| Server IP : 10.200.247.200 / Your IP : 216.73.217.19 Web Server : Apache System : Linux synergy-usa-sites 6.8.0-138-generic #138-Ubuntu SMP PREEMPT_DYNAMIC Fri Jul 31 22:41:49 UTC 2026 x86_64 User : jeremy ( 1001) PHP Version : 8.4.25 Disable Function : NONE MySQL : OFF | cURL : ON | WGET : ON | Perl : ON | Python : OFF | Sudo : ON | Pkexec : OFF Directory : /var/www/usa_sites/usafundingapplications.org/ |
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<?php
// The variables used in this page are supplied in order.php
require_once("{$_SERVER["DOCUMENT_ROOT"]}/tracker/client/TrackerLib.php");
$tracker = new TrackerLib("usafa");
$trackerformparams = $tracker->FormParameters();
$tc = (! isset($_POST['tc'])) ? 'none': $_POST['tc'];
include_once($_SERVER["DOCUMENT_ROOT"]."/header.php");
?>
<script type="text/javascript" src="/assets/js/orderform_verify.js"></script>
</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">
<?php
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></td>';
echo '</tr>';
echo '</table></center></td></tr>';
}
?>
<tr>
<td>
<p class="header" style="color:#ff0000;">SPECIAL INTERNET OFFER: $<?= number_format($vsa_price,2); ?> Instant Access</p>
<p>You are 1 step away from beginning the process of applying for Free Money of every kind.</p>
<form action="https://<?= $_SERVER['SERVER_NAME']; ?>/order.php" method="POST" name="orderform" onsubmit="return verify(this);">
<p class="header">Personal Information Summary</p>
<table 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; ?><input type="hidden" name="app_gender" value="<?= $app_gender; ?>"></td>
<td class="q">What is<br />your age?</td>
<td class="a"><?= $app_age; ?><input type="hidden" name="app_age" value="<?= $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="header">USA Funding Application User Account Info:</p>
<table 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="<?= $cc_email; ?>"></td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="s">
<i>** The Website and Password for the Members site will be given to you at the completion of the registration
process</i>
</td>
</tr>
</table>
<p class="header">Payment Information:</p>
<table cellpadding="1" cellspacing="0" class="questions" style="margin-bottom: 0px;">
<tr>
<td>
<table border="0" cellpadding="1" cellspacing="0" align="left">
<tr>
<td class="q">Credit Card Number:</td>
<td class="a"><input type="text" name="cc_num" size="20" maxlength="16" value="<?= ($cc_num != '') ? $cc_num : NULL; ?>"></td>
<td class="a"><img src="/images/creditcards.jpg"></td>
</tr>
</table>
</td>
<td class="q">
<table border="0" cellspacing="0" cellpadding="0" align="left">
<tr>
<td class="q">Exp:</td>
<td>
<select name="cc_month">
<option value="MM">MM</option>
<?
for($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 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 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 DISCOUNTED FEE OF $<?= number_format($vsa_price,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. <strong>WE ALSO HAVE A GUARANTEE. <u>If you don't qualify for a 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>So Start Applying Today!</strong></p>
<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>
<br/>
<br/>
<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; ?>">
<input type="hidden" name="so" value="1" />
<?= $trackerformparams; ?>
</center>
</form>
<br />
<br />
<center>
<table border="0">
<tr>
<!--
<td><img src="/images/privacy.jpg"></td>
//-->
<td>
<span id="siteseal"><script type="text/javascript" src="https://seal.godaddy.com/getSeal?sealID=41733686402c49c28810120abc25cd257fd2942571681064805707320"></script><br/><a style="font-family:arial;font-size:9px" href="https://www.godaddy.com/gdshop/ssl/ssl_opensource.asp" target="_blank">SSL Cert</a></span>
</td>
<!--
<td><img src="/images/security.jpg"></td>
//-->
</tr>
</table>
</center>
</td>
</tr>
</table>
</div>
</div>
<? include_once($_SERVER["DOCUMENT_ROOT"]."/footer.php"); ?>