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<?php
require_once($_SERVER['DOCUMENT_ROOT'].'/assets/includes/php_header.php');
if(!empty($_GET['prm'])) {
$prm_arr = explode('|',UnCryptify($_GET['prm']));
$prm = array();
$prm['cid'] = $prm_arr[0];
$prm['sid'] = $prm_arr[1];
$prm['initial'] = $prm_arr[2];
$prm['monthly'] = $prm_arr[3];
$_SESSION['prm'] = $prm;
}
//echo '<!-- https://americasgotfunding.com/order.php?s=1&prm='.Cryptify('Chat|Alesha|'.($_INITIAL_FEE*0.8).'|'.($_MONTHLY_FEE)).' -->';
$categories = get_categories();
$business_questions = get_business_questions();
//$education_questions = get_education_questions();
//$disability_questions = get_disability_questions();
/*function sub_question_recursive($q) {
global $education_questions;
if(isset($education_questions['subquestions'][$q])) {
foreach($education_questions['subquestions'][$q] as $s=>$d) { ?>
<div class="<?= $q;?>_sub" style="padding:5px 5px 5px 20px;display:block;clear:both;">
<?= $d['name'];?><br/>
<?php if($d['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $s;?>" id="<?= $s;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $s;?>" id="<?= $s;?>_no" /> No</label>
<br/>
<?php } elseif(strpos($d['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$d['type']);
$range_limits = explode('-',$pieces[1]);
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
} ?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php
}
?>
</select>
<?php
}
if(isset($education_questions['subquestions'][$s]))
{
sub_question_recursive($s);
}
?>
</div>
<?php
}
}
}*/
/*function sub_question_recursive_disability($q) {
global $disability_questions;
if(isset($disability_questions['subquestions'][$q])) {
foreach($disability_questions['subquestions'][$q] as $k=>$data) {
foreach($data as $s=>$d) { ?>
<div class="<?= $q;?>_sub" style="padding:5px 5px 5px 0px;display:block;clear:both;">
<?= $d['name'];?><br/>
<?php if($d['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $s;?>" id="<?= $s;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $s;?>" id="<?= $s;?>_no" /> No</label>
<br/>
<?php } elseif($d['type']=='text') {
?><input style="width:100%;" type="text" name="<?= $s;?>" id="<?= $s;?>" /><?php
} elseif(strpos($d['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$d['type']);
$range_limits = explode('-',$pieces[1]);
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
} ?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php
}
?>
</select>
<?php
} elseif($d['type']=='textarea') {
?>
<textarea name="<?= $s;?>" id="<?= $s;?>"></textarea>
<?php
} elseif(strpos($d['type'],'select') > -1) {
$select = array();
$pieces = explode(':',$d['type']);
$more_pieces = explode('|',$pieces[1]);
?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($more_pieces as $p) { ?>
<option value="<?= $p;?>"><?= $p;?></option>
<?php } ?>
</select>
<?php
}
if(isset($disability_questions['subquestions'][$s]))
{
sub_question_recursive_disability($s);
}
?>
</div>
<?php
}
}
}
} */
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="viewport" content="width=device-width" />
<title>America's Got Funding</title>
<link href="/lp2/assets/css/style.css" type="text/css" rel="stylesheet" />
<link href="/lp2/assets/css/sub_styles.css" type="text/css" rel="stylesheet" />
<link href="/lp2/assets/css/responsive.css" type="text/css" rel="stylesheet" />
<style>
.inline_block { display:inline-block; margin: 5px; }
.block { display:block; margin:5px; }
.clear { clear:both; }
</style>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.3/jquery.min.js"></script>
<script language="javascript" type="text/javascript" src="/assets/js/jquery.formatter.min.js"></script>
<script language="javascript" type="text/javascript">
$(document).ready(function() {
$('.subcategory,.subtext,#education_questions,#business_questions').hide().find('input,select,textarea').attr('disabled','disabled');
$('input[name=category_id]').click(function() {
$('.subcategory,.subtext').slideUp().find('input,select,textarea').attr('disabled','disabled');
$(this).parent().find('.subcategory,.subtext').slideDown().find('input,select,textarea').removeAttr('disabled');
var granttype = this.className;
$('#granttype_input').val(granttype);
var amount_needed = $('select[name=app_amount_needed]').val();
if(granttype == 'business') {
$('#amount_needed').html('<select name="app_amount_needed"><option selected>Select</option><option value="$500 - $10,000">$500 - $10,000</option><option value="$10,000 - $25,000">$10,000 - $25,000</option><option value="$25,000 - $50,000">$25,000 - $50,000</option><option value="$50,000 - $100,000">$50,000 - $100,000</option><option value="$100,000 - $250,000">$100,000 - $250,000</option><option value="$250,000 - $500,000">$250,000 - $500,000</option><option value="$500,000 - $1,000,000">$500,000 - $1,000,000</option><option value="$1,000,000 +">$1,000,000 +</option></select>');
$('#business_questions').show('slow').find('input,select,textarea').removeAttr('disabled');
} else {
$('#amount_needed').html('<select name="app_amount_needed"><option selected>Select</option><option value="$500 - $10,000">$500 - $10,000</option><option value="$10,000 - $25,000">$10,000 - $25,000</option><option value="$25,000 - $50,000">$25,000 - $50,000</option><option value="$50,000 - $100,000">$50,000 - $100,000</option><option value="$100,000 or More">$100,000 or More</option></select>');
$('#business_questions').hide('slow').find('input,select,textarea').attr('disabled','disabled');
}
/*
if(granttype == 'education') {
$('#education_questions').show('slow').find('input,select,textarea').removeAttr('disabled');
} else {
$('#education_questions').hide('slow').find('input,select,textarea').attr('disabled','disabled');
}*/
$('select[name=app_amount_needed]').val(amount_needed);
});
<?php
/*foreach($education_questions['subquestions'] as $slug=>$data) {
echo "$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');";
echo "$('#".$slug."_yes').click(function() {
$('.".$slug."_sub').slideDown().find('input,select,textarea').removeAttr('disabled');
});";
echo "$('#".$slug."_no').click(function() {
$('.".$slug."_sub').slideUp().find('input,select,textarea').attr('disabled','disabled');
});";
}*/
/*foreach($disability_questions['subquestions'] as $slug=>$data) {
echo "$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');";
echo "$('#".$slug."_yes').click(function() {
$('.".$slug."_sub').slideDown().find('input,select,textarea').removeAttr('disabled');
});";
echo "$('#".$slug."_no').click(function() {
$('.".$slug."_sub').slideUp().find('input,select,textarea').attr('disabled','disabled');
});";
}*/
if(!empty($_REQUEST)) {
echo "$('input:radio[name=category_id]').filter(function() { return $(this).val()=='{$_REQUEST['category_id']}'; }).click();\n";
}
?>
//IE doesn't handle labels with images properly
