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index.php
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<?php
/* Listed below are the variables that contain form item names, price, and description. */
/* These are all serving samples - feel free to rename and reprice in a fashion that works for you. */
$mycompanyname = 'My Consulting Company, LLC';
$mycompanycontact = 'Pat Smith';
$mycompanyaddress = '123 Main St';
$mycompanycity = 'Anytown';
$mycompanystate = 'LA';
$mycompanyzip = '70809';
$mycompanyphone = '+1-408-352-6145';
$mycompanyfax = '+1-408-352-6145';
$mycompanyemail = "watchman@watchmanmonitoring.com";
$mycustombranding = "Watchman Monitoring";// The name of your custom branded solution
$mycompanyemailsubject = $mycustombranding . " Agreement Form";
$item1name = 'Monitored Computers'; // Required
$item1price = 10;
$item1description = 'Active monitoring for impending failure for each computer with ' . $mycustombranding .'.';
$item1url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item1get = 'monitoring';
$item2name = 'Family Pack'; // Optional -- set to '' to skip
$item2price = 15;
$item2description = 'Monitoring for a household\'s computers.';
$item2url = ''; // set to '' to remove link
$item2get = 'monitoring-family';
$item3name = 'Managed Computers'; // Optional -- set to '' to skip
$item3price = 35;
$item3description = 'Active monitoring for pending failures, as well as system & application patch management.';
$item3url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item3get = 'managed';
$item4name = 'Managed Mac Servers'; // Optional -- set to '' to skip
$item4price = 100;
$item4description = 'Active monitoring, maintenance updates & manual verification of backup systems.';
$item4url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item4get = 'servers';
$item5name = 'Managed Windows Servers'; // Optional -- set to '' to skip
$item5price = 150;
$item5description = 'Active monitoring, maintenance updates, verification of backup systems and antivirus.';
$item5url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item5get = 'winservers';
$item6name = 'Personal Support Users'; //Required
$item6price = 25;
$item6description = 'The total number of people who will be contacting ' . $mycompanyname . ' for technical support.';
$item6url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item6get = 'personal';
$item7name = 'Premier Support Users'; // Optional -- set to '' to skip
$item7price = 70;
$item7description = '(Per Person, 5 User minimum) <br />All needed email, phone, and remote support.';
$item7url = 'http://www.watchmanmonitoring.com/sample-offering/'; // set to '' to remove link
$item7get = 'premier';
$item8name = 'Monthly Prepaid Hours'; // Optional -- set to '' to skip
$item8price = 100;
$item8description = '(2 hours per month minimum) <br />1/3 off our stock hourly rate.<br />';
$item8url = 'http://www.watchmanmonitoring.com/sample-offering/';
$item8get = 'hours';
$annualdiscountpercent = '10'; // enter the value of any annual discount, e.g. 10% off
/* If you are having trouble with mail() aka sendmail.
Download the PHPMailer class from https://github.com/PHPMailer/PHPMailer
Set $usePHPMailer to TRUE to include/use PHP Mailer,
and set the following settings. */
$usePHPMailer = FALSE; // Set to TRUE to use PHPMailer
if ($usePHPMailer) {
require 'PHPMailer/PHPMailerAutoload.php';
$mail = new PHPMailer;
// $mail->SMTPDebug = 1; // Uncomment for debugging
$mail->isSMTP(); // Set mailer to use SMTP
$mail->SMTPAuth = true; // enable SMTP authentication
