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<?php
/**
* Template Name: Order Page R
*/
get_header('order-v4');
if(!empty($_GET['uid'])) {
$id = base64_decode($_GET['uid']);
include_once($_SERVER['DOCUMENT_ROOT'].'/vx_/site_info.php');
include_once($_SERVER['DOCUMENT_ROOT'].'/vx/lib/mysql.php');
$res = $db->get_results("SELECT * FROM lc2{$siteCode}_lc.lc_leads WHERE id='".$db->clean($id)."'");
if(!empty($res)) {
if(!empty($res[0]->customerID)) {
header("Location: /vx/usa/members/");
exit(0);
}
$res2 = $db->get_results("SELECT profile_category_id,gender,age,money,citizenship,description,uniqueness FROM lc2{$siteCode}_lc.lead_profile WHERE lead_id='".$db->clean($id)."'");
$_SESSION['lead_id'] = $res[0]->id;
$_SESSION['application_form'] = array();
$_SESSION['application_form']['template-application-first-name'] = $res[0]->first;
$_SESSION['application_form']['template-application-last-name'] = $res[0]->last;
$_SESSION['application_form']['template-application-street-address'] = $res[0]->address1;
$_SESSION['application_form']['template-application-city'] = $res[0]->city;
$_SESSION['application_form']['template-application-state'] = $res[0]->state;
$_SESSION['application_form']['template-application-zip'] = $res[0]->zip;
$_SESSION['application_form']['template-application-gender'] = (empty($res2)) ? '' : $res2[0]->gender;
$_SESSION['application_form']['template-application-age'] = (empty($res2)) ? '' : $res2[0]->age;
$_SESSION['application_form']['template-application-citizenship-status'] = (empty($res2)) ? '' : $res2[0]->citizenship;
$_SESSION['application_form']['template-application-phone'] = $res[0]->phone;
$_SESSION['application_form']['template-application-money'] = (empty($res2)) ? '' : $res2[0]->money;
$_SESSION['use_unique_question'] = 'unique';
$_SESSION['application_form']['template-application-usedescription'] = (empty($res2)) ? '' : $res2[0]->description;
$_SESSION['application_form']['template-application-uniqueness'] = (empty($res2)) ? '' : $res2[0]->uniqueness;
$_SESSION['application_form']['template-application-email'] = $res[0]->email;
$_SESSION['special_price'] = '29.97';
}
}
if(empty($_SESSION['lead_id']) && empty($_GET['show_order_page'])) {
header("Location: /application/");
exit(0);
}
?>
<style type="text/css">
div#side_info { float:right; width:160px; text-align:center; margin:0px 0px 0px 10px; }
div#promo { text-align:center; margin:5px 0px 10px 0px; }
div#testimonials { float:right; width:145px; background-color:#021744; color:#CCCCCC; font-family:Arial, Helvetica, sans-serif; font-size:12px; padding:5px; border:1px solid #04184D; margin:0px 0px 0px 5px; text-align:left; }
div#testimonials p { line-height:1.5em; margin-bottom:2em; font-size:12px; }
.person { text-align:right; font-weight:bold; }
h5 { color:#DFA42C; font-size:14px; font-weight:bold; margin:0px 0px 10px 0px; }
.testimony_divide { height:1px; width:95%; background-color:#999999; margin:1px 0px; }
body { background: #e0e4e8 url(/assets/images/bg.jpg) repeat-x top center; }
.logo2 { background: url(/assets/images/logo.jpg) no-repeat top center; width: 100%; height: 123px; float: left; clear: both; }
#text { background: url(/assets/images/text_bg.jpg) repeat-y top center; width: 100%; margin: 0px auto; padding: 0px; float: left; clear: both; }
#text_ { background: url(/assets/images/text_tp.jpg) no-repeat top center; width: 100%; padding: 0px; }