/*if($.browser.msie) {
$("label img").click(function() {
$("#" + $(this).parents("label").attr("for")).click();
});
}*/
<?php
//if(apptype is set) { click on that apptype and hide the rest }
if(!empty($_SESSION['apptype'])) {
switch($_SESSION['apptype']) {
case 'education_tuition_funding':
?>
$('#main-categories').find('tr').hide();
$('#2-education').parents('tr:first').show();
$('#2-education').click();
<?php
break;
case 'real_estate_funding':
?>
$('#main-categories').find('tr').hide();
$('#5-real-estate').parents('tr:first').show();
$('#5-real-estate').click();
<?php
break;
case 'business_funding':
?>
$('#main-categories').find('tr').hide();
$('#1-business').parents('tr:first').show();
$('#1-business').click();
<?php
break;
case 'personal_funding':
?>
$('#main-categories').find('tr').hide();
$('#4-personal').parents('tr:first').show();
$('#4-personal').click();
<?php
break;
}
}
?>
});
var prettynames = {
category_id:"Funding Category",
cc_fname:"First Name",
cc_lname:"Last Name",
cc_addr:"Address",
cc_city:"City",
cc_state:"State",
cc_zip:"Zip",
cc_phonearea:"Phone Number Area Code",
cc_phoneprefix:"Phone Number Prefix",
cc_phoneextension:"Phone Number Ending",
cc_email:"Email Address",
app_gender:"Gender",
app_citizenship:"Citizenship",
app_age:"Your age",
app_amount_needed:"The amount needed",
app_usedescription:"Describe what you will use the money for",
app_uniqueness:"Uniqueness",
diploma:"Do you have a high school diploma or GED?",
online_business:"Would you like to start an online business to make money while you go to school if we could help pay for your training?",
serious_scale:"In a scale of 1-10 how serious are you about getting a degree online?",
college:"Have you gone to college?",
degree:"Do you have a degree?",
willing_second_degree:"Are you willing to get a second degree in business?",
have_computer:"Do you have access to a computer for taking the online classes and working on your business?",
/*applied_ssd:"Have you ever applied for Social Security Disability?",
currently_applying:"If yes, \"Are you currently receiving Social Security benefits?\"",
denied_ssd:"Have you been denied for Social Security Disability?",
when_denied:"When were you denied?",
why_denied:"Why were you denied?",
stopped_work:"Have you stopped working because of a disability?",
why_cant_work:"If yes, \"Why can't you work right now?\"",
out_of_work_12_months:"Do you expect to be out of work for at least 12 months?",
treatment:"Are you currently receiving treatment from a doctor?",
worked_5_years:"Have you worked approximately five of the last ten years?",
have_attorney:"Do you have an attorney helping you with this case?"*/
own_business:"Do you own your own business?",
name_of_business:"What is the Name of your Business?",
has_website:"Do you have a website?",
website:"What is your website?",
business_structured:"How is your business structured?",
how_many_employees:"How many employees do you have?",
annual_revenue:"What is the Total Gross Income of your business?",
defendant_lawsuit:"Have you or your business every been a defendant in a lawsuit?",
sued_protected:"Do you feel if you were sued, you are properly protected so you wouldn't lose any of your assets like your home, cars, building, etc?",
living_trust:"Do you have a living trust?"
};
function isblank(str) {
return ($.trim(str)=='') ? true : false;
}
function verify(f) {
// Loop through each element of the form and validate each item
//
// Set the parameters for each field to be valid
// If a field doesn't have any modifiers it is assumed to be
// a text field that can not be blank.
var msg;
var empty_fields = "";
var errors = "";
var required_fields = ['category_id','app_amount_needed','cc_fname','cc_lname','cc_zip','cc_email','phone_full','cc_addr','app_usedescription','app_uniqueness','cc_city','cc_state','app_age','app_gender'];
$(f).find('input,tel,textarea,select,number').each(function()
{
//only check for required fields
var element = $(this)[0];
var is_required = required_fields.indexOf(element.name);
if(is_required=='-1') {
//Not Required
} else {
//Required
if($(element).is(':hidden')) {
//Ignore
}
else if((element.name == 'cc_email')) {
if(/(.+)@(.+){2,}\.(.+){2,}/.test(element.value)) {
//valid email
} else {
errors += "- Please enter a valid email address\n";
}
}
else if ((element.name == 'phone_full')) {
var real_phone = element.value;
real_phone = real_phone.replace(/[^0-9]/g,'');
if(real_phone.length==10) {
//valid phone
} else {
errors += "- Please enter a valid phone number\n";
}
}
else if ((element.name == 'cc_zip')) {
var real_phone = element.value;
real_phone = real_phone.replace(/[^0-9]/g,'');
if(real_phone.length==5) {
//valid phone
} else {
empty_fields += "\n Zip Code";
}
}
else if ((element.type == 'text' || element.type == 'textarea') && (element.name != 'granttype_other'))
{
if ( (element.value == null || element.value == "") || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
}
else
{
if (element.numeric)
{
var v = parseFloat(element.value);
if (isNaN(v))
{
errors +="- The field " + prettynames[element.name] + " must be a number\n";
}
}
if ( (element.requiredlength > 0) && (element.value.length != element.requiredlength) )
{
errors += "- The field " + prettynames[element.name] + " must be " + element.requiredlength + " digits long\n";
}
}
}
else if (element.type == 'select-one')
{
// The first option, option[0] can not be selected
if ( (element.value == null || element.value == "" || element.selectedIndex == 0) || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
}
}
else if (element.type == 'radio')
{
if (!$('[name='+element.name+']').filter(':checked').val() && empty_fields.indexOf(prettynames[element.name]) == -1)
{
empty_fields += "\n " + prettynames[element.name];
}
}
}
});
if($('#agree2terms').is(':checked')) {
} else {
errors += (errors=='') ? '' : "\n";
errors += "You must agree to the terms of this site.";
}
if (!empty_fields && !errors) { return true; }
msg = "__________________________________\n\n";
msg += "The form was not submitted because of the following error(s).\n";
msg += "Please correct these error(s) and re-submit.\n";
msg += "__________________________________\n\n";
if (empty_fields)
{
msg += "- The following required field(s) are empty:" + empty_fields + "\n";
if (errors) { msg += "\n"; }
}
msg += errors;
alert(msg);
return false;
}
$(document).ready(function(){
$('.form_table .gender input:radio').css('visibility','hidden');
$('label').click(function(){
$(this).parent().find('label').removeClass('radio-focus');
$(this).addClass('radio-focus');
});
});
function TabNext(me,num,next) {
if(me.value.length==num) {
$(next).focus();
}
}
function checkZip(zip,me) {
zip = zip.replace(/[^0-9]/g,'');
if(zip.length==5) {
var str = 'zip='+encodeURIComponent(zip);