$mail->Port = 587; // set the SMTP port 25, 465, or 587
$mail->Host = 'smtp.myserver.com'; // Specify main and backup SMTP servers
$mail->SMTPAuth = true; // Enable SMTP authentication
$mail->Username = 'username'; // SMTP username
$mail->Password = 'password'; // SMTP password
$mail->SMTPSecure = 'tls'; // Enable encryption, 'ssl' also accepted
/* Notes on Debugging SMTP: */
// $mail->SMTPDebug = 1; // will echo errors and server responses
// $mail->SMTPDebug = 2; // will echo errors, server responses and client messages
/* And finally, don't forget to disable debugging before going into production. */
}
$error = "";
if ($_SERVER["REQUEST_METHOD"] == "POST") {
if (isset($_POST["firstname"]) && empty($_POST["firstname"]) ){
$error .= "Please fill out your first name";
}
if (isset($_POST["lastname"]) && empty($_POST["lastname"]) ){
if (!$error == "") {
$error .='<br />';
}
$error .= "Please fill out your last name";
}
if (isset($_POST["email"]) && empty($_POST["email"]) ){
if (!$error == "") {
$error .='<br />';
}
$error .= "Please enter an email address";
}
if (!filter_var($_POST["email"], FILTER_VALIDATE_EMAIL)){
if (!$error == "") {
$error .='<br />';
}
$error .= "Please enter a valid email address";
}
}
if ($_SERVER["REQUEST_METHOD"] == "POST" && empty($error) ){
if (!empty($_POST["billAnnually"]))
{
$agreementText = 'Annual Total';
$agreementAmount = strip_tags($_POST["annuallyTotal"]);
}
else
{
$agreementText = 'Monthly Total';
$agreementAmount = strip_tags($_POST["grandTotal"]);
}
?>
<?php
$company = strip_tags($_POST["company"]);
$name = strip_tags($_POST["firstname"]) . " " . strip_tags($_POST["lastname"]);
$email = strip_tags($_POST["email"]);
$address1 = strip_tags($_POST["address1"]);
$city = strip_tags($_POST["city"]);
$state = strip_tags($_POST["state"]);
$zip = strip_tags($_POST["zip"]);
$phone = strip_tags($_POST["phone"]);
$qty_item_1 = isset($_POST["qty_item_1"]) ? strip_tags($_POST["qty_item_1"]) : '';
$qty_item_2 = isset($_POST["qty_item_2"]) ? strip_tags($_POST["qty_item_2"]) : '';
$qty_item_3 = isset($_POST["qty_item_3"]) ? strip_tags($_POST["qty_item_3"]) : '';
$qty_item_4 = isset($_POST["qty_item_4"]) ? strip_tags($_POST["qty_item_4"]) : '';
$qty_item_5 = isset($_POST["qty_item_5"]) ? strip_tags($_POST["qty_item_5"]) : '';
$qty_item_6 = isset($_POST["qty_item_6"]) ? strip_tags($_POST["qty_item_6"]) : '';
$qty_item_7 = isset($_POST["qty_item_7"]) ? strip_tags($_POST["qty_item_7"]) : '';
$qty_item_8 = isset($_POST["qty_item_8"]) ? strip_tags($_POST["qty_item_8"]) : '';
$message = "
--Personal Information--
Company: $company
Name: $name
E-Mail: $email
Address: $address1
City: $city
State: $state
Zip: $zip
Phone: $phone
--Agreement Information--
$item1name: $qty_item_1
$item2name: $qty_item_2
$item3name: $qty_item_3
$item4name: $qty_item_4
$item5name: $qty_item_5
$item6name: $qty_item_6
$item7name: $qty_item_7
$item8name: $qty_item_8
Amount to be billed: $agreementAmount
Billing interval: $agreementText
";
if ($usePHPMailer) {
/* Send Summary Email with PHPMailer */
$mail->From = $email;
$mail->FromName = $name;
$mail->addAddress($mycompanyemail, $mycustombranding); // Add a recipient
$mail->addReplyTo($email, $name);
$mail->WordWrap = 70; // Set word wrap to 70 characters
$mail->isHTML(false); // Set email format to text
$mail->Subject = $mycompanyemailsubject . ' for ' . $company;
$mail->Body = $message;
if(!$mail->send()) {
echo 'Message could not be sent.';
echo 'Mailer Error: ' . $mail->ErrorInfo;
} else {
/* echo 'Message has been sent'; */
}
} else {
$headers = 'From: ' . $email . "\r\n";
