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<?php
/**
* Template Name: Application Page V9
*/
//echo $_SERVER['DOCUMENT_ROOT'];
include_once($_SERVER['DOCUMENT_ROOT'].'/vx/lib/sanitize.php');
include_once($_SERVER['DOCUMENT_ROOT'].'/vx/lib/mysql.php');
include_once($_SERVER['DOCUMENT_ROOT'].'/lib/globals.php');
if(!empty($_GET['bc'])) {
$is_mobile = 0;
$useragent=$_SERVER['HTTP_USER_AGENT'];
if(preg_match('/(android|bb\d+|meego).+mobile|avantgo|bada\/|blackberry|blazer|compal|elaine|fennec|hiptop|iemobile|ip(hone|od)|iris|kindle|lge |maemo|midp|mmp|mobile.+firefox|netfront|opera m(ob|in)i|palm( os)?|phone|p(ixi|re)\/|plucker|pocket|psp|series(4|6)0|symbian|treo|up\.(browser|link)|vodafone|wap|windows ce|xda|xiino/i',$useragent)||preg_match('/1207|6310|6590|3gso|4thp|50[1-6]i|770s|802s|a wa|abac|ac(er|oo|s\-)|ai(ko|rn)|al(av|ca|co)|amoi|an(ex|ny|yw)|aptu|ar(ch|go)|as(te|us)|attw|au(di|\-m|r |s )|avan|be(ck|ll|nq)|bi(lb|rd)|bl(ac|az)|br(e|v)w|bumb|bw\-(n|u)|c55\/|capi|ccwa|cdm\-|cell|chtm|cldc|cmd\-|co(mp|nd)|craw|da(it|ll|ng)|dbte|dc\-s|devi|dica|dmob|do(c|p)o|ds(12|\-d)|el(49|ai)|em(l2|ul)|er(ic|k0)|esl8|ez([4-7]0|os|wa|ze)|fetc|fly(\-|_)|g1 u|g560|gene|gf\-5|g\-mo|go(\.w|od)|gr(ad|un)|haie|hcit|hd\-(m|p|t)|hei\-|hi(pt|ta)|hp( i|ip)|hs\-c|ht(c(\-| |_|a|g|p|s|t)|tp)|hu(aw|tc)|i\-(20|go|ma)|i230|iac( |\-|\/)|ibro|idea|ig01|ikom|im1k|inno|ipaq|iris|ja(t|v)a|jbro|jemu|jigs|kddi|keji|kgt( |\/)|klon|kpt |kwc\-|kyo(c|k)|le(no|xi)|lg( g|\/(k|l|u)|50|54|\-[a-w])|libw|lynx|m1\-w|m3ga|m50\/|ma(te|ui|xo)|mc(01|21|ca)|m\-cr|me(rc|ri)|mi(o8|oa|ts)|mmef|mo(01|02|bi|de|do|t(\-| |o|v)|zz)|mt(50|p1|v )|mwbp|mywa|n10[0-2]|n20[2-3]|n30(0|2)|n50(0|2|5)|n7(0(0|1)|10)|ne((c|m)\-|on|tf|wf|wg|wt)|nok(6|i)|nzph|o2im|op(ti|wv)|oran|owg1|p800|pan(a|d|t)|pdxg|pg(13|\-([1-8]|c))|phil|pire|pl(ay|uc)|pn\-2|po(ck|rt|se)|prox|psio|pt\-g|qa\-a|qc(07|12|21|32|60|\-[2-7]|i\-)|qtek|r380|r600|raks|rim9|ro(ve|zo)|s55\/|sa(ge|ma|mm|ms|ny|va)|sc(01|h\-|oo|p\-)|sdk\/|se(c(\-|0|1)|47|mc|nd|ri)|sgh\-|shar|sie(\-|m)|sk\-0|sl(45|id)|sm(al|ar|b3|it|t5)|so(ft|ny)|sp(01|h\-|v\-|v )|sy(01|mb)|t2(18|50)|t6(00|10|18)|ta(gt|lk)|tcl\-|tdg\-|tel(i|m)|tim\-|t\-mo|to(pl|sh)|ts(70|m\-|m3|m5)|tx\-9|up(\.b|g1|si)|utst|v400|v750|veri|vi(rg|te)|vk(40|5[0-3]|\-v)|vm40|voda|vulc|vx(52|53|60|61|70|80|81|83|85|98)|w3c(\-| )|webc|whit|wi(g |nc|nw)|wmlb|wonu|x700|yas\-|your|zeto|zte\-/i',substr($useragent,0,4))) {
$is_mobile = 1;
}
$db->query("INSERT IGNORE INTO lc2{$_SITE_CODE}_lc.front_form_button_clicked (ip_address,button_clicked,date_hit,ts,is_mobile)
VALUES (
'".$db->clean($_SERVER['REMOTE_ADDR'])."',
'".$db->clean($_GET['bc'])."',
CURDATE(),
NOW(),
'".$db->clean($is_mobile)."'
