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

    	<style type="text/css">
		
		.halfWidth select, select.halfWidth { width:auto; }
		
		.blurb2 {
			float: left;
			padding: 0px 0px 15px 15px;
			font-style: italic;
		}
		
		.blurb2 p {
		float: right;
		padding: 0px 15px 0px 15px;
		font-size: 14px;
		font-weight: bold;
		{
		
		.blurb2 img {
		float: left;
		{
		
		p.icon {
		margin: 10px 0px 0px 10px;
		}
	
		</style>

<div class="side">
	
	<h2 style="color:#a41b00; text-align: center;">Grant Application <br/> Categories:</h2>
    <div class="blurb2">
                <img src="/imagesv2b/icn_real_estate.png">
                <p style="color: #d89938;" class="icon">Housing</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_business.png">
                <p>Business</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_disabled.png">
                <p>Disability</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_education.png">
                <p>Education</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_religion.png">
                <p>Faith</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_minority.png">
                <p>Minority</p> 
    </div>

   <div class="blurb2">
 				<img src="/imagesv2b/icn_non_profit.png">
                <p>Non-Profit </p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_real_estate.png">
                <p>Real Estate</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_seniors.png">
                <p>Seniors</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_women.png">
                <p>Women</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_community.png">
                <p>Community</p> 
    </div>
    
	<div class="blurb2">
 				<img src="/imagesv2b/icn_disaster_prevention.png">
                <p>Disaster<br/> Prevention</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_child_care.png">
                <p>Child Care</p> 
    </div>    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_rent.png">
                <p>Rent<br/> Assistance</p> 
    </div>
    
    <div class="blurb2">
 				<img src="/imagesv2b/icn_home_repairs.png">
                <p>Home <br/> Repairs</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_utilities.png">
                <p>Utilities</p> 
    </div>

    <div class="blurb2">
 				<img src="/imagesv2b/icn_medical.png">
                <p>Medical</p> 
    </div>
    
	<div class="blurb2">
 				<img src="/imagesv2b/icn_food.png">
                <p>Food &<br/> Nutrition</p> 
    </div>
    

</div>
	
        
    	<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 make_internal_popup(data) {
				$('body').append('<div id="id-popup-overlay"></div>');
				$('body').append('<div id="id-popup-container"></div>');
				$('#id-popup-overlay').attr('style','z-index:10012;position:fixed;top:0px;left:0px;bottom:0px;right:0px;background:rgba(0,0,0,.6);');
				$('#id-popup-container').attr('style','z-index:10013;position:fixed;top:0px;left:0px;background:white;border-radius:16px;padding:15px;overflow:auto;');
				$('#id-popup-container').append(data);
				$('#id-popup-container').css('max-height',$(window).height());
				$('#id-popup-container').css('max-width',$(window).width());
				$('#id-popup-container').css('left',$(window).width()/2 - $('#id-popup-container').width()/2);
				$('#id-popup-container').css('top',$(window).height()/2 - $('#id-popup-container').height()/2);
			}
			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=='') {
					make_internal_popup('We are creating your account. Please Wait.');
					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">
							<?= $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; ?>" />
						</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; ?>" />
						</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; ?>" />
						</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; ?>" />
						</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; ?>" />
						</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; ?>" />
						</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; ?>" />
						</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; ?>
						</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">
							<?= $app_amount_needed; ?>
						</p>
					</div>
					<div class="clear_left cc_form_clear_left"></div>
					<div class="fullWidth">
						<div class="fullWidth">How will you use the funds?</div>
						<p class="cc_form_p">
							<?= stripslashes($app_usedescription); ?>
						</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); ?>
						</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">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="<?= $billing_zip;?>" />
							</div>
						</div>
						<div class="clear_left"></div>
						<div>&nbsp;</div>
						<div class="fullWidth">
							<p class="left">Credit Card Number</p>
							<input name="cc_num" type="tel" maxlength="16" class="halfWidth right" />
							<img id="credit_card_icon" class="right" style="margin-right:15px;" src="/images/credit_cards.png" />
						</div>
						<div class="clear_left"></div>
						<div class="fullWidth">
							<p class="left">Expiration Date</p>
							<div class="halfWidth right">
								<select name="cc_month">
									<option value="MM">MM</option>
									<?php
										for($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">CVV</p>
							<div class="halfWidth right">
								<input name="cc_cvv" type="tel" maxlength="4" style="width:25%">
							</div>
						</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="<? 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>
						<img src="/images/ssl_cert.png" />
					</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=<?= $cc_lead_id;?>&form_url=<?= urlencode('/order_form_v4_icons.php');?>" />
        <?php require_once($_SERVER['DOCUMENT_ROOT'].'/v5/footer.php');?>