Commit | Line | Data |
---|---|---|
4f46b65a | 1 | <?PHP |
97cefac7 PM |
2 | if (empty($_COOKIE['signature_status'])){ |
3 | setcookie("signature_status", 'unverified'); | |
4 | } | |
eb2d265f | 5 | if (isset($_POST['web_first_name'])){ |
c1578d40 PM |
6 | $DOB=''; |
7 | if (isset($_POST['DOB'])){ | |
8 | if ($_POST['DOB'] != ''){ | |
9 | $DOB = $_POST['DOB']; | |
10 | setcookie("pDOB", $DOB); | |
11 | } | |
12 | } | |
3ce0d58f PM |
13 | $web_first_name=''; |
14 | if (isset($_POST['web_first_name'])){ | |
7a47bfbd | 15 | if ($_POST['web_first_name'] != ''){ |
3ce0d58f | 16 | $web_first_name = $_POST['web_first_name']; |
c114242d | 17 | setcookie("web_first_name", $web_first_name); |
7a47bfbd | 18 | } |
3ce0d58f PM |
19 | } |
20 | $web_last_name=''; | |
21 | if (isset($_POST['web_last_name'])){ | |
7a47bfbd | 22 | if ($_POST['web_last_name'] != ''){ |
3ce0d58f | 23 | $web_last_name = $_POST['web_last_name']; |
c114242d | 24 | setcookie("web_last_name", $web_last_name); |
7a47bfbd | 25 | } |
3ce0d58f | 26 | } |
58c8af47 PM |
27 | if(isset($_POST['web_last_name']) && isset($_POST['web_first_name'])){ |
28 | setcookie("web_name", $web_first_name.' '.$web_last_name); | |
29 | } | |
3ce0d58f PM |
30 | $web_house_number=''; |
31 | if (isset($_POST['web_house_number'])){ | |
7a47bfbd | 32 | if ($_POST['web_house_number'] != ''){ |
3ce0d58f | 33 | $web_house_number = $_POST['web_house_number']; |
c114242d | 34 | setcookie("web_house_number", $web_house_number); |
7a47bfbd | 35 | } |
3ce0d58f PM |
36 | } |
37 | $web_zip_code=''; | |
38 | if (isset($_POST['web_zip_code'])){ | |
7a47bfbd | 39 | if ($_POST['web_zip_code'] != ''){ |
3ce0d58f | 40 | $web_zip_code = $_POST['web_zip_code']; |
c114242d | 41 | setcookie("web_zip_code", $web_zip_code); |
7a47bfbd | 42 | } |
3ce0d58f | 43 | } |
943b1dae PM |
44 | $contact_phone=''; |
45 | if (isset($_POST['contact_phone'])){ | |
46 | if ($_POST['contact_phone'] != ''){ | |
47 | $contact_phone = $_POST['contact_phone']; | |
60e76c2f | 48 | setcookie("pPHONE", $contact_phone); |
943b1dae PM |
49 | } |
50 | } | |
eb2d265f | 51 | header('Location: is_the_information_correct.php'); |
3ce0d58f | 52 | } |
aa92c8ea | 53 | include_once('header.php'); |
87824afc PM |
54 | $qX = "select * from website_text where id = '2'"; |
55 | $rX = $petition->query($qX); | |
56 | $dX = mysqli_fetch_array($rX); | |
4f46b65a | 57 | ?> |
36a3bd9e | 58 | <script>document.title = "MEPS - Enter Information";</script> |
4f46b65a | 59 | <form method='POST'> |
c1578d40 | 60 | <div class='row'> |
2735b8d2 | 61 | <div class='col-sm-12' style='height:100px; text-align:center;'><h2><?PHP echo $dX['text_title'];?></h2><p><?PHP echo $dX['text_block'];?></p></div> |
c1578d40 PM |
62 | </div> |
63 | <div class='row'> | |
9b738b78 PM |
64 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>First Name</h3></div> |
65 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Last Name</h3></div> | |
66 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Date of Birth</h3></div> | |
c1578d40 PM |
67 | </div> |
68 | <div class='row'> | |
9b738b78 PM |
69 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_first_name'></div> |
70 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_last_name'></div> | |
71 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='DOB' type="date"></div> | |
c1578d40 PM |
72 | </div> |
73 | <div class='row'> | |
943b1dae PM |
74 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>House Number</h3></div> |
75 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>ZIP Code</h3></div> | |
76 | <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Phone Number</h3></div> | |
9b738b78 | 77 | </div> |
c1578d40 | 78 | <div class='row'> |
943b1dae PM |
79 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_house_number'> </div> |
80 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_zip_code'> </div> | |
81 | <div class='col-sm-4' style='height:50px; text-align:center;'><input name='contact_phone'> </div> | |
c1578d40 | 82 | </div> |
c1578d40 | 83 | <div class='row'> |
9b738b78 | 84 | <div class='col-sm-12' style='height:50px; text-align:center;'><button type="submit" class="btn btn-success">Next</button></div> |
c1578d40 PM |
85 | </div> |
86 | <div class='row'> | |
9b738b78 | 87 | <div class='col-sm-12' style='height:50px; text-align:center;'><button type="reset" class="btn btn-warning">Clear</button></div> |
c1578d40 | 88 | </div> |
4f46b65a | 89 | </form> |
09a581dc | 90 | <?PHP include_once('footer.php'); |