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<? include_once("{$_SERVER["DOCUMENT_ROOT"]}/header.php"); ?>
<script type="text/javascript" src="/assets/js/orderform_verify.js"></script>
<style type="text/css">
div#side_info { float:right; width:160px; text-align:center; margin:0px 0px 0px 10px; }
div#promo { text-align:center; margin:5px 0px 10px 0px; }
div#testimonials { float:right; width:145px; background-color:#021744; color:#CCCCCC; font-family:Arial, Helvetica, sans-serif; font-size:12px; padding:5px; border:1px solid #04184D; margin:0px 0px 0px 5px; text-align:left; }
div#testimonials p { line-height:1.5em; margin-bottom:2em; }
.person { text-align:right; font-weight:bold; }
h5 { color:#DFA42C; font-size:14px; font-weight:bold; margin:0px 0px 10px 0px; }
.testimony_divide { height:1px; width:95%; background-color:#999999; margin:1px 0px; }
</style>
</head>
<body>
<div id="size">
<div id="logo"></div>
<div id="text">
<div id="text_">
<div style="margin-left: 32px;margin-right:32px;">
<table cellpadding="2" cellspacing="0" border="0" align="center">
<?
if(isset($error_message)) {
echo '<tr><td><center><table style="margin:0px auto;border:3px solid #FF0000">';
echo '<tr>';
echo '<td>The following error has occured:</td>';
echo '</tr>';
echo '<tr>';
echo '<td><em>' . $error_message . '</em><br />If you need assistance, please call us at '.$_SITE_PHONE.'.</td>';
echo '</tr>';
echo '</table></center></td></tr>';
}
?>
<tr>
<td>
<center>
<div style="width:730px;"> <!--container-->
<div id="side_info">
<div id="promo">
<img src="images/promo_250.jpg" width="155" height="490" />
</div>
<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 style="width:550px; float:left;">
<p class="header2">Step 2 of 3: Confirm your Answers & Complete Registration</p>
<p class="left">Here is the summary of the answers on step 1 of this USA Funding 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 action="https://www.usafundingapplications.org/order2.php" method="POST" name="orderform" onSubmit="return verify(this);">
<p class="header2">Personal Information Summary</p>
<table width="550" cellpadding="0" cellspacing="0" class="questions">
<tr>
<td class="q">First Name:</td>
<td class="a"><?= $cc_fname; ?><input type="hidden" name="cc_fname" value="<?= $cc_fname; ?>"></td>
<td class="q">Last Name:</td>
<td class="a"><?= $cc_lname; ?><input type="hidden" name="cc_lname" value="<?= $cc_lname; ?>"></td>
</tr>
<tr>
<td class="q">Street Address:</td>
<td class="a"><?= $cc_addr; ?><input type="hidden" name="cc_addr" value="<?= $cc_addr; ?>"></td>
<td class="q">City:</td>
<td class="a"><?= $cc_city; ?><input type="hidden" name="cc_city" value="<?= $cc_city; ?>"></td>
</tr>
<tr>
<td class="q">State:</td>
<td class="a"><?= $cc_state; ?><input type="hidden" name="cc_state" value="<?= $cc_state; ?>"></td>
<td class="q">Zip:</td>
<td class="a"><?= $cc_zip; ?><input type="hidden" name="cc_zip" value="<?= $cc_zip; ?>"></td>
</tr>
<tr>
<td class="q">Gender:</td>
<td class="a"><?= $app_gender; ?></td>
<td class="q">What is<br />your age?</td>
<td class="a"><?= $app_age; ?></td>
</tr>
<tr>
<td class="q">Day Phone:</td>
<td class="a">
<?= $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; ?>">
</td>
<td colspan="2" class="q"> </td>
</tr>
</table>
<p class="header2">Application Question Summary</p>
<table width="550" cellpadding="0" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellpadding="0" cellspacing="0" align="left">
<tr>
<td class="q">Citizenship Status:</td><td class="a"><?= $app_citizenship; ?></td>
</tr>
</table>
</td>
</tr>
</table>
<table width="550" cellpadding="0" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td class="q" colspan="2">Types of funding areas you are interested in?</td>
</tr>
<tr>
<?
