<?php
require_once($_SERVER['DOCUMENT_ROOT'].'/inc/globals.php');
$title = ''; 
$body_class = 'order';
require_once($_SERVER['DOCUMENT_ROOT'].'/v5/header.php');
?>

        <?php require_once($_SERVER['DOCUMENT_ROOT'].'/v5/sidebar2.php');?>
        
    	<div class="main">
    	<div class="main_">
		<style type="text/css">
		
		.halfWidth select, select.halfWidth { width:auto; }

		-->
		</style>
		
		<?php if(isset($error_message)) { ?>
			<p style='margin:10px auto;width:90%;border:3px solid #FF0000'>
				<center>
				The following error has occurred:<br />
				<em><?= ($error_message=='Address Verification does not match') ? 'Address Verification does not match.<br />Please be sure the ADDRESS and ZIP CODE match the BILLING address on your CREDIT CARD STATEMENT and enter it in again.' : $error_message;?></em><br />
				If you need assistance, please call us at <?= $_SITE_PHONE;?>.
				</center>
			</p>
		<?php } ?>
        <script type="text/javascript">
					function validate_form(me) {
						var errors = '';
						if(!document.getElementById('agree2terms').checked) {
							errors += (errors=='') ? '' : "\n";
							errors += 'You must agree to the terms of the site.';
						}
						var v = parseFloat(document.getElementById('cc_num').value);
						if(isNaN(v)) {
							errors += (errors=='') ? '' : "\n";
							errors += 'Please enter a valid Credit Card Number.';
						}
						if(document.getElementById('cc_month').selectedIndex == -1) {
							errors += (errors=='') ? '' : "\n";
							errors += 'Please select an Expiration Month.';
						} else {
							if(document.getElementById('cc_month').options[document.getElementById('cc_month').selectedIndex].value=="MM") {
								errors += (errors=='') ? '' : "\n";
								errors += 'Please select an Expiration Month.';
							}
						}
						if(document.getElementById('cc_year').selectedIndex == -1) {
							errors += (errors=='') ? '' : "\n";
							errors += 'Please select an Expiration Year.';
						} else {
							if(document.getElementById('cc_year').options[document.getElementById('cc_year').selectedIndex].value=="YYYY") {
								errors += (errors=='') ? '' : "\n";
								errors += 'Please select an Expiration Year.';
							}
						}
						var v = parseFloat(document.getElementById('cc_cvv').value);
						if(isNaN(v)) {
							errors += (errors=='') ? '' : "\n";
							errors += 'Please enter a valid CVV number.';
						}
						if(errors=='') {
							return true;
						} else {
							alert("Please fix the following errors:\n\n"+errors);
							return false;
						}
					}
				</script>
        	<h1 style="white-space:normal">Step 2 of 3: Confirm your Answers &amp; Complete Registration</h1>
            <p>Here is the summary of the answers on step 1 of this USA Grant Application account registration process. Please confirm your answers to be sure they are correct and complete the last step at the bottom of the page. You are 1 step away from beginning the process of applying for funding of every kind if you qualify of course!!</p>
			
			<form id="form" method="post" action="order.php"  onsubmit="return validate_form(this);">
				<div class="order_form_section">
					<h2 class="cc_form_h2">Personal Information</h2>
					
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">First Name:</div>
						<p class="cc_form_p">
						
						Josh 
							<?= $cc_fname; ?><input type="hidden" name="cc_fname" value="<?= $cc_fname; ?>" />
							
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Last Name:</div>
						<p class="cc_form_p">
							<?= $cc_lname; ?><input type="hidden" name="cc_lname" value="<?= $cc_lname; ?>" />
							Jensen
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Email:</div>
						<p class="cc_form_p">
							<?= $cc_email; ?><input type="hidden" name="cc_email" value="<?= $cc_email; ?>" />
							josh@synergyproconsulting.com
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Phone Number:</div>
						<p class="cc_form_p">
							<?= $cc_phonearea; ?>-<?= $cc_phoneprefix; ?>-<?= $cc_phoneextension; ?>
							<input type="hidden" name="cc_phonearea" value="<?= $cc_phonearea; ?>" />
							<input type="hidden" name="cc_phoneprefix" value="<?= $cc_phoneprefix; ?>" />
							<input type="hidden" name="cc_phoneextension" value="<?= $cc_phoneextension; ?>" />
							435-555-5555
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Address:</div>
						<p class="cc_form_p">
							<?= $cc_addr; ?><input type="hidden" name="cc_addr" value="<?= $cc_addr; ?>" />
							345 E. 860 N. 
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">City:</div>
						<p class="cc_form_p">
							<?= $cc_city; ?><input type="hidden" name="cc_city" value="<?= $cc_city; ?>" />
							Hurricane
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">State:</div>
						<p class="cc_form_p">
							<?= $cc_state; ?><input type="hidden" name="cc_state" value="<?= $cc_state; ?>" />
							Utah
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Zip:</div>
						<p class="cc_form_p">
							<?= $cc_zip; ?><input type="hidden" name="cc_zip" value="<?= $cc_zip; ?>" />
							84737
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<br />
				</div>
                    
