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<? include_once("{$_SERVER["DOCUMENT_ROOT"]}/header.php"); ?>
<script type="text/javascript" src="/assets/js/jquery-1.11.1.min.js"></script>
<script type="text/javascript" src="/assets/js/orderform_verify.js"></script>
<script type="text/javascript">
function billing_same_as_street_addressf(me) {
if($(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('');
$('#billing_zip').val('');
}
}
</script>
<style type="text/css">
div#side_info { float:right; width:160px; text-align:center; margin:0px 0px 0px 10px; }
div#promo { text-align:center; margin:5px 0px 10px 0px; }
div#testimonials { float:right; width:145px; background-color:#021744; color:#CCCCCC; font-family:Arial, Helvetica, sans-serif; font-size:12px; padding:5px; border:1px solid #04184D; margin:0px 0px 0px 5px; text-align:left; }
div#testimonials p { line-height:1.5em; margin-bottom:2em; }
.person { text-align:right; font-weight:bold; }
h5 { color:#DFA42C; font-size:14px; font-weight:bold; margin:0px 0px 10px 0px; }
.testimony_divide { height:1px; width:95%; background-color:#999999; margin:1px 0px; }
</style>
</head>
<body>
<div id="size">
<div id="logo"></div>
<div id="text">
<div id="text_">
<div style="margin-left: 32px;margin-right:32px;">
<?php if(isset($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 } ?>
<table cellpadding="2" cellspacing="0" border="0" align="center">
<tr>
<td>
<center>
<div id="main_container"> <!--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>
<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/order.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"><?= $app_citizenship; ?></td>
</tr>
</table>
</td>
</tr>
</table>
<? /*<table width="550" cellpadding="0" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td class="q" colspan="2">Funding areas you are interested in?</td>
</tr>
<tr>
<?
if(!empty($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 $<?= number_format($initial_fee,2); ?> Access Fee:</p>
<p class="a">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 $<?= number_format($initial_fee,2); ?>,</strong> which we feel is a fair price to pay for such valuable information, which is updated on a regular basis. By ordering today you understand that you are enrolling into the Exclusive USA Funding Applications Membership Resource Center where we provide you application resources for hundreds of different funding options.</p>
<style>
.checkbox_container {
display: block;
position: relative;
padding-left: 40px;
padding-top:3px;
margin-bottom: 12px;
cursor: pointer;
font-size: 22px;
-webkit-user-select: none;
-moz-user-select: none;
-ms-user-select: none;
user-select: none;
}
.checkbox_container input {
position: absolute;
opacity: 0;
cursor: pointer;
height: 0;
width: 0;
}
.checkmark {
position: absolute;
top: 0;
left: 0;
height: 32px;
width: 32px;
background-color: #eee;
border:1px solid gray;
}
.checkbox_container:hover input ~ .checkmark {
background-color: #ccc;
}
.checkbox_container input:checked ~ .checkmark {
background-color: #2196F3;
}
.checkmark:after {
content: "";
position: absolute;
display: none;
}
.checkbox_container input:checked ~ .checkmark:after {
display: block;
}
.checkbox_container .checkmark:after {
left: 11px;
top: 5px;
width: 8px;
height: 15px;
border: solid white;
border-width: 0 3px 3px 0;
-webkit-transform: rotate(45deg);
-ms-transform: rotate(45deg);
transform: rotate(45deg);
}
</style>
<div style="padding-left:20px;">
<table>
<tr>
<td style="vertical-align:top;width:42px;text-align:center;">
<label class="checkbox_container">
<input type="checkbox" name="include_monthly_fee" value="1" />
<span class="checkmark"></span>
</label>
<input type="hidden" name="include_monthly_fee_order_form" value="1" />
<div style="margin-top:40px;padding-right:10px;font-size:9px;color:#033076;font-weight:bold;font-style:italic;">Click to mark yes</div>
</td>
<td style="vertical-align:top;">