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-type: text/plain; charset=iso-8859-1\r\n";
mail($mycompanyemail,$mycompanyemailsubject . " for " . $company,$message,$headers);
}
$baseurl = (isset($_SERVER['HTTPS']) ? 'https://' : 'http://').$_SERVER['SERVER_NAME'] . dirname($_SERVER['REQUEST_URI']) . '/';
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN"
"http://www.w3.org/TR/html4/strict.dtd">
<?php ob_start (); // Capture Form for email to customer ?>
<html lang="en">
<head>
<title>
<?php echo $mycompanyname; ?> Service Agreement Signup Form
</title><!-- Framework CSS -->
<link rel="stylesheet" href="<?php echo $baseurl ?>jquery.tooltip.css" type="text/css" media="screen, projection">
<link rel="stylesheet" href="<?php echo $baseurl ?>screen.css" type="text/css" media="print, screen, projection">
<!--[if lt IE 8]><link rel="stylesheet" href="<?php echo $baseurl ?>ie.css" type="text/css" media="screen, projection"><![endif]-->
<style type="text/css" media="screen">
div fieldset.sigbox {
background-color: transparent;
/* border-bottom: 1px solid #999;*/
height: 70px;
}
div.thecontainer {
position: relative;
}
.nobreak {
white-space: nowrap;
overflow: hidden;
}
body div.container h2#mylogo {
/* height: 162px;*/
display: block;
list-style-image: url(logo.png);
list-style-position: inside;
/* letter-spacing: -1000em;*/
/* font-size: 1pt; */
/* position: relative;*/
}
body div.container h2#mylogo .loseit {
display: none!important;
position: absolute;
color: #FFF;
text-indent: -999999px;
}
#mylogo img {
/* position: absolute;*/
position: relative;
text-indent: 0px!important;
top: 0px;
}
</style>
<script src="<?php echo $baseurl ?>jquery.min.js" type="text/javascript"></script>
<script src="<?php echo $baseurl ?>jquery.dimensions.min.js" type="text/javascript"></script>
<script src="<?php echo $baseurl ?>jquery.tooltip.js" type="text/javascript"></script>
</head>
<body id="index" class="index" onload="document.forms.pay.company.focus()">
<div class="container">
<!-- inactive class - showgrid -->
<h4 class="printme"><?php echo $mycompanyname; ?><br /><?php echo $mycompanyaddress; ?><br /><?php echo $mycompanycity; ?>, <?php echo $mycompanystate; ?> <?php echo $mycompanyzip; ?><br /><?php echo $mycompanyphone; ?></h4>
<h2 id="mylogo">
<img src="<?php echo $baseurl ?>logo.png" alt="" class="imageo" />
<br>
<small>Support Agreement</small>
</h2>
<hr>
<div>
<p>Your Support Agreement has been submitted. <p>
<strong>As a subscriber to our support package, you receive:</strong>
<ul>
<li>Brief emails and calls handled in 10 minutes or less, are covered by your agreement.</li>
<li>The rate for labor will be discounted from $150 to $120 an hour</li>
<li>Hardware and software sales will enjoy a 5.5% discount</li>
</ul>
<p>
<strong>Your Monitored Computers will have:</strong>
</p>
<ul>
<li>Automated monitoring and reporting on the overall health of your computer</li>
<li>A chance to identify small problems before they get develop to large ones, or to data loss.</li>
<li>Active notification of issues <?php echo $mycustombranding; ?> finds as it checks your backup status, hard drive, and more.</li>
<li>You get peace of mind knowing that <?php echo $mycompanyname; ?> will contact you if your computer is showing signs of failure.</li>
</ul>
<p>
We will enter your agreement into our system, send your invoice, and coordinate payment information with you directly.
Phone and email support is available immediately, and we will coordinate a time to install our monitoring software.
Thank you for your business and continued support.