$.ajax
({
cache: false,
type: "POST",
dataType:"json",
data: str,
url: "/php/ZipToCity.php",
success: function(data)
{
if(!data.error) {
$('[name=cc_city]').val(data.city);
$('[name=cc_state]').val(data.state);
}
},error: function(jqXHR, textStatus, errorThrown) {
}
});
}
}
$(document).ready(function(){
$('input[name=phone_full]').formatter({
'pattern': '({{999}}) {{999}}-{{9999}}',
'persistent': false
});
});
</script>
</head>
<body id="index">
<div class="size cen">
<table cellpadding="0" cellspacing="0" border="0" class="index_logo size">
<tr>
<td>
<a href="login.php"><img src="assets/images/login2.png" class="loginTop2" /></a>
<a href="login.php"><img src="assets/images/login.png" class="loginTop" /></a>
</td>
<td class="funding_tp"></td>
</tr>
</table>
<div class="index_top size">
<table cellpadding="0" cellspacing="0" border="0" class="data">
<tr>
<td class="data_tl"></td>
<td class="data_tp1"></td>
<td class="data_tp2"></td>
<td class="data_tr"><img src="/lp2/assets/images/funding_ri.png" /></td>
</tr>
<tr>
<td class="data_le"></td>
<td class="data_in" valign="top">
<div class="ajax_content">
<h1 style="margin-top:0px">WHO'S GIVING OUT MONEY?</h1>
<a href="#form"><img class="adImage" src="/lp2/assets/images/sml_buttons.jpg"></a>
<img class="adImage" src="/lp2/assets/images/sml_reuters1.jpg">
<img class="adImage" src="/lp2/assets/images/sml_washingtonpost.jpg">
<img class="adImage" src="/lp2/assets/images/sml_reuters2.jpg">
<img class="adImage" src="/lp2/assets/images/sml_missourian.jpg">
<img class="adImage" src="/lp2/assets/images/sml_stacey.jpg">
<img class="adImage" src="/lp2/assets/images/sml_jessica.jpg">
<img class="adImage" src="/lp2/assets/images/sml_elizabeth.jpg">
<p>Foundations and corporations, that's who! These (and other) organizations gift <strong>billions of dollars each year</strong> to Americans for nearly innumerable reasons: education, business start-up or expansion, real estate purchases, inventions, research, community development . . . the list goes on and on! New funding opportunities are becoming available all the time.</p>
<a href="#form"><img class="smlImage" src="/lp2/assets/images/sml_buttons.jpg"></a>
<h1>WHO QUALIFIES?</h1>
<p>Probably you! Funding is offered to so many different categories of people and needs. Here are some:</p>
<table class="format_table" width="470">
<tr>
<td valign="top" width="40%">
<ul>
<li>Disabled</li>
<li>Seniors</li>
<li>Minorities</li>
<li>Faith-based Organizations</li>
<li>Women</li>
<li>Inventors</li>
<li>Medical Research</li>
<li>Small and Large Businesses</li>
<li>Non-profit Organizations</li>
</ul>
</td>
<td valign="top" width="45%">
<ul>
<li>Community Development</li>
<li>Historical Building Restoration</li>
<li>Education and Tuition</li>
<li>Housing and Real Estate</li>
<li>Personal Assistance</li>
<li>Rent Assistance</li>
<li>Home Repair</li>
<li>Child Care</li>
</ul>
</td>
</tr>
</table>
<img class="smlImage" src="/lp2/assets/images/sml_stacey.jpg">
<p>Now, to be fair, not everyone qualifies for funding. For example, a lot of funding is not available for personal expenses or paying off debt. And all funding has eligibility requirements. But people and organizations are often surprised to learn that they do qualify, even when they didn't think they did. For example, funding for first-time home buyers aren't just for first-time home buyers: people who haven't owned a home in three years may also qualify! Additionally, there may be categories that fit you that you didn't even know existed. That's why it's so essential to have a mentor, with all the information, to guide you through this process.</p>
<img class="smlImage" src="/lp2/assets/images/sml_elizabeth.jpg">
<h1>TEAM UP!</h1>
<p>The process of researching funding resources, applying for funding, and writing funding proposals can be long and detailed. It can be overwhelming, especially for someone without experience. You may feel like you need a team of people to help you. That's what the people at <?=$_SITE_NAME;?> are: <strong>your team of experts!</strong> We offer all the tools you need to successfully apply for the right funding. With the right people supporting you, the entire process will become easier: organized, manageable, and realistic. You won't believe what you can accomplish for yourself, often with no required pay-back!</p>
<img class="smlImage" src="/lp2/assets/images/sml_reuters2.jpg">
<h1>HOW DO I START?</h1>
<p><?=$_SITE_NAME;?> offers a members-only website with all the information you need to successfully launch your quest for funding. <strong>We teach you the entire application process:</strong> from finding the funds you qualify for, organizing the application, writing a proposal, and following up. We charge a small fee of <?= (!empty($_SESSION['prm'])) ? '<span style="text-decoration:line-through">$'.$_INITIAL_FEE.'</span> <span style="color:#33aa66">$'.$_SESSION['prm']['initial'].'</span>' : '$'.$_INITIAL_FEE; ?> for you to have unlimited access to our members-only site. This fee comes with a <strong>guarantee</strong>: If you don't qualify for a free program, your entire total payment will be refunded to you immediately. You will have 90 days from the date of this transaction to submit your refund request along with your denial letter. The members-only site offers unbelievable resources much of it you'd only find through extensive research and reading dozens of funding books. And our team keeps researching and updating the website all the time. Your payment helps cover the research required to keep the site updated and all the information current.</p>
<?php if(!empty($_SESSION['prm'])) { ?>
<p class="text" style="color:#33aa66">Thanks to <?= $_SESSION['prm']['sid']; ?>, you can get access to these funding opportunities for only <span style='text-decoration:line-through'>$<?= $_INITIAL_FEE; ?></span> $<?= $_SESSION['prm']['initial']; ?>.</p>
<?php } ?>
</div>
<!-- FORM STARTS HERE -->
<a name="apply"></a>
<h1>REGISTRATION FORM</h1>
<form id="form" action="https://<?= $_SERVER['SERVER_NAME'].'/order.php'?>" method="post" name="apply" onSubmit="return verify(this);">
<div class="form">
<div class="note">Check the area of funding you are interested in:</div>
<table cellpadding="0" cellspacing="0" border="0" class="form_table">
<tr>
<td>
<?php if(!empty($categories)) {?>
<table id="main-categories" cellpadding="2" cellspacing="3" class="grant_category">
<?php
function get_subcats($cat,$categories) {
$subcats = array();
foreach($categories['subcategories'] as $key=>$value) {
if(isset($value['categories'][$cat])) {
$subcats[$key] = $categories['subcategories'][$key];
}
}
return $subcats;
}
foreach($categories['categories'] as $key=>$cat) {
$subcats = get_subcats($key,$categories);
?>
<tr>
<td>