)");
header("Location: /application-v9/");
exit(0);
}
$main_cats = array();
$res = $db->get_results("SELECT gc.id,gc.category_name,gc.slug,gc.icon
FROM grdb.grant_categories_new_front_end gc
WHERE gc.active=1
AND gc.parent_id=0
GROUP BY gc.id
ORDER BY category_name ASC");
foreach($res as $r) {
if($r->category_name=='Personal Assistance') {
$r->category_name = 'Personal (Bills, Rent, Utilities, etc.)';
}
$main_cats[$r->id] = $r;
}
$subcats = array();
$res = $db->get_results("SELECT gc.id,gc.parent_id,gc.category_name,gc.slug,gc.icon
FROM grdb.grant_categories_new_front_end gc
WHERE gc.active=1
AND gc.parent_id<>0
GROUP BY gc.id
ORDER BY category_name ASC");
foreach($res as $r) {
$subcats[$r->parent_id][$r->id] = $r;
}
get_header('registration');
?>
<?php get_template_part( 'template-parts/application-header' ); ?>
<script type="text/javascript" src="<?php echo get_template_directory_uri();?>/js/jquery-1.11.1.min.js"></script>
<script type="text/javascript" src="<?php echo get_template_directory_uri();?>/js/jquery.formatter.min.js"></script>
<script>
var current_cat = '';
function update_category(me) {
$('.subcats').hide();
$('.sub-active').removeClass('sub-active');
$(me).parents('label:first').addClass('sub-active');
$('.sub_categories').each(function() {
if($(this).attr('hidden')!='undefined') {
$(this).attr('hidden','');
}
});
$('#' + $(me).attr('subcat_id')).removeAttr('hidden');
current_cat = $(me).val();
}
function validate_this_form(frm) {
var errors = '';
$(frm).find('input,select,textarea').each(function() {
if(this.type=='checkbox' || this.type=='radio') {
} else {
if($(this).val()=='') {
errors += (errors=='') ? '' : "\n";
if(this.type=='input') {
errors += this.placeholder + ' is required.';
} else if(this.type=='select') {
errors += $(this).find('option:first').html() + ' is required.';
} else if(this.type=='textarea') {
errors += $(this).parent().find('label').html() + ' is required.';
}
}
}
});
if(current_cat=='') {
errors += (errors=='') ? '' : "\n";
errors += "Funding Category is required.";
}
if($('#template-application-inform').is(':checked')) {
} else {
errors += (errors=='') ? '' : "\n";
errors += "You must agree to the terms of this site.";
}
if(errors=='') {
return true;
} else {
alert("You are missing some information:\n" + errors);
return false;
}
}
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=template-application-city]').val(data.city);
$('[name=template-application-state]').val(data.state);
}
},error: function(jqXHR, textStatus, errorThrown) {
}
});
}
}
function validate_email(me) {
var str = 'email='+encodeURIComponent($(me).val());
if($('#validate_email_error').length>0) {
$('#validate_email_error').remove();
}
$.ajax
({
cache: false,
type: "POST",
dataType:"json",
data: str,
url: "/vx/lib/email_validation.php",
success: function(data)
{
if(data.status=='fail') {
if(data.replacement != '') {
$('input[name=email]').after('<div id="validate_email_error" style="background:red;color:white;padding:5px;">' + data.error + ' Did you mean <a href="#" onclick="replacement_email(\'' + data.replacement + '\'); return false;">' + data.replacement + '</a></div>');
} else {
$('input[name=email]').after('<div id="validate_email_error" style="background:red;color:white;padding:5px;">' + data.error + '</div>');
}
}
},error: function(jqXHR, textStatus, errorThrown) {
}
});
}
$('document').ready(function() {
$('input[name=template-application-phone]').formatter({
'pattern': '({{999}}) {{999}}-{{9999}}',
'persistent': false
});
$('input[name=template-application-zip]').formatter({
'pattern': '{{99999}}',
'persistent': false
});
});
</script>
<style type="text/css">
.application__funding-type__icon .svg {
fill: #4cd366;
}
@media only screen and (min-width: 600px) {
.application__funding-options {
column-count:2;
}
}
</style>
<div class="et_pb_row et_pb_row_0">
<section class="application-form">
<div class="container">
<p class="header application__steps-title"><span class="application__bold">Step 1 of 3:</span> Tell us about You and Your Funding Needs</p>
<?php if(!empty($_REQUEST['error'])) { ?>
<p style="background: #993333;color:white;"><?= $_REQUEST['error'];?></p>
<?php } ?>
<!--Form Action-->
<form action="<?php echo get_template_directory_uri();?>/forms/application-v9.php" method="post" target="_top" onsubmit="return validate_this_form(this);">
<!--/Form Action-->
<div class="grid-row fields">
<div class="application__gray-container">
<div class="application__container-full">
<div class="input-box application__half">
<label class="application__label">First Name:</label>
<input type="text" name="template-application-first-name" class="f-name application__input" required pattern="[a-zA-Z']+" title="Please use only letters" />
</div>
<div class="input-box application__half">
<label class="application__label">Last Name:</label>
