-<HTML><HEAD><TITLE>ISP Signup form</TITLE></HEAD>
-<BODY BGCOLOR="#e8e8e8" onUnload="myclose()">
-<script language="JavaScript"><!--
- var mywindow = -1;
- function myopen(filename,windowname,properties) {
- myclose();
- mywindow = window.open(filename,windowname,properties);
- }
- function myclose() {
- if ( mywindow != -1 )
- mywindow.close();
- mywindow = -1
- }
-//--></script>
-<FONT SIZE=7>ISP Signup form</FONT><BR><BR>
-<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="magic" VALUE="process">
-<INPUT TYPE="hidden" NAME="ref" VALUE="<%= $referral_custnum %>">
-<INPUT TYPE="hidden" NAME="ss" VALUE="">
-Where did you hear about our service? <SELECT NAME="refnum">
-<%=
- $OUT .= '<OPTION VALUE="">' unless $refnum;
- foreach my $part_referral ( @{$init_data->{'part_referral'}} ) {
- $OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
- $OUT .= ' SELECTED' if $part_referral->{'refnum'} eq $refnum;
- $OUT .= '>'. $part_referral->{'referral'};
- }
-%>
-</SELECT><BR><BR>
-Billing Address (where credit card statement is sent)
-<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>Exact name on card<BR>(last, first)</TH>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="last" VALUE="<%= $last %>" onChange="changed(this)">,
- <INPUT TYPE="text" NAME="first" VALUE="<%= $first %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Company</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="company" SIZE=70 VALUE="<%= $company %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="address1" SIZE=70 VALUE="<%= $address1 %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right"> </TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="address2" SIZE=70 VALUE="<%= $address2 %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
- <TD><INPUT TYPE="text" NAME="city" VALUE="<%= $city %>" onChange="changed(this)"></TD>
- <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
- <TD>
- <%=
- ($county_html, $state_html, $country_html) =
- regionselector( $county, $state, $country, '', 'changed(this)' );
-
- "$county_html $state_html";
- %>
- </TD>
- <TH><font color="#ff0000">*</font>Zip</TH>
- <TD><INPUT TYPE="text" NAME="zip" SIZE=10 VALUE="<%= $zip %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
- <TD><%= $country_html %></TD>
-<TR>
- <TD ALIGN="right">Day Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="daytime" VALUE="<%= $daytime %>" SIZE=18 onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Night Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="night" VALUE="<%= $night %>" SIZE=18 onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Fax</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="fax" VALUE="<%= $fax %>" SIZE=12 onChange="changed(this)"></TD>
-</TR>
-</TABLE>
-
-<SCRIPT>
-function changed(what) {
- what.form.same.checked = false;
-}
-function samechanged(what) {
- if ( what.checked ) {
-
- <%= foreach (qw(
- last first company address1 address2 city zip daytime night fax
- )) {
- $OUT .= "what.form.ship_$_.value = what.form.$_.value;\n";
- }
- %>
-
- what.form.ship_country.selectedIndex = what.form.country.selectedIndex;
- ship_country_changed(what.form.ship_country);
- what.form.ship_state.selectedIndex = what.form.state.selectedIndex;
- ship_state_changed(what.form.ship_state);
- what.form.ship_county.selectedIndex = what.form.county.selectedIndex;
- }
-}
-</SCRIPT>
-
-<BR><BR>
-Service Address
-(<INPUT TYPE="checkbox" NAME="same" VALUE="Y" onClick="samechanged(this)" <%= $same eq 'Y' ? 'CHECKED' : '' %>>same as billing address)<BR>
-<TABLE BGCOLOR="#c0c0c0" 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="ship_last" VALUE="<%= $ship_last %>" onChange="changed(this)">,
- <INPUT TYPE="text" NAME="ship_first" VALUE="<%= $ship_first %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Company</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_company" SIZE=70 VALUE="<%= $ship_company %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>Address</TH>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_address1" SIZE=70 VALUE="<%= $ship_address1 %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right"> </TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_address2" SIZE=70 VALUE="<%= $ship_address2 %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>City</TH>
- <TD><INPUT TYPE="text" NAME="ship_city" VALUE="<%= $ship_city %>" onChange="changed(this)"></TD>
- <TH ALIGN="right"><font color="#ff0000">*</font>State/Country</TH>
- <TD>
- <%=
- ($ship_county_html, $ship_state_html, $ship_country_html) =
- regionselector( $ship_county,
- $ship_state,
- $ship_country,
- 'ship_',
- 'changed(this)',
- );
-
- "$ship_county_html $ship_state_html";
- %>
- </TD>
- <TH><font color="#ff0000">*</font>Zip</TH>
- <TD><INPUT TYPE="text" NAME="ship_zip" SIZE=10 VALUE="<%= $ship_zip %>" onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TH ALIGN="right"><font color="#ff0000">*</font>Country</TH>
- <TD><%= $ship_country_html %></TD>
-<TR>
- <TD ALIGN="right">Day Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_daytime" VALUE="<%= $ship_daytime %>" SIZE=18 onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Night Phone</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_night" VALUE="<%= $ship_night %>" SIZE=18 onChange="changed(this)"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Fax</TD>