</p>
<p style="text-align: right;"><em>Sincerely,</em><br> <strong><?php echo $mycompanycontact; ?></strong> and <strong><?php echo $mycompanyname; ?></strong></p>
</div>
<hr>
<div class="thecontainer">
<div class="span-8">
<fieldset>
<legend>Your Billing Information</legend>
<table border="0" cellspacing="0" cellpadding="0">
<tr>
<td><label class="span-2" for="company">Company</label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["company"]; ?></td>
</tr>
<tr>
<td><label class="span-2" for="firstname">Name</label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["firstname"] . " " . $_POST["lastname"]; ?></td>
</tr>
<tr>
<td><label class="form-label" for="email">Email</label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["email"]; ?></td>
</tr>
<tr>
<td><label class="span-2" for="address1">Address</label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["address1"]; ?></td>
</tr>
<tr>
<td><label class="form-label" for="city"></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["city"] . ", " . $_POST["state"] . ", " . $_POST["zip"]; ?></td>
</tr>
<tr>
<td><label class="form-label" for="phone">Phone</label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["phone"]; ?></td>
</tr>
</table>
</fieldset>
</div>
<div class="span-8">
<fieldset>
<legend>Monthly Agreement Quantities</legend>
<table border="0" cellspacing="0" cellpadding="0">
<?php if ($item1name) { ?>
<tr>
<td><label class="form-label" for="qty_item_1"><?php echo $item1name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_1"]; ?></td>
</tr>
<?php }
if ($item2name) { ?>
<tr>
<td><label class="form-label" for="qty_item_2"><?php echo $item2name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_2"]; ?></td>
</tr>
<?php }
if ($item3name) { ?>
<tr>
<td><label class="form-label" for="qty_item_3"><?php echo $item3name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_3"]; ?></td>
</tr>
<?php }
if ($item4name) { ?>
<tr>
<td><label class="form-label" for="qty_item_4"><?php echo $item4name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_4"]; ?></td>
</tr>
<?php }
if ($item5name) { ?>
<tr>
<td><label class="form-label" for="qty_item_5"><?php echo $item5name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_5"]; ?></td>
</tr>
<?php }
if ($item6name) { ?>
<tr>
<td><label class="form-label" for="qty_item_6"><?php echo $item6name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_6"]; ?></td>
</tr>
<?php }
if ($item7name) { ?>
<tr>
<td><label class="form-label" for="qty_item_7"><?php echo $item7name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_7"]; ?></td>
</tr>
<?php }
if ($item8name) { ?>
<tr>
<td><label class="form-label" for="qty_item_8"><?php echo $item8name; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $_POST["qty_item_8"]; ?></td>
</tr>
<?php } ?>
<tr>
<td><label class="form-label"><?php echo $agreementText; ?></label></td>
<td style="text-align: right;" align="right"><?php echo $agreementAmount; ?></td>
</tr>
</table>
</fieldset>
</div>
<div class="span-8 last nobreak" style="height: 238px; position: relative">
<fieldset class="sigbox" style="margin-left: 20px;">
<legend>Authorized Signature</legend>
<p style="margin-top: 40px;">____________________________________</p>
</fieldset>
</div>
</div>
<br><br>
</div><!-- close: content -->
<div class="container">
<p><strong>Please print, sign, and return this form. Either in person, mail, or fax to <?php echo $mycompanyfax; ?><strong></p>
</div>
<div id="footer">
<!-- Footer Stuff -->
</div><!-- close: footer -->
<!-- close: kontainer -->
</body>
</html>
<?php
$customerform = ob_get_contents(); // Capture the form to a variable to send as email
ob_end_flush(); // Flush the output buffer & display page
// Send the form to the customer
if ($usePHPMailer) {
/* Send form to the customer as Email with PHPMailer */
$mail->From = $mycompanyemail;
$mail->FromName = $mycustombranding;
$mail->addAddress($email, $name); // Add a recipient
$mail->addBCC($mycompanyemail); // Add a BCC to ourselves
$mail->addReplyTo($email, $name);
$mail->WordWrap = 70; // Set word wrap to 70 characters
$mail->isHTML(true); // Set email format to text
$mail->Subject = $mycompanyemailsubject;
$mail->Body = $customerform;
if(!$mail->send()) {
echo 'Message could not be sent.';
echo 'Mailer Error: ' . $mail->ErrorInfo;
} else {
/* echo 'Message has been sent'; */
}
} else {
$headers = "From:" . $mycompanyemail . "\r\n";
$headers .= "BCC: " . $mycompanyemail . "\r\n";
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-Type: text/html; charset=ISO-8859-1\r\n";
mail($email,$mycompanyemailsubject,$customerform,$headers);
}
}
else {
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN"
"http://www.w3.org/TR/html4/strict.dtd">
