Add files via upload

[clinton/MarylandElectronicPetitionSignature.git] / enter_information.php

diff --git a/enter_information.php b/enter_information.php
index 00d5f6d..7efb9f9 100644 (file)
--- a/enter_information.php
+++ b/enter_information.php
@@ -1,9 +1,24 @@
 <?PHP
+if (isset($_COOKIE['form_version'])){
+  if ($_COOKIE['form_version'] == '2'){ 
+   header('Location: enter_information_v2.php');
+  } 
+  if ($_COOKIE['form_version'] == '3'){ 
+    header('Location: enter_information_v2.php'); 
+  }  
+}
 if (empty($_COOKIE['signature_status'])){
    setcookie("signature_status", 'unverified');
 }
 if (isset($_POST['web_first_name'])){
-  $DOB='';
+  $email='';
+  if (isset($_POST['email'])){
+    if ($_POST['email'] != ''){
+     $email = $_POST['email'];
+     setcookie("email", $email);
+    }
+  }
+   $DOB='';
   if (isset($_POST['DOB'])){
     if ($_POST['DOB'] != ''){
      $DOB = $_POST['DOB'];
@@ -62,29 +77,35 @@ slack_general('Enter Information ('.$_COOKIE['invite'].')','md-petition');
 ?>
 <script>document.title = "MEPS - Enter Information";</script>
 <form method='POST'>
-    <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>
+    
   <div class='row'>
-    <div class='col-sm-10' 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 class='col-sm-10' style='text-align:center;'><h1><?PHP echo $dX['text_title'];?></h1><h2 style="margin:10px; padding:10px; background-color:lightyellow;"><?PHP echo $dX['text_block'];?></h2></div>
   </div>
    
-   
+      
+  <div class='row'>
+    <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-7' 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-7' 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-7'>
+     <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>
+              <span class="input-group-addon"><i class="glyphicon glyphicon-th"></i></span><input name='DOB' type="text" class="form-control input-lg" required oninvalid="this.setCustomValidity('Please enter your date of birth in the format month month slash day day slash year year year year')" oninput="this.setCustomValidity('')">
             </div>
          <script>
                var $d = jQuery.noConflict();
@@ -94,41 +115,55 @@ slack_general('Enter Information ('.$_COOKIE['invite'].')','md-petition');
                });
          </script>
        </div>
-   </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-7' 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;'><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-7' style='text-align:left; background-color:lightyellow;'><h3>443-123-4567</h3></div>
+     <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;'></div>
   </div>
-   
   <div class='row'>
-    <div class='col-sm-3' style='text-align:right;'><h2>House Number</h2></div>
-    <div class='col-sm-7' style='text-align:left;'><input class="form-control input-lg" name='web_house_number' type='number' required> </div>
- </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-7' style='text-align:left; background-color:lightyellow;'><h3>321</h3></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-7' 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-7' style='text-align:left; background-color:lightyellow;'><h3>55555</h3></div>
+     <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;'></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;'><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 with the petitioners to reach you. It will never be sold.</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>
 
 <?PHP include_once('footer.php');