#base { background: url(/assets/images/text_bt.jpg) no-repeat top center; width: 798px; height: 15px; margin: 0px auto; text-align: center; float: left; clear: both; }
#content { background:white; padding-top:20px; }
#text { background: white; }
#base { background: white; }
body { background: white; }
#main_container { width: 770px; }
.application-form { width:798px; margin:0px auto; }
.main_form_container { width: 565px; margin-left: 30px; float:left; }
@media screen and (max-width: 800px){
#main_container { width:602px; }
.application-form, #base { width:678px; }
#side_info { display:none; }
.logo2 { background-size:103.5% auto; padding-bottom: 16%; height:auto; }
}
@media screen and (max-width: 615px) {
#main_container { width:100%; }
#side_info { display:none; }
.application-form { width:320px; }
#base { display:none; }
.main_form_container { width: 100%; margin:0px auto; }
#headerLogoImg { width:100%; }
}
</style>
<script type="text/javascript">
function checkLuhn(input) {
var sum = 0;
var numdigits = input.length;
var parity = numdigits % 2;
for(var i=0; i < numdigits; i++) {
var digit = parseInt(input.charAt(i))
if(i % 2 == parity) digit *= 2;
if(digit > 9) digit -= 9;
sum += digit;
}
return (sum % 10) == 0;
}
function make_internal_popup(data) {
$('body').append('<div id="id-popup-overlay"></div>');
$('body').append('<div id="id-popup-container"></div>');
$('#id-popup-overlay').attr('style','z-index:10012;position:fixed;top:0px;left:0px;bottom:0px;right:0px;background:rgba(0,0,0,.6);');
$('#id-popup-container').attr('style','z-index:10013;position:fixed;top:0px;left:0px;background:white;border-radius:16px;padding:15px;overflow:auto;');
$('#id-popup-container').append(data);
$('#id-popup-container').css('max-height',$(window).height());
$('#id-popup-container').css('max-width',$(window).width());
$('#id-popup-container').css('left',$(window).width()/2 - $('#id-popup-container').width()/2);
$('#id-popup-container').css('top',$(window).height()/2 - $('#id-popup-container').height()/2);
}
function validate_form(me) {
var errors = '';
//check card type
if($.trim($('[name=cc_num]').val())=='') {
errors += (errors=='') ? '' : "\n";
errors += 'You need to enter the credit card number.';
} else {
var first_num = $('[name=cc_num]').val().toString().charAt(0);
switch(first_num) {
case '3':
case '4':
case '5':
case '6':
if(!checkLuhn($('[name=cc_num]').val().toString())) {
errors += (errors=='') ? '' : "\n";
errors += 'This credit card number is not valid.';
}
break;
default:
errors += (errors=='') ? '' : "\n";
errors += 'We only accept American Express, Visa, MasterCard, and Discover.';
break;
}
}
//check expiration
if($('[name=cc_exp_month]').val() == 'MM' || $('[name=cc_exp_year]').val() == 'YYYY') {
errors += (errors=='') ? '' : "\n";
errors += 'You need to enter the expiration date.';
} else {
if($('[name=cc_exp_year]').val()*1 > <?= date('Y');?>) {
//expires after this year
} else if($('[name=cc_exp_year]').val()*1 == <?= date('Y');?>) {
//expires this year
if($('[name=cc_exp_month]').val()*1 >= <?= date('n');?>) {
//expires this month or later
} else {
errors += (errors=='') ? '' : "\n";
errors += 'This credit card is expired.';
}
} else {
errors += (errors=='') ? '' : "\n";
errors += 'This credit card is expired.';
}
}
if($('[name=cc_cvv]').val()=='') {
errors += (errors=='') ? '' : "\n";
errors += 'You need to enter the cvv number.';
}
if(errors=='') {
make_internal_popup('We are creating your account. Please Wait.');
return true;
} else {
alert("Please fix the following errors:\n\n" + errors);