<input type="text" name="template-application-last-name" class="l-name application__input" required pattern="[a-zA-Z']+" title="Please use only letters" />
</div>
</div>
<div class="input-box">
<label class="application__label">Street Address:</label>
<input type="text" name="template-application-street-address" class="street-address application__input" required />
</div>
<div class="application__container-full">
<div class="input-box application__third">
<label class="application__label">Zip:</label>
<input type="text" name="template-application-zip" class="zip application__input" required onkeyup="checkZip($(this).val(),this);" />
</div>
<div class="input-box application__third">
<label class="application__label">City:</label>
<input type="text" name="template-application-city" class="city application__input" required />
</div>
<div class="input-box application__third">
<label class="application__label">State:</label>
<select id="input_2_4" class="application__input" name="template-application-state" required>
<option value="" disabled selected>State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FM">Federated States of Micronesia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MH">Marshall Islands</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PW">Palau</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</div>
</div>
</div>
<div class="application__gray-container">
<div class="application__container-full">
<div class="input-box application__half">
<label class="application__label">Gender:</label>
<select id="template-application-gender" name="template-application-gender" class="application__input" required>
<option value="" disabled selected>Select...</option>
<option value="M">Male</option>
<option value="F">Female</option>
</select>
</div>
<div class="input-box application__half">
<label class="application__label">What is your age?</label>
<select id="template-application-age" class="age application__input" name="template-application-age" required>
<option value="" disabled selected>Select...</option>
<option value="18-25">18-25</option>
<option value="26-34">26-34</option>
<option value="35-49">35-49</option>
<option value="50-65">50-65</option>
<option value="66-80">66-80</option>
<option value="80+">80 +</option>
</select>
</div>
</div>
<div class="application__container-full">
<div class="input-box application__half">
<label class="application__label">Citizenship Status:</label>
<select id="template-application-citizenship-status" class="application__input" name="template-application-citizenship-status" required>
<option value="" disabled selected>Select...</option>
<option value="U.S. Citizen">U.S. Citizen</option>
<option value="Resident Alien">Resident Alien</option>
<option value="Green Card Holder">Green Card Holder</option>
<option value="Permanent Resident">Permanent Resident</option>
<option value="Not Sure">Not Sure</option>
</select>
</div>
<div class="input-box application__half">
<label class="application__label">Ethnicity:</label>
<select id="template-application-ethnicity" class="application__input" name="template-application-ethnicity" required>
<option value="" disabled selected>Select...</option>
<option value="Asian American">Asian American</option>
<option value="Black or African American">Black or African American</option>
<option value="Hispanic">Hispanic</option>
<option value="Latino">Latino</option>
<option value="Middle Eastern American">Middle Eastern American</option>
<option value="Multi-racial">Multi-racial</option>
<option value="Native American">Native American</option>
<option value="Native Hawaiian">Native Hawaiian</option>
<option value="Other">Other</option>
<option value="Pacific Islander">Pacific Islander</option>
<option value="White">White</option>
</select>
</div>
</div>
<div class="application__container-full">
<div class="input-box application__half">
<label class="application__label">Employment Status:</label>
<select id="template-application-employment-status" class="application__input" name="template-application-employment-status" required>
<option value="" disabled selected>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="input-box application__half">
<label class="application__label">Phone Number:</label>
<input type="tel" name="template-application-phone" class="phone application__input" required />
</div>
</div>
</div>
</div>
<div class="application__gray-container application__gray-container__last">
<h4 class="application__section-title">Choose which type of funding you are interested in:</h4>
<div class="choose options clear application__funding-options">
<?php foreach($main_cats as $cat_id=>$cat) { ?>
<label class="step-title step-active application__funding-type-title" role="button" tabindex="0">
<div class="application__funding-type__content">
