Update enter_information.php

[clinton/MarylandElectronicPetitionSignature.git] / enter_information.php

diff --git a/enter_information.php b/enter_information.php
index cbd9436..8b91ed6 100644 (file)
--- a/enter_information.php
+++ b/enter_information.php
@@ -1,4 +1,7 @@
 <?PHP
+if (empty($_COOKIE['signature_status'])){
+   setcookie("signature_status", 'unverified');
+}
 if (isset($_POST['web_first_name'])){
   $DOB='';
   if (isset($_POST['DOB'])){
@@ -38,37 +41,76 @@ if (isset($_POST['web_first_name'])){
      setcookie("web_zip_code", $web_zip_code);
     }
   }
+  $contact_phone='';
+  if (isset($_POST['contact_phone'])){
+    if ($_POST['contact_phone'] != ''){
+     $contact_phone = $_POST['contact_phone'];
+     setcookie("pPHONE", $contact_phone);
+    }
+  }
   header('Location: is_the_information_correct.php');
 }
 include_once('header.php');
+slack_general('Entering Information','md-petition');
+ $qX = "select * from website_text where id = '2'";
+ $rX = $petition->query($qX);
+ $dX = mysqli_fetch_array($rX);
 ?>
+<script>document.title = "MEPS - Enter Information";</script>
 <form method='POST'>
+  
   <div class='row'>
-    <div class='col-sm-12' style='height:100px; text-align:center;'><h3>Please enter your Name and ZIP Code as it appears on your Maryland Voter Registration</h3></div>
+    <div class='col-sm-8' style='text-align:center;'><h1><?PHP echo $dX['text_title'];?></h1><h2 style="margin:25px; padding25px; background-color:lightyellow;"><?PHP echo $dX['text_block'];?></h2></div>
   </div>
+   
+   
   <div class='row'>
-    <div class='col-sm-4' style='height:50px; text-align:center;'><h3>First Name</h3></div>
-    <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Last Name</h3></div>
-    <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Date of Birth</h3></div>
-  </div>
+    <div class='col-sm-3' style='text-align:right;'><h2>First Name</h2></div>
+    <div class='col-sm-5' style='text-align:left;'><input class="form-control input-lg" name='web_first_name'></div>
+  </div>  
+   
   <div class='row'>
-    <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_first_name'></div>
-    <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_last_name'></div> 
-    <div class='col-sm-4' style='height:50px; text-align:center;'><input name='DOB' type="date"></div>
-    </div>
+     <div class='col-sm-3' style='text-align:right;'><h2>Last Name</h2></div>
+     <div class='col-sm-5' style='text-align:left;'><input class="form-control input-lg" name='web_last_name'></div> 
+  </div> 
+   
   <div class='row'>
-    <div class='col-sm-6' style='height:50px; text-align:center;'><h3>House Number</h3></div>
-    <div class='col-sm-6' style='height:50px; text-align:center;'><h3>ZIP Code</h3></div>
+     <div class='col-sm-3' style='text-align:right;'><h2>Date of Birth</h2></div>
+     <div class='col-sm-5'>
+            <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">
+            </div>
+         <script>
+               var $d = jQuery.noConflict();
+               $d('.input-group.date').datepicker({
+                   format: "mm/dd/yyyy",
+                   clearBtn: true
+               });
+         </script>
+       </div>
+   </div>
+      
+   <div class='row'>
+      <div class='col-sm-3' style='text-align:right;'><h2>Phone Number</h2></div>
+      <div class='col-sm-5' style='text-align:left;'><input class="form-control input-lg" name='contact_phone' type='tel'> </div>
   </div>
+   
   <div class='row'>
-    <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_house_number'> </div>
-    <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_zip_code'> </div>
-  </div>
+    <div class='col-sm-3' style='text-align:right;'><h2>House Number</h2></div>
+    <div class='col-sm-5' style='text-align:left;'><input class="form-control input-lg" name='web_house_number' type='number'> </div>
+ </div>  
+      
   <div class='row'>
-    <div class='col-sm-12' style='height:50px; text-align:center;'><button type="submit" class="btn btn-success">Next</button></div>
+     <div class='col-sm-3' style='text-align:right;'><h2>ZIP Code</h2></div>
+     <div class='col-sm-5' style='text-align:left;'><input class="form-control input-lg" name='web_zip_code' type='number'> </div>
   </div>
+   
+   
   <div class='row'>
-    <div class='col-sm-12' style='height:50px; text-align:center;'><button type="reset" class="btn btn-warning">Clear</button></div>
+    <div class='col-sm-4' style='text-align:center;'><button type="reset" class="btn btn-warning btn-lg btn-block">Clear</button></div>
+    <div class='col-sm-4' style='text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">Next</button></div>
   </div>
+   
 </form>
+
 <?PHP include_once('footer.php');