if(!empty($types_of_grants)) {
$counter = 0;
foreach ($types_of_grants as $grant)
{
echo "<td class=\"a\">$grant</td>";
$counter++;
if ($counter % 2 == 0)
{
echo "</tr><tr>";
}
}
}
?>
</tr>
</table>
<table width="550" cellpadding="0" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellpadding="1" cellspacing="0" align="left">
<tr>
<td class="q">How much money do you need?</td><td class="a"><?= $app_amount_needed; ?></td>
</tr>
</table>
</td>
</tr>
</table>
<table width="550" cellpadding="2" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td class="q">Describe what you will use the money for:</td>
</tr>
<tr>
<td class="a"><p><?= $app_usedescription; ?></p></td>
</tr>
</table>
<table width="550" cellpadding="2" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td class="q">What unique things would separate you from other applicants applying for this money?</td>
</tr>
<tr>
<td class="a"><p><? echo stripslashes($app_uniqueness); ?></p></td>
</tr>
</table>
<p class="header2">USA Funding Application User Account Info:</p>
<table width="550" cellpadding="1" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellpadding="1" cellspacing="0" align="left">
<tr>
<td class="q">Username for Online Funding Application:</td>
<td class="a"><?= $cc_email; ?><input type="hidden" name="cc_email" value="<?= $cc_email; ?>"></td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="s">
<p class="left"><i>** The Website and Password for the Members site will be given to you at the completion of the registration
process</i></p>
</td>
</tr>
</table>
<p class="header2">Payment Information for the $24.95 Access Fee:</p>
<p class="left">Our accountant tells us we have to charge a registration fee to help pay for the Internet advertising we have
to do to get this information out to you and to cover administration expenses. <strong>So we have settled on $24.95,</strong>
which we feel is a fair price to pay for such valuable information, which is updated on a regular basis. You will have access
to the applications and training through the USA Funding Applications site for the next month. You will also have continued access
each month thereafter for the same monthly amount above. <strong>WE ALSO HAVE A GUARANTEE. <u>If you don't qualify for a Free Funding Program,
you will be refunded immediately.</u></strong> Just provide us with the funding application you applied for and the response letter from the
funder. <strong>Either you qualify for the Free Funding Program or you will have your payment refunded to you. <u>You have
nothing to lose!</u></strong></p>
<table width="550" cellpadding="1" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellpadding="1" cellspacing="0" align="left">
<tr>
<td class="q">Credit Card Number:</td>
<td class="a"><input type="text" name="cc_num" size="20" maxlength="16"></td>
<td class="a"><img src="/images/creditcards.jpg"></td>
</tr>
</table>
</td>
<td class="q">
<table border="0" cellspacing="0" cellpadding="0" align="left">
<tr>
<td class="q">Exp:</td>
<td>
<select name="cc_month">
<option value="MM">MM</option>
<?
for($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>
</td>
<td>
<select name="cc_year">
<option value="YYYY">YYYY</option>
<?
$years = range(date('Y'), date('Y')+20);
foreach($years as $year) {
$selected = (strcmp($year, $cc_year) == 0) ? "selected" : NULL;
echo "\n<option value='$year' $selected>$year</option>";
}
?>
</select>
</td>
</tr>
</table>
</td>
</tr>
</table>
<table width="550" cellpadding="1" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellspacing="0" cellpadding="0" align="left">
<tr>
<td class="q">
3 Digit Verification Code on back of Card:
</td>
<td class="a"><input size=5 maxlength="4" name="cc_cvv" value="<?php echo $cc_cvv ?>"></td>
</tr>
</table>
</td>
</tr>
</table>
<p align="center">
<label for="agree2terms" title="I agree to the terms of this site">
<input type="checkbox" id="agree2terms" name="agree2terms" value="agreed">I agree to the terms of this site
</label>
</p>
<center>
<input type="submit" value="CLICK HERE TO START APPLYING">
<input type="hidden" name="submitted" value="submitted">
<input type="hidden" name="cc_lead_id" value="<? echo $cc_lead_id; ?>">
<input type="hidden" name="tc" value="<?= $tc; ?>">
<?= $trackerformparams; ?>
</center>
</form>
<br />
<br />
<center>
<table border="0">
<tr>
<td align="center">
<span id="siteseal"><script type="text/javascript" src="https://seal.godaddy.com/getSeal?sealID=41733686402c49c28810120abc25cd257fd2942571681064805707320"></script><br/><a style="font-family:arial;font-size:9px" href="https://www.godaddy.com/gdshop/ssl/ssl_opensource.asp" target="_blank">SSL Cert</a></span>
</td>
</tr>
</table>
</center>
</div> <!--end left div-->
<div style="clear:both;"></div>
</div> <!--end container-->
</center>
</td>
</tr>
</table>
</div>
</div>
<img src="https://www.surfcrm.com/lcapi/FormCCImpressionTracking.php?site=usafa&lead_id=<?= $cc_lead_id;?>&form_url=<?= urlencode('/order_form2.php');?>" />
<? include_once($_SERVER["DOCUMENT_ROOT"]."/footer.php"); ?>