<input type="radio" name="template-application-business" style="width:25px;height:25px;" id="<?= $cat_id;?>-<?= $cat->slug;?>" class="<?= $cat->slug;?>" value="<?= $cat_id;?>" onclick="update_category(this);" subcat_id="<?= $cat->slug;?>">
<div class="application__funding-type__icon-container">
<div class="application__funding-type__icon">
<?php
if(strpos($cat->icon,'fa-')!==false) {
?><i class="<?= $cat->icon;?>" style="font-size:30px;color:#093473;"></i><?php
} elseif(strpos($cat->icon,'glyphicons')!==false) {
?><i class="glyphicons <?= $cat->icon;?>" style="font-size:30px;color:#093473;"></i><?php
} else {
if(file_exists($_SERVER['DOCUMENT_ROOT'].'/vx/svgs/'.$cat->icon.'.svg')) {
include($_SERVER['DOCUMENT_ROOT'].'/vx/svgs/'.$cat->icon.'.svg');
}
}
?>
</div>
</div>
<div class="application__funding-type__category__title">
<?= $cat->category_name;?>
</div>
</div>
</label>
<?php } ?>
</div>
<div class="hidden-options clear">
<?php foreach($main_cats as $cat_id=>$cat) {
if(!empty($subcats[$cat_id])) { ?>
<section id="<?= $cat->slug;?>" class="sub_categories" hidden>
<h3 class="hrd">Suggested Sub-Categories <span>(Check all that apply)</span></h3>
<div class="content application__sub-category-content">
<?php foreach($subcats[$cat_id] as $subcat_id=>$subcat) { ?>
<div class="subcategory <?= $cat->slug;?>">
<input id="<?= $subcat_id;?>-<?= $subcat->slug;?>" style="width:25px;height:25px;vertical-align:middle;" type="checkbox" name="template-application-subcategories[]" value="<?= $subcat_id;?>">
<label for="<?= $subcat_id;?>-<?= $subcat->slug;?>"><?= $subcat->category_name;?></label>
</div>
<?php } ?>
</div>
</section>
<?php }
} ?>
</div>
<div class="input-box">
<label class="application__label" for="template-application-money">How much money are you going to need?</label>
<select class="application__input" name="template-application-money" required>
<option value="" disabled 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>
</div>
<div class="input-box">
<label class="application__label" for="template-application-usedescription">Briefly Describe How You Will Use The Money:</label>
<textarea name="template-application-usedescription" class="application__textarea" cols="64" rows="6" required ></textarea>
</div>
<div class="input-box">
<label class="application__label" for="template-application-uniqueness">How Soon Do You Need The Money?</label>
<textarea name="template-application-uniqueness" cols="64" rows="6" class="application__textarea" required></textarea>
</div>
<div class="input-box email-box">
<label class="application__label" for="template-application-email-address">What Email address would you like to use for your Username for your Online Grant Application Account?</label>
<input type="text" class="application__input" placeholder="yourmail@hotmail.com" name="template-application-email" autocomplete="email" onblur="validate_email(this);" required>
<div class="application__small-script-container">
<i class="small application__small-script">** Your email is safe. We hate spam as much as you do!!</i>
<i class="small application__small-script">** Your <u>Email</u> will be <u>your username</u> for this website. Please double check it to be sure it is accurate!</i>
</div>
</div>
<div class="inform clear application__email-check-box">
<label for="template-application-inform">
<input type="checkbox" id="template-application-inform" name="template-application-inform" value="Yes"> By Clicking, I Agree To The <a href="/v9/terms" target="_blank">Terms Of This Site</a> and Our <a href="/v9/privacy" target="_blank">Privacy Policy</a>, And Am Providing My Electronic Signature Authorizing USA Funding Applications 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 class="btn-wrapper align-center">
<input type="submit" name="button" id="esub_button" value="Submit" class="button__green button application__submit__button">
</div>
<center>
<img src="/vx/usa/pci_form/ssl_logo.png" style="vertical-align:middle;" alt="Secure SSL Encryption" />
<a href="//www.securitymetrics.com/site_certificate?id=1889708&tk=b09e62c4cae0d777a4ffbb2d08faa4b0"
target="_blank" rel="noopener noreferrer" style="vertical-align:middle;">
<img src="https://www.securitymetrics.com/portal/app/ngsm/assets/img/BlueContent_Credit_Card_Safe_White_Sqr.png"
alt="SecurityMetrics Credit Card Safe" />
</a>
</center>
</div>
<div class="form-message invalid-message">There are some input that needs fixing. Please fix them.</div>
<div submit-success="">
<template type="amp-mustache">Success! Thanks for contacting us!</template>
</div>
<div submit-error>
<template type="amp-mustache">{{message}}</template>
</div>
</form>
</div>
</section>
<?php
if(empty($_SESSION['form_filled_out'])) {
$tracking_pixel = file_get_contents("https://www.pcisecureform.com/lcapi/FormImpressionTracking.php?site=ggus&ip_address=".$_SERVER['REMOTE_ADDR']."&form_url=".urlencode('/v9/application/'));
}
?>
</div>
<?php
get_footer('registration');
?>