<input type="radio" name="category_id" id="<?= $key;?>-<?= $cat['slug'];?>" class="<?= $cat['slug'];?>" value="<?= $key;?>" <?= (isset($_REQUEST['category_id']) && $_REQUEST['category_id']==$key) ? 'checked=true' : null;?> />
<label for="<?= $key;?>-<?= $cat['slug'];?>" title="<?= $cat['name'];?> - <?= $cat['description'];?>"><span style="font-size: 15px;color: #993333;font-weight: bold;"><?= $cat['name'];?></span></label><br />
<p style="display:none;"><?= $cat['description'];?></p>
<?php foreach($subcats as $k=>$c) { ?>
<div class="subcategory <?= $cat['slug'];?>">
<input id="<?= $cat['slug'];?>-<?= $k;?>-<?= $c['slug'];?>" type="checkbox" name="subcategories[]" value="<?= $k;?>" <?= (isset($_REQUEST['subcategories']) && in_array($k,$_REQUEST['subcategories'])) ? 'checked=true' : null;?> />
<label for="<?= $cat['slug'];?>-<?= $k;?>-<?= $c['slug'];?>"><?= $c['name'];?></label>
</div>
<?php } ?>
<?php if($cat['slug']=='personal') { ?>
<p class="subtext" style="clear:left;padding-top: 5px;margin: 0px 10px;font-size: 10px;font-style: italic;">*There are many Personal Assistance Programs that you can apply for as long as you meet the criteria, however there is no funding to pay off your credit cards or debt.</p>
<?php }?>
</td>
</tr>
<?php } ?>
</table>
<?php }?>
</td>
</tr>
</table>
<?php /*
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="disability_questions">
<?php foreach($disability_questions['questions'] as $slug=>$data) {?>
<tr>
<td><?= $data['name'];?></td>
</tr>
<tr>
<td>
<?php if($data['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $slug;?>" id="<?= $slug;?>_no" /> No</label>
<?php } elseif(strpos($data['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$data['type']);
$range_limits = explode('-',$pieces[1]);
if($range_limits[0] > $range_limits[1]) {
for($i=$range_limits[0]; $i>=$range_limits[1]; $i--) {
$range[$i] = $i;
}
} else {
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
}
}
?>
<select name="<?= $slug;?>" id="<?= $slug;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php }?>
</select>
<?php } elseif($data['type']=='textarea') {
?>
<textarea name="<?= $slug;?>" id="<?= $slug;?>"></textarea>
<?php
}
sub_question_recursive_disability($slug);
?>
</td>
</tr>
<?php } ?>
</table>
*/ ?>
<?php /*<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="education_questions">
<?php foreach($education_questions['questions'] as $slug=>$data) {?>
<tr>
<td><?= $data['name'];?></td>
</tr>
<tr>
<td>
<?php if($data['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $slug;?>" id="<?= $slug;?>_no" /> No</label>
<?php } elseif(strpos($data['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$data['type']);
$range_limits = explode('-',$pieces[1]);
if($range_limits[0] > $range_limits[1]) {
for($i=$range_limits[0]; $i>=$range_limits[1]; $i--) {
$range[$i] = $i;
}
} else {
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
}
}
?>
<select name="<?= $slug;?>" id="<?= $slug;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php }?>
</select>
<?php }
sub_question_recursive($slug);
?>
</td>
</tr>
<?php } ?>
</table> */?>
<?php /*
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="business_questions">
<tr>
<td>What are the major financial needs for your business? <i>(Check all that apply)</i></td>
</tr>
<?php foreach($business_questions['questions'] as $slug=>$data) {?>
<tr>
<td>
<label><input type="checkbox" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" style="vertical-align:middle;" /> <?= $data['name'];?></label>
</td>
</tr>
<?php } ?>
<tr>
<td>
Do you own your own business?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="own_business" value="yes" style="vertical-align:middle;" onclick="$('.has_business_show').show();" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="own_business" value="no" style="vertical-align:middle;" onclick="$('.has_business_show').hide();" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
<label>What is the Name of your Business? <input type="text" name="name_of_business" value="" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
Do you have a website?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="has_website" value="yes" style="vertical-align:middle;" onclick="$('.has_website_show').show();" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="has_website" value="no" style="vertical-align:middle;" onclick="$('.has_website_show').hide();" /></label>
</td>
</tr>
<tr class="has_website_show" style="display:none;">
<td>
<label>What is your website? <input type="text" name="website" value="" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
<label>
How is your business structured?
<select name="business_structured" style="vertical-align:middle;">
<option value=""></option>
<option value="Sole Proprietor">Sole Proprietor</option>
<option value="Corporation">Corporation</option>
<option value="LLC">LLC</option>
</select>
</label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
<label>How many employees do you have? <input type="number" name="how_many_employees" value="" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
<label>What is the Total Gross Income of your business? <small><i>(Total money received before any deductions like rent, cost of goods, and taxes)</i></small> <input type="number" name="annual_revenue" value="" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
Have you or your business every been a defendant in a lawsuit?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="defendant_lawsuit" value="yes" style="vertical-align:middle;" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="defendant_lawsuit" value="no" style="vertical-align:middle;" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
Do you feel if you were sued, you are properly protected so you wouldn't lose any of your assets like your home, cars, building, etc?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="sued_protected" value="yes" style="vertical-align:middle;" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="sued_protected" value="no" style="vertical-align:middle;" /></label>
</td>
</tr>
<tr class="has_business_show" style="display:none;">
<td>
Are you putting money into the business?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="putting_money_into_business" value="yes" style="vertical-align:middle;" onclick="$('.putting_money_into_business_show').show();" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="putting_money_into_business" value="no" style="vertical-align:middle;" onclick="$('.putting_money_into_business_show').hide();" /></label>
</td>
</tr>
<tr class="putting_money_into_business_show" style="display:none;">
<td>
<label>How much? <input type="number" name="putting_money_how_much" placeholder="$0.00" /></label>
</td>
</tr>
<tr>
<td>
Do you have a living trust?
