGN="right"><%=$r%>Contact&nbsp;name<BR>(last,&nbsp;first)</TH>
5   <TD COLSPAN=5>
6     <INPUT TYPE="text" NAME="<%=$pre%>last" VALUE="<%= encode_entities(${$pre.'last'}) %>" onChange="<%= $onchange %>" <%=$disabled%>> , 
7     <INPUT TYPE="text" NAME="<%=$pre%>first" VALUE="<%= encode_entities(${$pre.'first'}) %>" onChange="<%= $onchange %>" <%=$disabled%>>
8   </TD>
9 </TR>
10
11 <TR>
12   <TD ALIGN="right">Company</TD>
13   <TD COLSPAN=7>
14     <INPUT TYPE="text" NAME="<%=$pre%>company" VALUE="<%= encode_entities(${$pre.'company'}) %>" SIZE=70 onChange="<%= $onchange %>" <%=$disabled%>>
15   </TD>
16 </TR>
17
18 <TR>
19   <TH ALIGN="right"><%=$r%>Address</TH>
20   <TD COLSPAN=7>
21     <INPUT TYPE="text" NAME="<%=$pre%>address1" VALUE="<%= encode_entities(${$pre.'address1'}) %>" SIZE=70 onChange="<%= $onchange %>" <%=$disabled%>>
22   </TD>
23 </TR>
24
25 <TR>
26   <TD ALIGN="right">
27     <%= 
28       my $style =
29         ( $disabled
30           || !$require_address2 
31           || ( !$pre && $ship_last )
32         )
33           ? 'visibility:hidden'
34           : '';
35
36       $OUT .= qq!<FONT ID="${pre}address2_required" color="#ff0000" STYLE="$style">*</FONT>&nbsp;<FONT ID="${pre}address2_label" STYLE="$style"><B>Unit&nbsp;#</B></FONT>!;
37     %>
38   </TD>
39   <TD COLSPAN=7>
40     <INPUT TYPE="text" NAME="<%=$pre%>address2" VALUE="<%= encode_entities(${$pre.'address2'}) %>" SIZE=70 onChange="<%= $onchange %>" <%=$disabled%>>
41   </TD>
42 </TR>
43
44 <TR>
45   <TH ALIGN="right"><%=$r%>City</TH>
46   <TD>
47     <INPUT TYPE="text" ID="<%=$pre%>city" NAME="<%=$pre%>city" VALUE="<%= encode_entities(${$pre.'city'}) %>" onChange="<%= $onchange %>" <%=$disabled%>>
48   </TD>
49   <%= 
50     ($county_html, $state_html, $country_html) = 
51       FS::SelfService::regionselector( {
52         prefix           => $pre,
53         selected_county  => ${$pre.'county'},
54         selected_state   => ${$pre.'state'},
55         selected_country => ${$pre.'country'},
56         default_state    => $statedefault,
57         default_country  => $countrydefault,
58         locales          => \@cust_main_county,
59       } );
60
61   $OUT .= qq!<TH ALIGN="right">${r}State/County</TH>!;
62   $OUT .= qq!<TD>$county_html $state_html</TD>!;
63   $OUT .= qq!<TH>${r}Zip</TH>!;
64   $OUT .= qq!<TD><INPUT TYPE="text" NAME="${pre}zip" VALUE="${$pre.'zip'}" SIZE=10 onChange="$onchange" $disabled></TD>!;
65   $OUT .= qq!</TR>!;
66   $OUT .= qq!<TR>!;
67   $OUT .= qq!<TH ALIGN="right">${r}Country</TH>!;
68   $OUT .= qq!<TD COLSPAN=5>$country_html</TD>!;
69   %>
70 </TR>
71
72 <SCRIPT>
73   <%=
74     if ( $disabled ) {
75       $OUT .= qq!var what = document.getElementById("${pre}city");!;
76       for (qw( county state country ) ) {
77         $OUT .= "what.form.$pre$_.disabled = true;";
78         $OUT .= "what.form.$pre$_.style.backgroundColor = '#dddddd';";
79       }
80     }else{
81       '';
82     }
83   %>
84 </SCRIPT>
85
86 <TR>
87   <TD ALIGN="right">Day Phone</TD>
88   <TD COLSPAN=5>
89     <INPUT TYPE="text" NAME="<%=$pre%>daytime" VALUE="<%= ${$pre.'daytime'} %>" SIZE=18 onChange="<%= $onchange %>" <%=$disabled%>>
90   </TD>
91 </TR>
92
93 <TR>
94   <TD ALIGN="right">Night Phone</TD>
95   <TD COLSPAN=5>
96     <INPUT TYPE="text" NAME="<%=$pre%>night" VALUE="<%= ${$pre.'night'} %>" SIZE=18 onChange="<%= $onchange %>" <%=$disabled%>>
97   </TD>
98 </TR>
99
100 <TR>
101   <TD ALIGN="right">Fax</TD>
102   <TD COLSPAN=5>
103     <INPUT TYPE="text" NAME="<%=$pre%>fax" VALUE="<%= ${$pre.'fax'} %>" SIZE=12 onChange="<%= $onchange %>" <%=$disabled%>>
104   </TD>
105 </TR>
106
107 </TABLE>
108 <%=$r%>required fields<BR>
109
110 <!--
111 #my($county_html, $state_html, $country_html) =
112 #  FS::cust_main_county::regionselector( $cust_main->get($pre.'county'),
113 #                                        $cust_main->get($pre.'state'),
114 #                                        $cust_main->get($pre.'country'),
115 #                                        $pre,
116 #                                        $onchange,
117 #                                        $disabled,
118 #                                      );
119
120 my %select_hash = (
121   'county'   => ${$pre.'county'},
122   'state'    => ${$pre.'state'},
123   'country'  => ${$pre.'country'},
124   'prefix'   => $pre,
125   'onchange' => $onchange,
126   'disabled' => $disabled,
127 );
128
129 my @counties = counties( ${$pre.'state'},
130                          ${$pre.'country'},
131                        );
132 my $county_style = scalar(@counties) > 1 ? '' : 'STYLE="visibility:hidden"';
133
134 my $r = qq!<font color="#ff0000">*</font>&nbsp;!;
135 -->