- <TD COLSPAN=5><INPUT TYPE="text" NAME="ship_fax" VALUE="<%= $ship_fax %>" SIZE=12 onChange="changed(this)"></TD>
-</TR>
-</TABLE>
-
-<font color="#ff0000">*</font> required fields<BR>
-
-<BR>Billing information<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
-<TR><TD>
-
- <%=
- $OUT .= '<INPUT TYPE="checkbox" NAME="invoicing_list_POST" VALUE="POST"';
- my @invoicing_list = split(', ', $invoicing_list );
- $OUT .= ' CHECKED'
- if ! @invoicing_list || grep { $_ eq 'POST' } @invoicing_list;
- $OUT .= '>';
- %>
-
- Postal mail invoice
-</TD></TR>
-<TR><TD>Email invoice <INPUT TYPE="text" NAME="invoicing_list" VALUE="<%= join(', ', grep { $_ ne 'POST' } split(', ', $invoicing_list ) ) %>">
-</TD></TR>
-<%= scalar(@payby) > 1 ? '<TR><TD>Billing type</TD></TR>' : '' %>
-</TABLE>
-<TABLE BGCOLOR="#c0c0c0" BORDER=1 WIDTH="100%">
-<TR>
-
- <%=
-
- my $cardselect = '<SELECT NAME="CARD_type"><OPTION></OPTION>';
- 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!<OPTION $selected VALUE="$types{$_}">$_</OPTION>!;
- }
- $cardselect .= '</SELECT>';
-
- my %payby = (
- 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$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="">!,
- 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD"), #. qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="">!,
- 'CHEK' => qq!Electronic check<BR>${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="">!,
- '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>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!,
- 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="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="">!,
- '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">!,
- '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"),
- 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="" MAXLENGTH=80>!,
- );
-
- if ( $init_data->{'cvv_enabled'} ) {
- foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
- $payby{$payby} .= qq!<BR>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>) <INPUT TYPE="text" NAME=${payby}_paycvv VALUE="" SIZE=4 MAXLENGTH=4>!;
- }
- }
-
- my( $account, $aba ) = split('@', $payinfo);
- my %paybychecked = (
- 'CARD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="CARD_payinfo" VALUE="$payinfo" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("CARD", $paydate), #. qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="CARD_payname" VALUE="$payname">!,
- '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">!,
- '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">!,
- '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">!,
- '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="">!,
- '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">!,
- '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", $paydate),
- 'PREPAY' => qq!Prepaid card<BR><font color="#ff0000">*</font><INPUT TYPE="text" NAME="PREPAY_payinfo" VALUE="$payinfo" MAXLENGTH=80>!,
- );
-
- if ( $init_data->{'cvv_enabled'} ) {
- foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5
- $paybychecked{$payby} .= qq!<BR>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>) <INPUT TYPE="text" NAME=${payby}_paycvv VALUE="$paycvv" SIZE=4 MAXLENGTH=4>!;
- }
- }
-
- for (@payby) {
- if ( scalar(@payby) == 1) {
- $OUT .= '<TD VALIGN=TOP>'.
- qq!<INPUT TYPE="hidden" NAME="payby" VALUE="$_">!.
- "$paybychecked{$_}</TD>";
- } else {
- $OUT .= qq!<TD VALIGN=TOP><INPUT TYPE="radio" NAME="payby" VALUE="$_"!;
- if ($payby eq $_) {
- $OUT .= qq! CHECKED> $paybychecked{$_}</TD>!;
- } else {
- $OUT .= qq!> $payby{$_}</TD>!;
- }
-
- }
- }
- %>
-
-</TR></TABLE><font color="#ff0000">*</font> required fields for each billing type
-<BR><BR>First package
-<INPUT TYPE="hidden" NAME="promo_code" VALUE="<%= $cgi->param('promo_code') %>">
-<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
-<TR>
- <TD COLSPAN=2><SELECT NAME="pkgpart">
-
- <%=
- $OUT .= '<OPTION VALUE="">(none)' unless scalar(@$packages) == 1;
- foreach my $package ( @{$packages} ) {
- $OUT .= '<OPTION VALUE="'. $package->{'pkgpart'}. '"';
- $OUT .= ' SELECTED'
- if ( $pkgpart && $package->{'pkgpart'} == $pkgpart )
- || scalar(@$packages) == 1;
- $OUT .= '>'. $package->{'pkg'};
- }
- %>
-
- </SELECT></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Username</TD>
- <TD><INPUT TYPE="text" NAME="username" VALUE="<%= $username %>"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Password</TD>
- <TD><INPUT TYPE="password" NAME="_password" VALUE="<%= $password %>"></TD>
-</TR>
-<TR>
- <TD ALIGN="right">Re-enter Password</TD>
- <TD><INPUT TYPE="password" NAME="_password2" VALUE="<%= $password2 %>"></TD>
-</TR>
-<%=
- if ( $init_data->{'security_phrase'} ) {
- $OUT .= <<ENDOUT;
-<TR>
- <TD ALIGN="right">Security Phrase</TD>
- <TD><INPUT TYPE="text" NAME="sec_phrase" VALUE="$sec_phrase">
- </TD>
-</TR>
-ENDOUT
- } else {
- $OUT .= '<INPUT TYPE="hidden" NAME="sec_phrase" VALUE="">';
- }
-%>
-<%=
- if ( scalar(@$pops) ) {
- $OUT .= '<TR><TD ALIGN="right">Access number</TD><TD>'.
- popselector($popnum). '</TD></TR>';
- } else {
- $OUT .= popselector($popnum);
- }
-%>
-</TABLE>
-<BR><BR><INPUT TYPE="submit" NAME="signup" VALUE="Signup">
-</FORM></BODY></HTML>
projects / freeside.git / blobdiff