<div><strong>UPGRADE to VIP Member Services</strong></div>
<div>1. <strong>Grant Deadline Calendar</strong></div>
<div>2. Access the <strong>Newest Grant Applications</strong> found in the <strong>last 30 Days!</strong></div>
<div>3. New <strong>Grant Application ALERTS</strong> delivered to your INBOX</div>
<div>4. Weekly <strong>Grant Tele-Seminars</strong> from our Grant Writing Professionals</div>
<div>5. <strong>Business Plan Template</strong></div>
<div style="padding-top:5px;font-size:11px;font-style:italic;">By checking the box above, you agree to receive ALL VIP Member Services FREE for 30 DAYS. It's normally $34.95 per month, but if you include it now, we'll lower the price to $29.95 per month and you can cancel at any time!!</div>
</td>
</tr>
</table>
</div>
<p class="a"><strong>OUR GUARANTEE.</strong> If you don't qualify for a Funding Program, you will be refunded immediately. Just provide us with the funding application you applied for and the response letter from the funder. <strong>So, you qualify for a funding program or you will have your payment refunded to you!</strong> <strong>So Start Applying Today!</strong></p>
<table width="550" cellpadding="1" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td class="q">Billing Information</td>
<td class="a" colspan="2"><label><input type="checkbox" value="1" id="billing_same_as_street_address" name="billing_same_as_street_address" onclick="billing_same_as_street_addressf(this);" /> Same as Street Address</label></td>
</tr>
<tr>
<td class="q">Cardholder Name</td>
<td class="a" colspan="2"><input type="text" name="cardholder_name" id="cardholder_name" class="full" maxlength="128" value="<?= $cardholder_name;?>" /></td>
</tr>
<tr>
<td class="q">Billing Address</td>
<td class="a" colspan="2"><input type="text" name="billing_street_address" id="billing_street_address" class="full" maxlength="64" value="<?= $billing_street_address;?>" /></td>
</tr>
<tr>
<td class="q">City</td>
<td class="a" colspan="2"><input type="text" name="billing_city" id="billing_city" class="full" maxlength="64" value="<?= $billing_city;?>" /></td>
</tr>
<tr>
<td class="q">State</td>
<td class="a" colspan="2"><input type="text" name="billing_state" id="billing_state" class="full" maxlength="2" value="<?= $billing_state;?>" /></td>
</tr>
<tr>
<td class="q">Zip</td>
<td class="a" colspan="2"><input type="text" name="billing_zip" id="billing_zip" class="full" maxlength="5" value="<?= $billing_zip;?>" /></td>
</tr>
<tr>
<td colspan="3"> </td>
</tr>
<tr>
<td class="q">Credit Card Number:</td>
<td class="a"><input type="tel" name="cc_num" size="20" maxlength="16"></td>
<td><img src="/images/credit_cards.png"></td>
</tr>
<tr>
<td class="q">Exp:</td>
<td>
<select name="cc_month">
<option value="MM">MM</option>
<?
for($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>
<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>
<td> </td>
</tr>
<tr>
<td class="q">
3 Digit Verification Code on back of Card:
</td>
<td class="a"><input size=5 maxlength="4" type="tel" name="cc_cvv" value="<?php echo $cc_cvv ?>"></td>
<td> </td>
</tr>
<?php /*
<tr>
<td colspan="3">
<label><input type="checkbox" name="send_login_text" value="1" checked onclick="if($(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>
</td>
</tr>
*/ ?>
</table>
<?php
//No longer ask if they want a text, just send one
?>
<input type="hidden" name="send_login_text" value="1" />
<input type="hidden" name="text_phone" value="<?= $cc_phonearea; ?>-<?= $cc_phoneprefix; ?>-<?= $cc_phoneextension; ?>" />
<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">
<p>Your Order is Protected by SSL Security</p>
<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; ?>
<br />
<img src="/images/ssl_cert.png" />
</center>
</form>
</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=<?= $cc_lead_id;?>&form_url=<?= urlencode('/order_form_v2.php');?>" />
<? include_once($_SERVER["DOCUMENT_ROOT"]."/footer.php"); ?>