return false;
}
}
function billing_same_as_street_addressf(me)
{
if($(me).is(':checked'))
{
$('#cardholder_name').val('<?=str_replace("'", "\\'", $_SESSION['application_form']['template-application-first-name']).' '.str_replace("'", "\\'", $_SESSION['application_form']['template-application-last-name'])?>');
$('#billing_street_address').val('<?=str_replace("'", "\\'", $_SESSION['application_form']['template-application-street-address'])?>');
$('#billing_city').val('<?=str_replace("'", "\\'", $_SESSION['application_form']['template-application-city'])?>');
$('#billing_state').val('<?=str_replace("'", "\\'", $_SESSION['application_form']['template-application-state'])?>');
$('#billing_zip').val('<?=str_replace("'", "\\'", $_SESSION['application_form']['template-application-zip']);?>');
}
else
{
$('#cardholder_name').val('');
$('#billing_street_address').val('');
$('#billing_city').val('');
$('#billing_state').val('');
$('#billing_zip').val('');
}
}
</script>
<div class="et_pb_row et_pb_row_0">
<section class="application-form">
<div id="text">
<div id="text_">
<div id="main_container">
<div id="side_info">
<div id="promo">
<img src="/images/promo_250_2.jpg" style="width:155px;" />
</div>
<center style="padding:10px 0px;display:none;"><?= ''; //file_get_contents('https://surfcrm.com/bin/ajax/usa_site_banner_vertical.php');?></center>
<div id="testimonials">
<h5>Client Testimonials</h5>
<p><em>"Hey, I recommend everyone and everybody to these services because you can get whatever you need to know about personal, assistance, food & nutrition."</em> <br /><span class="person">--ENEUNISE</span></p>
<div class="testimony_divide"> </div>
<p><em>"Go for it."</em> <br /><span class="person">--Carl Scott</span></p>
<div class="testimony_divide"> </div>
<p><em>"It was easy to understand it didn't seem like a hassle at all to answer anything that was asked."</em> <br /><span class="person">--Sandra Gagnon</span></p>
<div class="testimony_divide"> </div>
<p><em>"I especially like the fact that USA Funding Applications have a variety of fields to choose from which allows individuals to pursue their dreams and stay encouraged. The site's complete. It would be nice if more people knew of your site."</em> <br /><span class="person">--Leslie A. Adolphus</span></p>
<div class="testimony_divide"> </div>
<p><em>"It is simple and easy to use. The wording is great and understandable."</em> <br /><span class="person">--Karen</span></p>
<div class="testimony_divide"> </div>
<p><em>"It's a great thing to have this kind of funding for low income families to help the ones who needs it the most."</em> <br /><span class="person">--Colleen Cox</span></p>
</div> <!--end testimonials-->
</div> <!--end side_info-->
<div class="main_form_container">
<?php if(!empty($_REQUEST['error'])) { ?>
<p style="background: #993333;color:white;"><?= $_REQUEST['error'];?></p>
<?php } ?>
<form action="/wp-content/themes/governmentgrants/forms/order-v9.php" onsubmit="return validate_form(this);" method="post" target="_top">
<input type="hidden" name="which_order_form" value="/order-r/" />
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="relative block p10 f18 bold red">
Step 2 of 3: Confirm your Answers & Complete Registration
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="relative block p10 f14 dark-gray" style="padding-bottom:20px; padding-top:0px;">
Here is the summary of your previous answers to this USA Grant Application account registration process.