<label style="display:inline-block;width:auto;">Yes <input type="radio" name="living_trust" value="yes" style="vertical-align:middle;" /></label>
<label style="display:inline-block;width:auto;">No <input type="radio" name="living_trust" value="no" style="vertical-align:middle;" /></label>
</td>
</tr>
</table>*/?>
<?php /*
<div id="bankruptcy_questions" style="padding:0px 5px;">
<div style="padding:5px 0px;">
Have you filed a prior bankruptcy:<br />
<label>
<input type="radio" name="filed_bankruptcy" value="Yes" <?= $_REQUEST['filed_bankruptcy']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#filed_bankruptcy_yes').show(); } else { $('#filed_bankruptcy_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="filed_bankruptcy" value="No" <?= $_REQUEST['filed_bankruptcy']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#filed_bankruptcy_yes').hide(); } else { $('#filed_bankruptcy_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="filed_bankruptcy_yes" style="padding-left:40px;display:<?= $_REQUEST['filed_bankruptcy']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
What chapter was it?<br />
<label>
<input type="radio" name="what_chapter" value="Chapter 7" <?= $_REQUEST['what_chapter']=='Chapter 7' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Chapter 7
</label>
<label>
<input type="radio" name="what_chapter" value="Chapter 13" <?= $_REQUEST['what_chapter']=='Chapter 13' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Chapter 13
</label>
</div>
<div style="padding:5px 0px;">
<label>
Date Filed:
<input type="date" name="date_filed" value="<?= $_REQUEST['date_filed'];?>" />
</label>
</div>
<div style="padding:5px 0px;">
Result:<br />
<label>
<input type="radio" name="bankruptcy_result" value="Dismissed" <?= $_REQUEST['bankruptcy_result']=='Dismissed' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Dismissed
</label>
<label>
<input type="radio" name="bankruptcy_result" value="Discharged" <?= $_REQUEST['bankruptcy_result']=='Discharged' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Discharged
</label>
<label>
<input type="radio" name="bankruptcy_result" value="In the middle of the process" <?= $_REQUEST['bankruptcy_result']=='In the middle of the process' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
In the middle of the process
</label>
</div>
</div>
<div style="padding:5px 0px;">
Have you considered bankruptcy?<br />
<label>
<input type="radio" name="considered_bankruptcy" value="Yes" <?= $_REQUEST['considered_bankruptcy']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#considered_bankruptcy_yes').show(); } else { $('#considered_bankruptcy_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="considered_bankruptcy" value="No" <?= $_REQUEST['considered_bankruptcy']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#considered_bankruptcy_yes').hide(); } else { $('#considered_bankruptcy_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="considered_bankruptcy_yes" style="padding-left:40px;display:<?= $_REQUEST['considered_bankruptcy']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
<label>
Why?
<textarea name="considered_why"><?= $_REQUEST['considered_why'];?></textarea>
</label>
</div>
</div>
<div style="padding:5px 0px;">
Are you behind on ANY of your payments/bills including credit cards, car loans, mortgage, or tax payments?<br />
<label>
<input type="radio" name="behind_on_bills" value="Yes" <?= $_REQUEST['behind_on_bills']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#behind_on_bills_yes').show(); } else { $('#behind_on_bills_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="behind_on_bills" value="No" <?= $_REQUEST['behind_on_bills']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#behind_on_bills_yes').hide(); } else { $('#behind_on_bills_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="behind_on_bills_yes" style="padding-left:40px;display:<?= $_REQUEST['behind_on_bills']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
<label>
How far behind are you?<br />
<label>
<input type="radio" name="how_far_behind" value="1 Month" <?= $_REQUEST['how_far_behind']=='1 Month' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
1 Month
</label>
<label>
<input type="radio" name="how_far_behind" value="2-3 Months" <?= $_REQUEST['how_far_behind']=='2-3 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
2-3 Months
</label>
<label>
<input type="radio" name="how_far_behind" value="3-6 Months" <?= $_REQUEST['how_far_behind']=='3-6 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
3-6 Months
</label>
<label>
<input type="radio" name="how_far_behind" value="Over 6 Months" <?= $_REQUEST['how_far_behind']=='Over 6 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Over 6 Months
</label>
</label>
</div>
<div style="padding:5px 0px;">
<label>
What is the approximate amount of your total unsecured debt <i>(credit cards)</i>:<br />
<input type="number" name="amount_of_unsecured_debt" value="<?= $_REQUEST['amount_of_unsecured_debt'];?>" />
</label>
</div>
<div style="padding:5px 0px;">
Do you owe past due taxes?<br />
<label>
<input type="radio" name="owe_backtaxes" value="Yes" <?= $_REQUEST['owe_backtaxes']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#owe_backtaxes_yes').show(); } else { $('#owe_backtaxes_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="owe_backtaxes" value="No" <?= $_REQUEST['owe_backtaxes']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#owe_backtaxes_yes').hide(); } else { $('#owe_backtaxes_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="owe_backtaxes_yes" style="padding-left:40px;display:<?= $_REQUEST['owe_backtaxes']=='Yes' ? 'block' : 'none';?>;">
<?php if(!empty($_REQUEST['bankruptcy_which_year'])) { ?>
<?php foreach($_REQUEST['bankruptcy_which_year'] as $k=>$v) { ?>
<div>
<label>
Which Tax Year?
<input type="number" name="bankruptcy_which_year[]" value="<?= $v;?>" />
</label><br />
<label>
Amount Owed?
<input type="number" name="bankruptcy_amount_owed[]" value="<?= $_REQUEST['bankruptcy_amount_owed'][$k];?>" />
</label>
</div>
<?php } ?>
<?php } ?>
<div onclick="$(this).clone().insertAfter(this); $(this).attr('onclick','');">
<label>
Which Tax Year?
<input type="number" name="bankruptcy_which_year[]" />
</label><br />
<label>
Amount Owed?
