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<?php
session_start();
require_once($_SERVER['DOCUMENT_ROOT'].'/php/mysql.php');
function pretty_phone($str) {
$str = preg_replace('/[^0-9]/','',$str);
return '('.substr($str,0,3).') '.substr($str,3,3).'-'.substr($str,6);
}
?>
<!doctype html>
<html>
<head>
<title>PCI Compliant Credit Card Form</title>
<meta name='robots' content='noindex,follow' />
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="stylesheet" href="/css/font-awesome/css/all.css" />
<style type="text/css">
.container {
width:500px;
max-width:100%;
margin:0px auto;
text-align:center;
font-size:16px;
background:white;
}
.header {
text-align:center;
}
.header img {
width:100%;
}
.main_area {
text-align:left;
padding:10px;
}
.big_line {
margin:10px 0px;
}
.big_text {
font-size:28px;
color:#1e3891;
padding-bottom:10px;
}
.pci_logo {
float:right;
}
input[type=text],input[type=tel],select {
padding:10px 20px;
width:90%;
margin:0px auto;
font-size:20px;
}
#submit_button {
background:#dfedd6;
color:black;
border:1px solid black;
border-radius:5px;
cursor:pointer;
text-align:center;
padding:10px;
font-size:18px;
width:100%;
}
.text_icon {
position:relative;
width:100%;
border:1px solid #CCC;
border-radius:5px;
padding:5px;
margin-bottom:10px;
}
.text_icon .fa {
position:absolute;
font-size:24px;
padding:15px;
background:#CCC;
margin:-5px;
width:22px;
}
.text_icon input {
padding-left:60px;
width: calc(100% - 80px);
border:none;
outline:none;
}
</style>
<script type="text/javascript" src="/js/jquery-2.1.1.min.js"></script>
<script type="text/javascript" src="/js/jquery.formatter.min.js"></script>
<script type="text/javascript">
$(document).ready(function(){
$('input[name=cc_num]').formatter({
'pattern': '{{9999}}-{{9999}}-{{9999}}-{{9999}}',
'persistent': false
});
$('input[name=phone]').formatter({
'pattern': '({{999}}) {{999}}-{{9999}}',
'persistent': false
});
});
function change_cc_type() {
if($('[name=cc_type]:checked').val()=='amex') {
$('input[name=cc_num]').formatter().resetPattern('{{9999}}-{{999999}}-{{99999}}');
$('input[name=cc_cvv]').formatter().resetPattern('{{9999}}');
$('input[name=cc_cvv]').css('width','46px');
$('input[name=cc_cvv]').attr('placeholder','3333');
$('input[name=cc_cvv]').attr('maxlength','4');
$('.cvv_info_not_amex').hide();
$('.cvv_info_amex').show();
} else {
$('input[name=cc_num]').formatter().resetPattern('{{9999}}-{{9999}}-{{9999}}-{{9999}}');
$('input[name=cc_cvv]').formatter().resetPattern('{{999}}');
$('input[name=cc_cvv]').css('width','32px');
$('input[name=cc_cvv]').attr('placeholder','333');
$('input[name=cc_cvv]').attr('maxlength','3');
$('.cvv_info_not_amex').show();
$('.cvv_info_amex').hide();
}
}
function save_cc_info(frm) {
if($('#saving_cc_info_icon').length==0) {
$(frm).append('<center id="saving_cc_info_icon"><div class="fa-3x"><i class="fas fa-spinner fa-pulse"></i></div></center>');
var str="action=save_cc_info";
$(frm).find('input,select,textarea').each(function() {
if(this.type=='checkbox' || this.type=='radio') {
if($(this).is(':checked')) {
str += "&" + encodeURIComponent(this.name) + '=' + encodeURIComponent($(this).val());
}
} else {
str += "&" + encodeURIComponent(this.name) + '=' + encodeURIComponent($(this).val());
}
});
$.ajax({
url:"/php/save_cc_info.php",
cache: false,
type: "POST",
data: str,
success: function(results) {
$('#saving_cc_info_icon').remove();
if(!results.startsWith('Success|')) {
alert(results);
} else {
var arr = results.split('|');
var unique_code = arr[1];
var html = '<center>' +
'<p style="font-size:18px;">Thank You!</p>' +
'<p style="font-size:18px;">Write your <strong>Confirmation Number</strong> on the Order Form and give it to the presenter.</p>' +
'<div style="font-size:48px;margin:40px 0px;color:#990000;">' + unique_code + '</div>' +
'<div style="margin:20px 0px;font-size:18px;">Your Invincible Legal Tools will ship within 1 business day.</div>' +
'<div><img src="/images/ups.png" /></div>' +
'</center>';
$('.main_area').html(html);
}
},
