<?php
require_once($_SERVER['DOCUMENT_ROOT'].'/inc/globals.php');
$title = ''; 
$body_class = 'order';
require_once($_SERVER['DOCUMENT_ROOT'].'/v2/header.php');
?>
<script type="text/javascript" src="/assets/js/jquery-1.11.1.min.js"></script>
<script type="text/javascript">
function billing_same_as_street_addressf(me) {
	if($(me).is(':checked')) {
		$('#cardholder_name').val('<?= str_replace("'","\\'",$cc_fname).' '.str_replace("'","\\'",$cc_lname);?>');
		$('#billing_street_address').val('<?= str_replace("'","\\'",$cc_addr);?>');
		$('#billing_city').val('<?= str_replace("'","\\'",$cc_city);?>');
		$('#billing_state').val('<?= str_replace("'","\\'",$cc_state);?>');
		$('#billing_zip').val('<?= str_replace("'","\\'",$cc_zip);?>');
	} else {
		$('#cardholder_name').val('');
		$('#billing_street_address').val('');
		$('#billing_city').val('');
		$('#billing_state').val('');
		$('#billing_zip').val('');
	}
}
</script>

        <?php require_once($_SERVER['DOCUMENT_ROOT'].'/v2/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 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 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_month]').val() == 'MM' || $('[name=cc_year]').val() == 'YYYY') {
					errors += (errors=='') ? '' : "\n";
					errors += 'You need to enter the expiration date.';
				} else {
					if($('[name=cc_year]').val()*1 > <?= date('Y');?>) {
						//expires after this year
					} else if($('[name=cc_year]').val()*1 == <?= date('Y');?>) {
							//expires this year
						if($('[name=cc_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($('#agree2terms').is(':checked')) {
				} else {
					errors += (errors=='') ? '' : "\n";
					errors += 'You must agree to the terms of the site.';
				}
				if(errors=='') {
					return true;
				} else {
					alert("Please fix the following errors:\n\n" + errors);
					return false;
				}
			}
		</script>
        	<h1>Registration Page</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);">
				<h2>Personal Information</h2>
				
                <div class="fullWidth">
                    <div class="halfWidth left">First Name:</div>
                    <p>
                    	<?= $cc_fname; ?><input type="hidden" name="cc_fname" value="<?= $cc_fname; ?>" />
                	</p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">Last Name:</div>
                    <p>
                    	<?= $cc_lname; ?><input type="hidden" name="cc_lname" value="<?= $cc_lname; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">Email:</div>
                    <p>
                    	<?= $cc_email; ?><input type="hidden" name="cc_email" value="<?= $cc_email; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">Phone Number:</div>
                    <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; ?>" />
                	</p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">Address:</div>
                    <p>
                    	<?= $cc_addr; ?><input type="hidden" name="cc_addr" value="<?= $cc_addr; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">City:</div>
                    <p>
                    	<?= $cc_city; ?><input type="hidden" name="cc_city" value="<?= $cc_city; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">State:</div>
                    <p>
                    	<?= $cc_state; ?><input type="hidden" name="cc_state" value="<?= $cc_state; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">Zip:</div>
                    <p>
                    	<?= $cc_zip; ?><input type="hidden" name="cc_zip" value="<?= $cc_zip; ?>" />
                    </p>
                </div>
                <div class="clear_left"></div>
                <br />

                    
				<h2>Application Question Summary</h2>
				
				
                <div class="fullWidth">
                    <div class="halfWidth left">Citizenship:</div>
                    <p>
                    	<?= $app_citizenship; ?>
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="halfWidth left">How much do you need?</div>
                    <p>
                    	<?= $app_amount_needed; ?>
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="fullWidth">How will you use the funds?</div>
                    <p>
                    	<?= $app_usedescription; ?>
                    </p>
                </div>
                <div class="clear_left"></div>
                <div class="fullWidth">
                    <div class="fullWidth">What qualifies you above other applicants?</div>
                    <p>
                    	<?= stripslashes($app_uniqueness); ?>
                    </p>
                </div>
                <div class="clear_left"></div>
                <br /><br />