<input type="number" name="bankruptcy_amount_owed[]" />
</label>
</div>
</div>
<div style="padding:5px 0px;">
Are your wages being garnished or are any garnishments pending?<br />
<label>
<input type="radio" name="wages_garnished" value="Yes" <?= $_REQUEST['wages_garnished']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#wages_garnished_yes').show(); } else { $('#wages_garnished_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="wages_garnished" value="No" <?= $_REQUEST['wages_garnished']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#wages_garnished_yes').hide(); } else { $('#wages_garnished_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="wages_garnished_yes" style="padding-left:40px;display:<?= $_REQUEST['wages_garnished']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
<label>
How much do you have in garnishments?
<input type="number" name="garnished_amount" value="<?= $_REQUEST['garnished_amount'];?>" />
</label>
</div>
</div>
<div style="padding:5px 0px;">
Do you have any judgments?<br />
<label>
<input type="radio" name="have_judgements" value="Yes" <?= $_REQUEST['have_judgements']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="have_judgements" value="No" <?= $_REQUEST['have_judgements']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div style="padding:5px 0px;">
Are you being harassed by creditors?<br />
<label>
<input type="radio" name="harrased_by_creditors" value="Yes" <?= $_REQUEST['harrased_by_creditors']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="harrased_by_creditors" value="No" <?= $_REQUEST['harrased_by_creditors']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div style="padding:5px 0px;">
Do you Own or Rent your Home?<br />
<label>
<input type="radio" name="rent_or_own" value="Own" <?= $_REQUEST['rent_or_own']=='Own' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#own_yes').show(); } else { $('#own_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Own
</label>
<label>
<input type="radio" name="rent_or_own" value="Rent" <?= $_REQUEST['rent_or_own']=='Rent' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#own_yes').hide(); } else { $('#own_yes').show(); }" style="vertical-align:middle;margin:0px;" />
Rent
</label>
</div>
<div id="own_yes" style="padding-left:40px;display:<?= $_REQUEST['rent_or_own']=='Own' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
<label>
Current assessed value your home:<br />
<input type="number" name="value_of_home" value="<?= $_REQUEST['value_of_home'];?>" />
</label>
</div>
<div style="padding:5px 0px;">
Are you delinquent on your mortgage?<br />
<label>
<input type="radio" name="deliquent_on_mortgage" value="Yes" <?= $_REQUEST['deliquent_on_mortgage']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="deliquent_on_mortgage" value="No" <?= $_REQUEST['deliquent_on_mortgage']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
</div>
<div style="padding:5px 0px;">
<label>
How many dependants are in your home?<br />
<input type="number" name="dependents_in_home" value="<?= $_REQUEST['dependents_in_home'];?>" />
</label>
</div>
<div style="padding:5px 0px;">
<label>
What is your average monthly household income?<br />
<input type="number" name="average_monthly_income" value="<?= $_REQUEST['average_monthly_income'];?>" />
</label>
</div>
<div style="padding:5px 0px;">
Any other income contributed to the household?<br />
<label>
<input type="radio" name="other_income_sources" value="Yes" <?= $_REQUEST['other_income_sources']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="other_income_sources" value="No" <?= $_REQUEST['other_income_sources']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div style="padding:5px 0px;">
Are you currently in the middle of a lawsuit/injury settlement?<br />
<label>
<input type="radio" name="in_lawsuit" value="Own" <?= $_REQUEST['in_lawsuit']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#in_lawsuit_yes').show(); } else { $('#in_lawsuit_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="in_lawsuit" value="Rent" <?= $_REQUEST['in_lawsuit']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#in_lawsuit_yes').hide(); } else { $('#in_lawsuit_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="in_lawsuit_yes" style="padding-left:40px;display:<?= $_REQUEST['in_lawsuit']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
<label>
Please Explain:
<textarea name="lawsuit_explain"><?= $_REQUEST['lawsuit_explain'];?></textarea>
</label>
</div>
</div>
<div style="padding:5px 0px;">
Would you be open to visiting with a debt relief consultant to help you improve your situation?<br />
<label>
<input type="radio" name="open_to_debt_relief" value="Yes" <?= $_REQUEST['open_to_debt_relief']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="open_to_debt_relief" value="No" <?= $_REQUEST['open_to_debt_relief']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
</div>
</div>
*/ ?>
<div id="credit_questions" style="padding:0px 5px;">
<div style="padding:5px 0px;">
How would you describe your credit?<br />
<label>
<input type="radio" name="describe_credit" value="Excellent" <?= $_REQUEST['describe_credit']=='Excellent' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Excellent
</label>
<label>
<input type="radio" name="describe_credit" value="Good" <?= $_REQUEST['describe_credit']=='Good' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Good
</label>
<label>
<input type="radio" name="describe_credit" value="Fair" <?= $_REQUEST['describe_credit']=='Fair' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Fair
</label>
<label>
<input type="radio" name="describe_credit" value="Poor" <?= $_REQUEST['describe_credit']=='Poor' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Poor
</label>
</div>
<div style="padding:5px 0px;">
Do you want to improve your credit?<br />
<label>
<input type="radio" name="want_to_improve_credit" value="Yes" <?= $_REQUEST['want_to_improve_credit']=='Yes' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#want_to_improve_credit_yes').show(); } else { $('#want_to_improve_credit_yes').hide(); }" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="want_to_improve_credit" value="No" <?= $_REQUEST['want_to_improve_credit']=='No' ? 'checked' : '';?> onclick="if($(this).is(':checked')) { $('#want_to_improve_credit_yes').hide(); } else { $('#want_to_improve_credit_yes').show(); }" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="want_to_improve_credit_yes" style="padding-left:40px;display:<?= $_REQUEST['want_to_improve_credit']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
Have you been turned down for a loan in the last 60 days?<br />
<label>
<input type="radio" name="turned_down_for_loan" value="Yes" <?= $_REQUEST['turned_down_for_loan']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="turned_down_for_loan" value="No" <?= $_REQUEST['turned_down_for_loan']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div style="padding:5px 0px;">
What is your main goal or reason to have good credit?<br />
<label>
<input type="radio" name="main_goal_for_good_credit" value="Buy a home" <?= $_REQUEST['main_goal_for_good_credit']=='Buy a home' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Buy a home
</label>
<label>
<input type="radio" name="main_goal_for_good_credit" value="Buy a car" <?= $_REQUEST['main_goal_for_good_credit']=='Buy a car' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Buy a car
</label>
<label>
<input type="radio" name="main_goal_for_good_credit" value="Other" <?= $_REQUEST['main_goal_for_good_credit']=='Other' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Other
</label>
</div>
<div style="padding:5px 0px;">
What is your time frame for accomplishing your goal?<br />
<label>
<input type="radio" name="goal_time_frame" value="1-3 Months" <?= $_REQUEST['goal_time_frame']=='1-3 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
1-3 Months
</label>
<label>
<input type="radio" name="goal_time_frame" value="4-6 Months" <?= $_REQUEST['goal_time_frame']=='4-6 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
4-6 Months
</label>
<label>
<input type="radio" name="goal_time_frame" value="6-12 Months" <?= $_REQUEST['goal_time_frame']=='6-12 Months' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
6-12 Months
</label>
</div>
<div style="padding:5px 0px;">
How serious are you about fixing your credit?<br />
<div>
<label>
<input type="radio" name="how_serious" value="Very interested!" <?= $_REQUEST['how_serious']=='Very interested!' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
<strong>Very interested!</strong> I need to make a large purchase soon and need to improve it.