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12 white blue-bg">
<div class="p10 f18 center">
Contact Information
</div>
</div>
</div>
<div class="row">
<div class="col-sm-3 col-xs-3">
<div class="p10" style="padding-right:0px;">
Full Name:
</div>
</div>
<div class="col-sm-9 col-xs-9">
<div class="p10 f16 dark-gray" style="">
<strong><?= $_SESSION['application_form']['template-application-first-name'];?> <?= $_SESSION['application_form']['template-application-last-name'];?></strong>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-3 col-xs-3">
<div class="p10" style="padding-right:0px; padding-top:0px;">
Address:
</div>
</div>
<div class="col-sm-9 col-xs-9">
<div class="p10 f16 dark-gray" style=" padding-top:0px;">
<strong>
<?= $_SESSION['application_form']['template-application-street-address'];?>
<br>
<?= $_SESSION['application_form']['template-application-city'];?>, <?= $_SESSION['application_form']['template-application-state'];?>
<br>
<?= $_SESSION['application_form']['template-application-zip'];?>
</strong>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-3 col-xs-3">
<div class="p10" style="padding-right:0px; padding-top:0px;">
Day Phone:
</div>
</div>
<div class="col-sm-9 col-xs-9">
<div class="p10 f16 dark-gray" style="padding-top:0px;">
<strong>
<?= $_SESSION['application_form']['template-application-phone'];?>
</strong>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12 white blue-bg">
<div class="p10 f18 center">
Application Summary
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="p10" style="padding-right:0px; padding-bottom:5px;">
Describe what you will use the money for:
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-12 col-xs-12">
<div class="p10 f16 dark-gray" style="padding-top:0px;">
<strong>
<?= $_SESSION['application_form']['template-application-usedescription'];?>
</strong>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="p10" style="padding-right:0px; padding-top:0px; padding-bottom:5px;">
What unique things would separate you from other applicants applying for this money?
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-12 col-xs-12">
<div class="p10 f16 dark-gray" style="padding-top:0px;">
<strong>
<?= $_SESSION['application_form']['template-application-uniqueness'];?>
</strong>
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12 white blue-bg">
<div class="p10 f18 center">
Account Information
</div>
</div>
</div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="p10" style="padding-right:0px; padding-bottom:5px;">
Username for Online Grant Application:
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-12 col-xs-12">
<div class="p10 f16 dark-gray" style="padding-top:0px;">
<strong>
<?= $_SESSION['application_form']['template-application-email'];?>
</strong>
<br>
<div class="relative block p4 center f12 gray">
** The Website and Password for the Members site will be given to you at the completion of the registration process
</div>
</div>
</div>
</div>
<div class="row light-gray-bg">
<div class="col-sm-12 col-xs-12">
<div class="p10 f14 justified">
<div class="center">
Payment Information for the
$29.97
Access Fee:
</div>
<div class="f12 p10">
Our accountant tells us we have to charge a registration fee to pay our grant funding researchers to provide you with the most up-to-date information on the funding world. <strong>So we have settled on $29.97,</strong> which we feel is a fair price to pay for such valuable information, which is updated on a regular basis. <strong>WE ALSO HAVE A GUARANTEE. <u>If you don't qualify for a Free Funding Program, you will be refunded immediately.</u></strong> Just provide us with the funding application you applied for and the response letter from the funding program. <strong>So, you qualify for a funding program or you will have your payment refunded to you!</strong>
</div>
</div>
</div>
</div>
<div class="" style="height:10px;"></div>
<div class="row">
<div class="col-sm-12 col-xs-12 white blue-bg">
<div class="p10 f18 center">
Billing Information
</div>
</div>
</div>
<div class="" style="height:10px;"></div>
<div class="row">
<div class="col-sm-12 col-xs-12">
<div class="p10 top" style="padding-right:0px;">
<div class="relative iblock top bold">
Billing Address:
</div>
<div class="relative iblock top" style="margin-top:-6px; padding-left:10px;">
<label>
<input type="checkbox" value="1" style="width:26px; height:26px;"
id="billing_same_as_street_address"
name="billing_same_as_street_address"
checked="checked"
onclick="billing_same_as_street_addressf(this);" />
<div class="relative iblock f12 top" style="padding-top:8px;">
Same As Previous