				<div class="order_form_section">
					<h2 class="cc_form_h2">Application Question Summary</h2>
					
					
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Citizenship:</div>
						<p class="cc_form_p">
							<?= $app_citizenship; ?>USA
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">How much do you need?</div>
						<p class="cc_form_p">
							<?= $app_amount_needed; ?>
							Because I am really bored and need the money.
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="fullWidth">How will you use the funds?</div>
						<p class="cc_form_p">
							<?= stripslashes($app_usedescription); ?>
							Spend it all on candy and pop.
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="fullWidth">What qualifies you above other applicants?</div>
						<p class="cc_form_p">
							<?= stripslashes($app_uniqueness); ?>
							nothing really
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<br /><br />
				</div>
				<div class="order_form_section">
					<h2 class="cc_form_h2">USA Grant Application User Account Info:</h2>
					<div class="fullWidth">
						<div class="halfWidth cc_form_halfWidth left">Username:</div>
						<p class="cc_form_p">
							<span style="color:#a41b00;font-family:'ErasBD';"><?= $cc_email; ?></span>
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<p class="cc_form_p"><em>The Website and Password for the Members site will be given to you at the completion of the registration process</em></p>
					<br /><br />
				</div>
				<div class="order_form_section">
					<h2 class="cc_form_h2">Payment Information for the $<?= $_INITIAL_FEE;?> Access Fee:</h2>
					<small>Our accountant tells us we have to charge a registration fee to pay our funding writers and provide you with the most up-to-date information from the funding world. <strong>So we have settled on $<?= $_INITIAL_FEE;?>,</strong> which we feel is a fair price to pay for such valuable information, which is updated on a regular basis. <strong> WE ALSO HAVE A GUARANTEE. <u>If you don't qualify for a Grant Program, you will be refunded immediately.</u></strong> Just provide us with the grant application you applied for and the response letter from the grantor. <strong>So, you qualify for a funding program or you will have your payment refunded to you!</strong> <strong>So Start Applying Today!</strong></small>
					<div id="card" class="form_section" style="display:block">
						<div class="fullWidth">
							<p class="left cc_form_p_small">Credit Card Number
								<input name="cc_num" type="tel" maxlength="16" id="cc_num" />
								<img id="credit_card_icon" src="/images/credit_cards.png" />
							</p>
						</div>
						<div class="clear_left cc_form_clear_left"></div>
						<div class="fullWidth">
							<p class="left cc_form_p_small">Expiration Date</p>
							<div class="cc_form_right_data">
								<select name="cc_month" id="cc_month">
									<option value="MM">MM</option>
									<?php
										for($i = 1; $i <= 12; $i++) {
											$month = sprintf('%02s',$i);
											$selected = (strcmp($month, $cc_month) == 0) ? "selected" : NULL; 
											echo "\n<option value='$month' $selected>$month</option>";
										}
									?>
								</select>
								<select name="cc_year" id="cc_year">
									<option value="YYYY">YYYY</option>
									<?php 
										$years = range(date('Y'), date('Y')+15);
										foreach($years as $year) {
											$selected = (strcmp($year, $cc_year) == 0) ? "selected" : NULL; 
											echo "\n<option value='$year' $selected>$year</option>";
										}
									?>
								</select>
							</div>
						</div>
						<div class="clear_left cc_form_clear_left"></div>
						<div class="fullWidth">
							<p class="left cc_form_p_small">CVV</p>
							<div class="cc_form_right_data" style="margin-left:117px;">
								<input name="cc_ccv" type="tel" maxlength="4" id="cc_cvv" style="width:25%">
							</div>
						</div>
						<div class="clear_left cc_form_clear_left"></div>
					</div>
					
					<div style="width:100%;text-align:center">
						<input type="checkbox" value="agreed" name="agree2terms" id="agree2terms">
						<label title="I agree to the terms of this site" for="agree2terms">I agree to the terms of this site</label>
					</div>
					<br /><br />
					<input type="hidden" name="submitted" value="submitted">
					<input type="hidden" name="cc_lead_id" value="<? echo $cc_lead_id; ?>">
					<center><input type="submit" class="submit cc_form_submit" value="Start Applying" /><br /><p class="cc_form_p">Your Order is Protected by SSL Security</p></center>

					<br /><br />
				</div>

			</form>
			<center>
			<table border="0">
				<tr>
					<!--
					<td><img src="/images/privacy.jpg"></td>
					//-->
					<td>
						<span id="siteseal"><script type="text/javascript" src="https://seal.godaddy.com/getSeal?sealID=saW9RCVk4tcYnX47eEQehGOEX4AKveCSAVqxqibFbUyXhNhYOMTV2"></script></span>
					</td>
					<!--
						<td><img src="/images/security.jpg"></td>
					//-->
				</tr>
			</table>
			</center>

            
        </div>
        </div>
        
        <?php require_once($_SERVER['DOCUMENT_ROOT'].'/v5/footer.php');?>