--- /dev/null
+<% include('/elements/header.html', 'Customer Signup Summary' ) %>
+
+<FORM ACTION="cust_signup.html" METHOD="GET">
+
+<TABLE>
+
+<% include('/elements/tr-select-from_to.html' ) %>
+
+<% include('/elements/tr-select-agent.html',
+ 'curr_value' => scalar($cgi->param('agentnum')),
+ 'label' => 'For agent: ',
+ 'disable_empty' => 0,
+ )
+%>
+
+<% include('/elements/tr-select-part_referral.html',
+ 'curr_value' => scalar($cgi->param('refnum')),
+ 'label' => 'Advertising source: ',
+ 'disable_empty' => 0,
+ 'pre_options' => [ 'all' => 'all (aggregate)' ],
+ 'empty_label' => 'all (breakdown)',
+ )
+%>
+
+</TABLE>
+
+<BR><INPUT TYPE="submit" VALUE="Display">
+</FORM>
+
+<% include('/elements/footer.html') %>
+<%init>
+
+#XXX use a different ACL for package churn?
+die "access denied"
+ unless $FS::CurrentUser::CurrentUser->access_right('Financial reports');
+
+</%init>