error: function(jqXHR, textStatus, errorThrown) {
}
});
}
}
</script>
</head>
<body>
<div class="container">
<div class="header">
<img src="/images/logo_sml.png" style="width:145px;" />
</div>
<div class="main_area">
<div class="big_line">
<div class="pci_logo"><img src="/images/pci_logo.png" /></div>
<div class="big_text">PCI Compliant Credit Card Form</div>
<div style="clear:both;"></div>
</div>
<form onsubmit="save_cc_info(this); return false;">
<input type="hidden" name="action" value="save_cc_info" />
<div class="big_line">
<div class="big_text">
Contact Info on Order Form
</div>
<div>
<div>
<div class="text_icon">
<i class="fa fa-user"></i>
<input type="text" name="first_name" placeholder="First Name" value="" required />
</div>
</div>
<div>
<div class="text_icon">
<i class="fa fa-user"></i>
<input type="text" name="last_name" placeholder="Last Name" value="" required />
</div>
</div>
<div>
<div class="text_icon">
<i class="fa fa-envelope"></i>
<input type="text" name="email" placeholder="Email Address" value="" required />
</div>
</div>
<div>
<div class="text_icon">
<i class="fa fa-phone"></i>
<input type="text" name="phone" class="phone_number" placeholder="Mobile Phone" value="" required />
</div>
</div>
</div>
</div>
<div class="big_line">
<div class="big_text">Payment Options</div>
<div style="padding-left:20px;">
<div><label><input type="radio" name="payment_plan" value="pay_in_full" required style="vertical-align:middle;width:20px;height:20px;" /> Pay in Full $3,995</label></div>
<div><label><input type="radio" name="payment_plan" value="payment_plan" required style="vertical-align:middle;width:20px;height:20px;" /> $799 down, 4 Payments of $799<br /><div style="font-size:10px;padding-left:30px;">Payments will be processed using the same card provided</div></label></div>
</div>
</div>
<div class="big_line">
<div class="big_text">Payment Type</div>
<div class="credit_cards">
<label><input type="radio" name="cc_type" value="visa" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/visa.png" style="vertical-align:middle;" /></label>
<label><input type="radio" name="cc_type" value="mast" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/mast.png" style="vertical-align:middle;" /></label>
<label><input type="radio" name="cc_type" value="disc" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/disc.png" style="vertical-align:middle;" /></label>
<label><input type="radio" name="cc_type" value="amex" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/amex.png" style="vertical-align:middle;" /></label>
</div>
</div>
<div class="big_line">
<input type="tel" id="cc_num" name="cc_num" placeholder="Credit Card Number" required />
</div>
<div class="big_line">
<div style="display:inline-block;vertical-align:middle;">
Expires
<select name="cc_exp_month" style="width:70px;padding:10px 0px;" required>
<option value="">MM</option>
<?php for($i=1;$i<=12;$i++) {?>
<option value="<?= str_pad($i,2,'0',STR_PAD_LEFT);?>"><?= str_pad($i,2,'0',STR_PAD_LEFT);?></option>
<?php } ?>
</select> /
<select name="cc_exp_year" style="width:90px;padding:10px 0px;" required>
<option value="">YYYY</option>
<?php $this_year = date('Y');
$end_year = $this_year*1 + 10;
for($i=$this_year;$i<=$end_year;$i++) { ?>
<option value="<?= $i;?>"><?= $i;?></option>
<?php } ?>
</select>
</div>
<div style="display:inline-block;vertical-align:middle;">
CVV <input type="tel" name="cc_cvv" placeholder="333" style="width:32px;padding:10px 5px;" required />
</div>
<div class="cvv_info_not_amex" style="display:none;"><i style="font-size:14px;">* The CVV is a 3 digit number on the back of your card.</i></div>
<div class="cvv_info_amex" style="display:none;"><i style="font-size:14px;">* The CVV is a 4 digit number on the front of your card.</i></div>
</div>
<div class="big_line">
<center><button type="submit" id="submit_button">Save and Receive Confirmation Code</button></center>
</div>
</form>
<div class="big_line">
<center><img src="/images/ssl_logo.png" /></center>
</div>
</div>
</div>
</body>
</html>