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
*
Username
*
Password
*
Re-enter Password
<%= if ( $init_data->{'security_phrase'} ) { <
Security Phrase
ENDOUT } else { '
'; } %> <%= if ( scalar(@$pops) ) { '
Access number
'. popselector($popnum). '
'; } else { popselector($popnum); } %>
*
required fields
First package <%= use Tie::IxHash; my %pkgpart2payby = map { $_->{pkgpart} => $_->{payby}[0] } @{$packages}; tie my %options, 'Tie::IxHash', '' => '(none)', map { $_->{pkgpart} => $_->{pkg} } @{$packages} ; use HTML::Widgets::SelectLayers 0.02; my $widget = new HTML::Widgets::SelectLayers( options => \%options, selected_layer => $pkgpart, form_name => 'dummy', form_action => $self_url, form_text => [qw( magic ref ss agentnum last first company address1 address2 city zip daytime night fax )], form_select => [qw( state )], #county country layer_callback => sub { my $layer = shift; my $html = qq(
); if ( $pkgpart2payby{$layer} eq 'BILL' ) { $html .= <
ENDOUT } elsif ( $pkgpart2payby{$layer} eq 'CARD' ) { my $postal_checked = ''; my @invoicing_list = split(', ', $invoicing_list ); $postal_checked = 'CHECKED' if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list; $invoicing_list= join(', ', grep { $_ ne 'POST' } @invoicing_list ); my $expselect = expselect("CARD", $paydate); my $cardselect = '
'; my %types = ( 'VISA' => 'VISA card', 'MasterCard' => 'MasterCard', 'Discover' => 'Discover card', 'American Express' => 'American Express card', ); foreach ( keys %types ) { $selected = $cgi->param('CARD_type') eq $types{$_} ? 'SELECTED' : ''; $cardselect .= qq!
$_
!; } $cardselect .= '
'; $html .= <
Billing information
Email statement to
*
Credit card type
$cardselect
*
Card number
*
*Exp
$expselect
*
Name on card
*
required fields
ENDOUT } else { $html = <
Please select a package.
ENDOUT } $html; }, ); $widget->html; %>