</label>
</div>
<div>
<label>
<input type="radio" name="how_serious" value="No Rush." <?= $_REQUEST['how_serious']=='No Rush.' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
<strong>No Rush.</strong> I'm just looking for options.
</label>
</div>
</div>
<div style="padding:5px 0px;">
Would you like to talk to a specialist to improve your credit?<br />
<label>
<input type="radio" name="talk_to_specialist" value="Yes" <?= $_REQUEST['talk_to_specialist']=='Yes' ? 'checked' : '';?> onclick="$('#talk_to_specialist_yes').show();" style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="talk_to_specialist" value="No" <?= $_REQUEST['talk_to_specialist']=='No' ? 'checked' : '';?> onclick="$('#talk_to_specialist_yes').hide();" style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
<div id="talk_to_specialist_yes" style="display:<?= $_REQUEST['talk_to_specialist']=='Yes' ? 'block' : 'none';?>;">
<div style="padding:5px 0px;">
I give permission to have a credit pro from Pinnacle Credit Pros contact me.<br />
<label>
<input type="radio" name="give_permission_for_specialist" value="Yes" <?= $_REQUEST['give_permission_for_specialist']=='Yes' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
Yes
</label>
<label>
<input type="radio" name="give_permission_for_specialist" value="No" <?= $_REQUEST['give_permission_for_specialist']=='No' ? 'checked' : '';?> style="vertical-align:middle;margin:0px;" />
No
</label>
</div>
</div>
</div>
</div>
<table cellpadding="0" cellspacing="0" border="0" class="form_table">
<tr>
<td>How much money are you looking for?</td>
</tr>
<tr>
<td id="amount_needed"><select name="app_amount_needed">
<option value="" selected="selected">Select...</option>
<option value="$500-$10,000">$500 - $10,000</option>
<option value="$10,000 - $25,000">$10,000 - $25,000</option>
<option value="$25,000 - $50,000">$25,000 - $50,000</option>
<option value="$50,000 - $100,000">$50,000 - $100,000</option>
<option value="$100,000 or More">$100,000 or More</option>
</select></td>
</tr>
<tr>
<td>Describe in detail how you'll use the money:</td>
</tr>
<tr>
<td><textarea name="app_usedescription"></textarea></td>
</tr>
<tr>
<td>What makes you the ideal candidate for this funding?</td>
</tr>
<tr>
<td><textarea name="app_uniqueness"></textarea></td>
</tr>
</table>
<div class="inline_block">
Citizenship<br />
<select class="third_" name="app_citizenship">
<option value="" >Select</option>
<option value="citizen" >U.S. Citizen</option>
<option value="resident" >Resident Alien</option>
<option value="greencard" >Green Card Holder</option>
<option value="permanent" >Permanent Resident</option>
<option value="unsure" >Not Sure</option>
</select>
</div>
<div class="inline_block">
Age<br />
<input type="tel" maxlength="3" class="third" name="app_age" value="<?= $_POST['app_age'];?>" />
</div>
<div class="inline_block">
Gender<br />
<select name="app_gender">
<option value="">Select</option>
<option value="M">Male</option>
<option value="F">Female</option>
</select>
</div>
<div class="clear"></div>
<div class="inline_block">
Ethnicity<br />
<select name="ethnicity">
<option value="">Select</option>
<option value="White">White</option>
<option value="Black or African American">Black or African American</option>
<option value="Native American">Native American</option>
<option value="Asian American">Asian American</option>
<option value="Native Hawaiian">Native Hawaiian</option>
<option value="Pacific Islander">Pacific Islander</option>
<option value="Middle Eastern American">Middle Eastern American</option>
<option value="Hispanic">Hispanic</option>
<option value="Latino">Latino</option>
<option value="Multi-racial">Multi-racial</option>
<option value="Other">Other</option>
</select>
</div>
<div class="inline_block">
Employment Status<br />
<select name="employment_status">
<option value="">Select</option>
<option value="Employed Full-time">Employed Full-time</option>
<option value="Employed Part-time">Employed Part-time</option>
<option value="Self Employed">Self Employed</option>
<option value="Unemployed">Unemployed</option>
<option value="Retired">Retired</option>
<option value="Collecting Social Security">Collecting Social Security</option>
<option value="Disabled">Disabled</option>
</select>
</div>
<div class="clear"></div>
<div class="inline_block">
First Name<br />
<input type="text" class="text" name="cc_fname" value="<?= ($_REQUEST['cc_fname']) ? $_REQUEST['cc_fname'] : null; ?>" required pattern="[a-zA-Z']+" title="Please only used letters" />
</div>
<div class="inline_block">
Last Name<br />
<input type="text" class="text" name="cc_lname" value="<?= ($_REQUEST['cc_lname']) ? $_REQUEST['cc_lname'] : null; ?>" required pattern="[a-zA-Z']+" title="Please only used letters" />
</div>
<div class="clear"></div>
<div class="inline_block">
Zip<br />
<input type="tel" class="third" maxlength="5" id="id-cc-zip" name="cc_zip" onkeyup="checkZip($(this).val(),this);" value="<?= isset($_REQUEST['cc_zip']) ? $_REQUEST['cc_zip'] : null;?>" /></label>
</div>
<div class="inline_block">
City<br />
<input type="text" name="cc_city" value="<?= $_POST['cc_city'];?>" />
</div>
<div class="inline_block">
State<br />
<select name="cc_state">
<?php
$_STATES = array(''=>'','AL'=>'Alabama','AK'=>'Alaska','AS'=>'American Samoa','AZ'=>'Arizona','AR'=>'Arkansas','CA'=>'California','CO'=>'Colorado','CT'=>'Connecticut','DE'=>'Delaware','DC'=>'District of Columbia','FM'=>'Federated States of Micronesia','FL'=>'Florida','GA'=>'Georgia','GU'=>'Guam','HI'=>'Hawaii','ID'=>'Idaho','IL'=>'Illinois','IN'=>'Indiana','IA'=>'Iowa','KS'=>'Kansas','KY'=>'Kentucky','LA'=>'Louisiana','ME'=>'Maine','MD'=>'Maryland','MH'=>'Marshall Islands','MA'=>'Massachusetts','MI'=>'Michigan','MN'=>'Minnesota','MS'=>'Mississippi','MO'=>'Missouri','MT'=>'Montana','NE'=>'Nebraska','NV'=>'Nevada','NH'=>'New Hampshire','NJ'=>'New Jersey','NM'=>'New Mexico','NY'=>'New York','NC'=>'North Carolina','ND'=>'North Dakota','MP'=>'Northern Mariana Islands','OH'=>'Ohio','OK'=>'Oklahoma','OR'=>'Oregon','PW'=>'Palau','PA'=>'Pennsylvania','PR'=>'Puerto Rico','RI'=>'Rhode Island','SC'=>'South Carolina','SD'=>'South Dakota','TN'=>'Tennessee','TX'=>'Texas','UT'=>'Utah','VT'=>'Vermont','VI'=>'Virgin Islands','VA'=>'Virginia','WA'=>'Washington','WV'=>'West Virginia','WI'=>'Wisconsin','WY'=>'Wyoming');
