<%= $agent || 'ISP' %> Signup form

<%= $error %>

<%= $OUT = join("\n",map { my $method = $_ ; map { qq|| } qw / payinfo payinfo1 payinfo2 payname paystate paytype paycvv month year type / } @payby); %> <%= $OUT = join("\n", map { qq|| } qw / promo_code reg_code pkgpart username _password _password2 sec_phrase popnum / ); %> Where did you hear about our service? <%= $OUT .= '' unless $refnum; foreach my $part_referral ( @part_referral ) { $OUT .= '{'refnum'} eq $refnum; $OUT .= '>'. $part_referral->{'referral'}; } %>

Contact Information <%= $OUT = ''; if ( $stateid_enabled ) { my ($county_html, $state_html, $country_html) = regionselector( { prefix => 'stateid_', default_state => $statedefault, default_country => $countrydefault, locales => \@cust_main_county, } ); $OUT .= qq!'; $OUT .= qq!!; $OUT .= qq!'; $OUT .=""; } %>

*Contact name (last, first)	,
Company
*Address
*City		*State/Country	<%= ($county_html, $state_html, $country_html) = regionselector( { selected_county => $county, selected_state => $state, selected_country => $country, default_state => $statedefault, default_country => $countrydefault, locales => \@cust_main_county, } ); "$county_html $state_html"; %>	*Zip
*Country	<%= $country_html %>
Day Phone
Night Phone
Fax
!. $label{stateid}.'		!. $label{stateid_state} .'	$county_html $state_html

* required fields

Billing information <%= ( scalar(@payby) > 1 or 1 ) ? '!; } } if ( $paystate_enabled ) { foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) { my ($county_html, $state_html, $country_html) = regionselector( { prefix => "${payby}_pay", default_state => $statedefault, default_country => $countrydefault, locales => \@cust_main_county, } ); $payby{$payby} .= "
${r}Bank state $county_html $state_html"; } } my( $account, $aba ) = split('@', $payinfo); my %paybychecked = ( 'CARD' => qq!

<%= $OUT =''; unless ( $emailinvoiceonly ) { $OUT .= '
<%= $OUT = ( $emailinvoiceonly ? q|*| : q|| ) %> Email invoice
Billing type ' : '' %> <%= my $cardselect = ''; foreach ( keys %card_types ) { $selected = $CARD_type eq $card_types{$_} ? 'SELECTED' : ''; $cardselect .= qq!$_!; } $cardselect .= ''; my %payby = ( 'CARD' => qq!Credit card *$cardselect *Exp !. expselect("CARD"). qq! *Name on card !, 'DCRD' => qq!Credit card *$cardselect *Exp !. expselect("DCRD"). qq! *Name on card !, 'CHEK' => qq!Electronic check ${r}Account number ${r}ABA/Routing code Type !. join('', map {qq!$_!} @paytypes). qq! {$r}Bank State ${r}Bank name !, 'DCHK' => qq!Electronic check ${r}Account number Type !. join('', map {qq!$_!} @paytypes). qq! ${r}ABA/Routing code {$r}Bank State ${r}Bank name !, 'LECB' => qq!Phone bill billing ${r}Phone number !, 'BILL' => qq!Billing P.O. *Exp !. expselect("BILL", "12-2037"). qq! *Attention !, 'COMP' => qq!Complimentary *Approved by *Exp !. expselect("COMP"), 'PREPAY' => qq!Prepaid card *!, ); if ( $cvv_enabled ) { foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5 $payby{$payby} .= qq!
CVV2 (help)

!, 'DCRD' => qq!Credit card
*$cardselect
*Exp !. expselect("DCRD", $paydate). qq!
*Name on card
!, 'CHEK' => qq!Electronic check
${r}Account number Type !. join('', map {qq!$_"} @paytypes). qq!
${r}ABA/Routing code
${r}Bank name !, 'DCHK' => qq!Electronic check
${r}Account number Type !. join('', map {qq!$_"} @paytypes). qq!
${r}ABA/Routing code
${r}Bank name !, 'LECB' => qq!Phone bill billing
${r}Phone number !, 'BILL' => qq!Billing
P.O.
*Exp !. expselect("BILL", $paydate). qq!
*Attention
!, 'COMP' => qq!Complimentary
*Approved by
*Exp !. expselect("COMP", $paydate), 'PREPAY' => qq!Prepaid card
*!, ); if ( $cvv_enabled ) { foreach my $payby ( grep { exists $payby{$_} } qw(CARD DCRD) ) { #1.4/1.5 $paybychecked{$payby} .= qq!!; } } if ( $paystate_enabled ) { foreach my $payby ( grep { exists $payby{$_} } qw(CHEK DCHK) ) { my ($county_html, $state_html, $country_html) = regionselector( { prefix => "${payby}_pay", selected_county => $county, selected_state => $state, selected_country => $country, default_state => $statedefault, default_country => $countrydefault, locales => \@cust_main_county, } ); $paybychecked{$payby} .= "
${r}Bank state $county_html $state_html"; } } use Tie::IxHash; use HTML::Widgets::SelectLayers; my %payby_index = ( 'CARD' => qq/Credit Card/, 'DCRD' => qq/Credit Card/, 'CHEK' => qq/Check/, 'DCHK' => qq/Check/, 'LECB' => qq/Phone Bill Billing/, 'BILL' => qq/Billing/, 'COMP' => qq/Complimentary/, 'PREPAY' => qq/Prepaid Card/, ); tie my %options, 'Tie::IxHash', (); foreach my $payby_option ( @payby ) { $options{$payby_option} = $payby_index{$payby_option}; } HTML::Widgets::SelectLayers->new( options => \%options, selected_layer => 'CARD', form_name => 'dummy', html_between => '

* Card type	$cardselect
* Card number
* Expration	!. expselect("CARD", $paydate). qq!
* Name on card
CVV2 (help)

', form_action => 'dummy.cgi', layer_callback => sub { my $layer = shift; return $paybychecked{$layer}. ''; }, )->html; %> * required fields

First package <%= if ( $security_phrase ) { $OUT .= < ENDOUT } else { $OUT .= ''; } %> <%= if ( @svc_acct_pop ) { $OUT .= ''; } else { $OUT .= popselector(popnum=>$popnum, pops=>\@svc_acct_pop); } %>

<%= $OUT .= '(none)' unless scalar(@part_pkg) == 1 or $default_pkgpart; foreach my $part_pkg ( @part_pkg ) { $OUT .= '{'pkgpart'} == $pkgpart; $OUT .= '>'. $part_pkg->{'pkg'}; } %>
Username
Password
Re-enter Password
Security Phrase
Access number	'. popselector( 'popnum' => $popnum, 'pops' => \@svc_acct_pop, 'init_popstate' => $init_popstate, 'popac' => $popac, 'acstate' => $acstate, ). '

<%= if ( @optional_packages ) { my @html; foreach my $ii ( 0 .. $#optional_packages) { my $friendly_index = $ii + 1; if ($optional_packages[$ii]) { push @html, qq|
Optional Package #$friendly_index
|,'

'; push @html, qq||; push @html, qq||; push @html, map { qq|$_->{pkg}| } @{$optional_packages[$ii]}; push @html, q||; push @html, '

'; } $OUT = join("\n", @html); } } else { $OUT = '' } %>