Update enter_information.php

[clinton/MarylandElectronicPetitionSignature.git] / enter_information.php

diff --git a/enter_information.php b/enter_information.php
index dec38d8..244d11d 100644 (file)
--- a/enter_information.php
+++ b/enter_information.php
@@ -76,75 +76,82 @@ slack_general('Enter Information ('.$_COOKIE['invite'].')','md-petition');
    
       
   <div class='row'>
-    <div class='col-sm-3' style='text-align:right;'><h2>E-Mail for Follow Up</h2><br>(not required)</div>
-    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='email'></div>
+    <div class='col-sm-3' style='text-align:right;'><h2>E-Mail for Follow Up*</h2></div>
+    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='email' oninvalid="this.setCustomValidity('Please enter an email address for follow up')" oninput="this.setCustomValidity('')" ></div>
     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div>  
      
   <div class='row'>
     <div class='col-sm-3' style='text-align:right;'><h2>First Name</h2></div>
-    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_first_name' required></div>
+    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_first_name' required oninvalid="this.setCustomValidity('Please enter only your first name')" oninput="this.setCustomValidity('')" ></div>
     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div>  
    
   <div class='row'>
      <div class='col-sm-3' style='text-align:right;'><h2>Last Name</h2></div>
-     <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_last_name' required></div>
+     <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_last_name' required oninvalid="this.setCustomValidity('Please enter only your last name')" oninput="this.setCustomValidity('')"></div>
      <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div> 
    
+  
+     
   <div class='row'>
      <div class='col-sm-3' style='text-align:right;'><h2>Date of Birth</h2></div>
-     <div class='col-sm-6'>
-            <div class="input-group date">
-              <span class="input-group-addon"><i class="glyphicon glyphicon-th"></i></span><input name='DOB' type="text" class="form-control input-lg" required>
-            </div>
-         <script>
-               var $d = jQuery.noConflict();
-               $d('.input-group.date').datepicker({
-                   format: "mm/dd/yyyy",
-                   clearBtn: true
-               });
-         </script>
-       </div>
+     <div class='col-sm-6' style='text-align:left;'><input type='number' class="form-control input-lg" name='web_dob_day' required oninvalid="this.setCustomValidity('Please the day you were born.')" oninput="this.setCustomValidity('')"><input type='number' class="form-control input-lg" name='web_dob_month' required oninvalid="this.setCustomValidity('Please enter the month you were born.')" oninput="this.setCustomValidity('')"><input type='number' class="form-control input-lg" name='web_dob_year' required oninvalid="this.setCustomValidity('Please enter the year you were born.')" oninput="this.setCustomValidity('')"></div>
      <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div> 
   <div class='row'>
-      <div class='col-sm-3' style='text-align:right;'><h2>Phone Number</h2></div>
-      <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" id="contact_phone" name="contact_phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" required></div>
+     <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>Date of Birth Format</h3></div>
+     <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>MM DD YYYY</h3></div>
+     <div class='col-sm-1' style='text-align:center;'></div>
+  </div>
+  <div class='row'>
+      <div class='col-sm-3' style='text-align:right;'><h2>Phone Number**</h2></div>
+      <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" id="contact_phone" name="contact_phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" required oninvalid="this.setCustomValidity('please enter your phone number with area code with hyphens like 1 2 3 dash 4 5 6 dash 7 8 9 0')" oninput="this.setCustomValidity('')"></div>
       <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</div>
   </div>
   <div class='row'>
      <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>Phone Format</h3></div>
      <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>443-123-4567</h3></div>
-     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
+     <div class='col-sm-1' style='text-align:center;'></div>
   </div>
   <div class='row'>
-    <div class='col-sm-3' style='text-align:right;'><h2>House Number</h2></div>
-    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_house_number' type='number' required> </div>
+    <div class='col-sm-3' style='text-align:right;'><h2>Building Number</h2></div>
+    <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_house_number' type='number' required oninvalid="this.setCustomValidity('Please enter your house number without street name')" oninput="this.setCustomValidity('')"> </div>
     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div>  
   <div class='row'>
-     <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>House Format</h3></div>
-     <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>321</h3></div>
-     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
-  </div>     
+     <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>House: 321 Here St.</h3></div>
+     <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>Use: 321</h3></div>
+     <div class='col-sm-1' style='text-align:center;'></div>
+  </div>
+  <div class='row'>
+     <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>Apartment: 21 Here St. Apt 1323</h3></div>
+     <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>Use: 21</h3></div>
+     <div class='col-sm-1' style='text-align:center;'></div>
+  </div>  
   <div class='row'>
      <div class='col-sm-3' style='text-align:right;'><h2>ZIP Code</h2></div>
-     <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_zip_code' type='number' required> </div>
+     <div class='col-sm-6' style='text-align:left;'><input class="form-control input-lg" name='web_zip_code' type='number' required oninvalid="this.setCustomValidity('Please enter your five digit zip code')" oninput="this.setCustomValidity('')"> </div>
      <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
   </div>
   <div class='row'>
      <div class='col-sm-3' style='text-align:right; background-color:lightyellow;'><h3>ZIP Code Format</h3></div>
      <div class='col-sm-6' style='text-align:left; background-color:lightyellow;'><h3>55555</h3></div>
-     <div class='col-sm-1' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">↴</button></div>
+     <div class='col-sm-1' style='text-align:center;'></div>
   </div> 
   <div class='row'>
-     <div class='col-sm-10' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block"><img class='click_me' src="files/click_here.gif">Next</button></div>
+     <div class='col-sm-10' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block"><img alt='Click Here to Continue' class='click_me' src="files/click_here.gif">Next</button></div>
   </div>
   <div class='row'>
      <div class='col-sm-10' style='text-align:center;'><button type="reset" class="btn btn-warning btn-lg btn-block not_me">Clear</button></div>
   </div>
+  <div class='row'>
+     <div class='col-sm-10' style='text-align:center;'>* E-Mail is not required, and will only be used internally, if we need to reach you. It will never sold or given out.</div>
+  </div>
+     <div class='row'>
+     <div class='col-sm-10' style='text-align:center;'>** PHONE NUMBER IS REQUIRED BY STATE OF MARYLAND. WE WILL NEVER USE YOUR PHONE NUMBER - NEVER CALL - NEVER FOR TEXT MESSAGES.</div>
+  </div>
 </form>
 
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