				<h2>USA Grant Application User Account Info:</h2>
				<p><em>Your Username and Password for Online Grant Applications will be given to you at the completion of the registration process</em></p>
                <br /><br />
				
				<h2>Payment Information</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="sub_section form_section" style="display:block">
                    <div class="fullWidth">
						<p class="left">Billing Information</p>
						<label class="halfWidth right"><input type="checkbox" value="1" id="billing_same_as_street_address" name="billing_same_as_street_address" onclick="billing_same_as_street_addressf(this);" style="padding:0px;margin:0px;width:auto;height:auto;position:static;" /> Same as Street Address</label>
					</div>
					<div class="clear_left"></div>
					<div class="fullWidth">
						<p class="left">Cardholder Name</p>
						<input type="text" name="cardholder_name" class="halfWidth right" id="cardholder_name" maxlength="128" value="<?= $cardholder_name;?>" />
					</div>
					<div class="clear_left"></div>
					<div class="fullWidth">
						<p class="left">Billing Address</p>
						<input type="text" name="billing_street_address" class="halfWidth right" id="billing_street_address" maxlength="64" value="<?= $billing_street_address;?>" />
					</div>
					<div class="clear_left"></div>
					<div class="fullWidth">
						<p class="left">City, State, Zip</p>
						<div class="halfWidth right" style="width:51%;">
							<input type="text" name="billing_city" id="billing_city" maxlength="64" value="<?= $billing_city;?>" />
							<input type="text" name="billing_state" id="billing_state" maxlength="2" value="<?= $billing_state;?>" />
							<input type="text" name="billing_zip" id="billing_zip" maxlength="5" value="<?= $billing_zip;?>" />
						</div>
					</div>
					<div class="clear_left"></div>
					<div>&nbsp;</div>
					<div class="fullWidth">
                        <p class="left">Credit Card Number</p>
                        <input class="halfWidth right" name="cc_num" type="tel" maxlength="16">
						<img id="credit_card_icon" src="/images/credit_cards.png" />
                    </div>
                    <div class="clear_left"></div>
                    <div class="fullWidth">
                        <p class="left">Expiration Date</p>
                        <div class="halfWidth right" style="padding:5px 10px 5px 0">
                            <select name="cc_month">
								<option value="MM">MM</option>
								<?php
									for($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">
								<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"></div>
                    <div class="fullWidth">
                        <p class="left">Card Verification<br /><small>(Last 3 or 4 digits on back)</small></p>
                        <div class="halfWidth right" style="padding:5px 10px 5px 0">
                            <input class="halfWidth left" name="cc_cvv" type="tel" maxlength="4" style="width:25%">
                        </div>
                        <br />
                    </div>
					<div class="clear_left"></div>
                    <div class="fullWidth">
                        <label><input type="checkbox" name="send_login_text" value="1" checked onclick="if($(this).is(':checked')) { $('#login_text_hidden_box').show(); } else { $('#login_text_hidden_box').hide(); }" /> Send login information in a text</label>
						<div id="login_text_hidden_box" style="display:block;">
						<label>Cell Phone: <input type="text" name="text_phone" value="<?= $cc_phonearea; ?>-<?= $cc_phoneprefix; ?>-<?= $cc_phoneextension; ?>" /></label>
						</div>
                    </div>
                    <div class="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="Start Applying">
                <center><input type="submit" class="submit" value="Register >" /></center>

                <br /><br />

			</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>
        <img src="https://www.surfcrm.com/lcapi/FormCCImpressionTracking.php?site=usaga&lead_id=<?= $cc_lead_id;?>&form_url=<?= urlencode('/order_form_v4.php');?>" />
        <?php require_once($_SERVER['DOCUMENT_ROOT'].'/v4/footer.php');?>