foreach($_STATES as $k=>$v) {
?><option value="<?= $k;?>" <?= ($_POST['cc_state']==$k) ? 'selected' : '';?>><?= $v;?></option><?php
}
?>
</select>
</div>
<div class="clear"></div>
<div class="inline_block">
Address<br />
<input type="text" class="text" name="cc_addr" value="<?= ($_REQUEST['cc_addr']) ? $_REQUEST['cc_addr'] : null; ?>" />
</div>
<div class="clear"></div>
<div class="inline_block">
Your Email Address<br />
<input type="text" class="text" name="cc_email" value="<?= ($_REQUEST['cc_email']) ? $_REQUEST['cc_email'] : null; ?>" />
</div>
<div class="inline_block">
Phone<br />
<input type="tel" class="full" name="phone_full" value="<?= $_REQUEST['phone_full'];?>" />
</div>
<div style="margin-top:10px;padding:5px;">
<label for="agree2terms" title="I agree to the terms of this site">
<?php /*
<input type="checkbox" id="agree2terms" name="agree2terms" value="agreed" /> By Clicking, I Agree To The <a href="/terms.php" target="_blank">Terms Of This Site</a> and the Collection, Processing, and Sharing of my Personal Information in Accordance With Our Privacy Policy, And Am Providing My Electronic Signature Authorizing America's Got Funding and it Affiliates To Contact Me By Email, Text, Or Phone Regarding My Funding Applications Service Account With Any New Funding Services Or Sources That May Become Available.
*/ ?>
<input type="checkbox" id="agree2terms" name="agree2terms" value="agreed" /> By Clicking, I Agree To The Terms Of This Site and Our Privacy Policy, And Am Providing My Electronic Signature Authorizing America's Got Funding and it Affiliates To Contact Me By Email, Text, Or Phone Regarding My Funding Applications Service Account With Any New Funding Services Or Sources That May Become Available.
</label>
</div>
<div>
<input type="hidden" id="granttype_input" name="granttype" value="<?= (isset($_REQUEST['granttype'])) ? $_REQUEST['granttype'] : null; ?>" />
<input type="hidden" name="application" value="application" />
<input type="hidden" name="tc" value="<?= $tc; ?>" />
<input type="hidden" name="form_filled_out" value="index.php" />
<?= $trackerformparams; ?>
<input type="submit" class="submit" value="" />
</div>
</div>
</form>
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<h1>WHY WAIT?</h1>
<p>Maybe the application deadline for your perfect funding opportunity is fast-approaching. How will you know whether there's funding available for you unless you get started right away? The longer you wait to sign up, the longer you wait for your funding.</p>
<!--center><a href="#apply"><img src="/lp2/assets/images/apply.jpg" border="0" style="margin:20px auto" /></a></center-->
</td>
<!-- Change to ajax call -->
<td class="data_fd" valign="top">
<div id="icon">
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/1sthome.jpg" />1st Time Home-buyer Funding</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/childcare.jpg" />Child Care Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/nonprofit.jpg" />Non-profit Business Funding</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/tuition.jpg" />Tuition Education Funding</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/business.jpg" />Small Business Funding</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/women.jpg" />Funding for Women</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/rent.jpg" />Housing Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/disaster.jpg" />Disaster Prevention</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/minority.jpg" />Funding for Minorities</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/veteran.jpg" />Veterans Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/medical.jpg" />Medical Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/community.jpg" />Non-Profit Community Projects</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/realestate.jpg" />Real Estate Funding</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/disabled.jpg" />Assistance for the Disabled</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/police.jpg" />Crime Prevention</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/nutrition.jpg" />Nutrition and Food Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/repairs.jpg" />Home Repair Assistance</a></div>
<div class="icon"><a href="#apply"><img src="/lp2/assets/images/icons/elderly.jpg" />Assistance for the Elderly</a></div>
<div class="icon" style="margin-bottom:20px"><a href="#apply"><img src="/lp2/assets/images/icons/faith.jpg" />Faith-based Funding</a></div>
<div class="icon" style="margin-bottom:20px"><a href="#apply"><img src="/lp2/assets/images/icons/utility.jpg" />Utilities Assistance</a></div>
<div class="redLink" style="margin-left:25px; float:left">
<? require_once("ads.php");?>
</div>
<img src="/lp2/assets/images/fundingNews.png" class="image" />
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<img src="/lp2/assets/images/clientTestimonials.png" class="image" />
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<img src="/lp2/assets/images/sml_susan.jpg" class="image" />
<img src="/lp2/assets/images/sml_elizabeth.jpg" class="image" />
</div>
</td>
<td class="data_ri" valign="top"><img src="/lp2/assets/images/data_ri_img.png" /></td>
</tr>
<tr>
<td class="data_bl"></td>
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<td class="data_br"></td>
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</table>
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</ul>
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