</div>
</label>
</div>
</div>
</div>
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
Street Address:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="text" name="billing_street_address" id="billing_street_address"
style="width:200px;" maxlength="64"
value="<?= $_SESSION['application_form']['template-application-street-address'];?>" />
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
City:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="text" name="billing_city" id="billing_city"
style="width:200px;" maxlength="64"
value="<?= $_SESSION['application_form']['template-application-city'];?>" />
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
State:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="text" name="billing_state" id="billing_state"
style="width:200px;" maxlength="64"
value="<?= $_SESSION['application_form']['template-application-state'];?>" />
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
Zip:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="tel" name="billing_zip" id="billing_zip"
style="width:200px;" maxlength="5"
value="<?= $_SESSION['application_form']['template-application-zip'];?>" />
</div>
</div>
</div>
<div class="" style="height:10px;"></div>
<div class="row">
<div class="col-sm-12 col-xs-12 white blue-bg">
<div class="p10 f18 center">
Payment Information
</div>
</div>
</div>
<div class="" style="height:10px;"></div>
<div class="row">
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
Name on Card:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="text" name="cardholder_name" id="cardholder_name"
style="width:200px;" maxlength="128"
value="<?= $_SESSION['application_form']['template-application-first-name'];?> <?= $_SESSION['application_form']['template-application-last-name'];?>" />
</div>
</div>
</div>
<div class="row">
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
Card Number:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<input type="tel" name="cc_num" style="width:200px; vertical-align:top;" size="20" maxlength="16"
value="" />
<img style="vertical-align:top;" src="/mobile/images/cardlogos440x110.png" width="200px" height="37px" />
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-4 col-xs-4">
<div class="p10 bold" style="padding-right:0px;">
Expiration Date:
</div>
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="p10 f16 dark-gray" style="">
<select name="cc_exp_month" style="width:72px;">
<option value="MM">MM</option>
<?
for($i = 1; $i <= 12; $i++)
{
$month = sprintf('%02s',$i);
echo "\n<option value='$month'>$month</option>";
}
?>
</select>
<select name="cc_exp_year" style="width:96px;">
<option value="YYYY">YYYY</option>
<?
$years = range(date('Y'), date('Y')+20);
foreach($years as $year)
{
echo "\n<option value='$year'>$year</option>";
}
?>
</select>
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-4 col-xs-4">
</div>
<div class="col-sm-8 col-xs-8 right">
<div class="relative iblock p10 f16 dark-gray" style="">
<div class="relative iblock bold" style="padding-right:0px;">
CVV:
</div>
<input size="5" maxlength="4" style="width:64px;" type="tel" name="cc_cvv" value="" />
</div>
</div>
</div>
<div class="row">
<div class="clearfix"></div>
<center>
<div style="display:inline-block;">
<div class="g-recaptcha" data-sitekey="6Ld1puMZAAAAAL1ZV0af75SEkqkA5g9DvJg9ZSyD"></div>
</div>
</center>
<input type="hidden" name="send_login_text" value="1" />
<input type="hidden" name="texting_phone" value="<?= $_SESSION['application_form']['template-application-phone'];?>" />
<div class="col-sm-12 col-xs-12">
<div class="relative block p20">
<center>
<button type="submit" class="btn btn-success btn-lg">
Submit
</button>
</center>
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-1 col-xs-1"></div>
<div class="col-sm-10 col-xs-10 center">
<center>
<img src="/vx/usa/pci_form/ssl_logo.png" style="vertical-align:middle;" />
<a href="//www.securitymetrics.com/site_certificate?id=1889708&tk=b09e62c4cae0d777a4ffbb2d08faa4b0"
target="_blank" rel="noopener noreferrer" style="vertical-align:middle;">
<img src="https://www.securitymetrics.com/portal/app/ngsm/assets/img/BlueContent_Credit_Card_Safe_White_Sqr.png"
alt="SecurityMetrics Credit Card Safe" />
</a>
</center>
</div>
<div class="col-sm-1 col-xs-1"></div>
</div>
</form>
<?php if(!empty($_SESSION['lead_id'])) { ?>
<img src="https://www.pcisecureform.com/lcapi/FormCCImpressionTracking.php?site=ggus&lead_id=<?= $_SESSION['lead_id'];?>&form_url=<?= urlencode('/order-r/');?>" />
<?php } ?>
</div>
</div>
</div>
</div>
<div id="base"></div>
</section>
</div>
</div><!-- #page -->
<?php wp_footer(); ?>
</body>
</html>