<html lang="en">
<head>
<title>
Support Agreement
</title><!-- Framework CSS -->
<link rel="stylesheet" href="jquery.tooltip.css" type="text/css" media="screen, projection">
<link rel="stylesheet" href="screen.css" type="text/css" media="screen, projection">
<link rel="stylesheet" href="print.css" type="text/css" media="print"><!--[if lt IE 8]><link rel="stylesheet" href="ie.css" type="text/css" media="screen, projection"><![endif]-->
<style type="text/css" media="screen">
table, td, th {
vertical-align: baseline;
}
table.bvalign, td.bvalign, th.bvalign {
vertical-align: bottom;
}
#grandTotal {
margin: 2px 0px;
}
</style>
<script type="text/javascript" src="jquery-1.4.2.min.js"></script>
<script type="text/javascript" src="jquery-ui-1.8.4.custom.min.js"></script>
<script type="text/javascript" src="jquery.field.js"></script>
<script type="text/javascript" src="jquery.calculation.js"></script>
<script type="text/javascript" src="jquery.validate.js"></script>
<script type="text/javascript" src="jquery.supportform.js"></script>
<link rel="shortcut icon" href="favicon.ico" />
</head>
<body id="index" class="index">
<div class="container">
<!-- inactive class - showgrid -->
<h4 class="printme"><?php echo $mycompanyname; ?><br /><?php echo $mycompanyaddress; ?><br /><?php echo $mycompanycity; ?>, <?php echo $mycompanystate; ?> <?php echo $mycompanyzip; ?><br /><?php echo $mycompanyphone; ?></h4>
<h2 id="mylogo">
<br>
<small>Monthly Support Agreement</small>
</h2>
<?php
if (!$error == "") { ?>
<div style="font-family:Arial, Helvetica, sans-serif; font-size:13px;color: #D8000C;background-color: #FFBABA;border: 1px solid;margin: 10px 0px;padding:15px 10px 15px 10px;background-repeat: no-repeat;background-position: 10px center;"><?php echo $error?></div>
<?php } ?>
<hr>
<div>
<h3 id=""><strong>Thank you for choosing <?php echo $mycompanyname; ?></strong></h3>
<p>
This Monthly Support Agreement sign-up form creates an agreement between <?php echo $mycompanyname; ?> and you, the Client.
</p>
<h3 id=""><strong>Members of our Personal Support agreement receive:</strong></h3>
<ul>
<li>Brief emails and calls handled in 10 minutes or less, are covered by your agreement.</li>
<li>The rate for labor will be discounted from $150 to $120 an hour</li>
<li>Hardware and software sales will enjoy a 5.5% discount</li>
</ul>
<h3 id=""><strong>Monitored Computers have:</strong></h3>
<ul>
<li>Automated monitoring and reporting on the overall health of your computer, via <?php echo $mycustombranding; ?></li>
<li>A chance to identify small problems before they become large ones, or lead to data loss.</li>
<li>Active notification of issues discovered by <?php echo $mycustombranding; ?>, as it checks your backup status, hard drive, and more.</li>
<li>You get peace of mind knowing that the <?php echo $mycompanyname; ?> will contact you if your computer is showing signs of failure.</li>
</ul>
<h3 id=""><strong>To create your support agreement</strong></h3>
<p font size="11">
<strong>Enter your billing contact information</strong><br>
We will email PDF copies of your invoice to this address. Please contact us if you prefer copies to be mailed or faxed.
<br><br>
<strong>Adjust the quantities for each category of support</strong><br>
See the notes by each category to tailor the support agreement for your needs.<br>
We recommend adding Personal Support for each person who enjoys having our services available.<br>
Pre-payment for hours on a monthly basis is requested by some clients, however this is not a requirement for our services.<br>
We understand choosing the right agreement for you can be complex. We are happy to speak with you to create your agreement. Call <?php echo $mycompanyphone; ?>.
</p>
<p style="text-align: right;"><em>Sincerely,</em><br> <strong><?php echo $mycompanycontact; ?></strong> and <strong><?php echo $mycompanyname; ?></strong></p>
</div>
<hr>
<!-- <div class="span-8"> -->
<form action="<?php echo htmlspecialchars($_SERVER["PHP_SELF"]);?>" method="post" accept-charset="utf-8" name="pay" id="pay">
<div class="span-9">
<fieldset>
<legend><span class="order_num">1</span> Your Contact Information</legend>
<div class="span-8">
<label class="span-2" for="company">Company (if applicable)</label><br>
<input type="text" name="company" value="<?php if (isset($_GET["company"])){echo $_GET["company"];} ?><?php if (isset($_POST["company"])){echo $_POST["company"];}?>" id="company" style="width: 300px;" class="text"><br>
</div>
<div class="span-4">
<label class="span-2" for="firstname">First Name <span style="color:red;">*</span></label><br>
<input type="text" name="firstname" value="<?php if (isset($_GET["firstname"])){echo $_GET["firstname"];} ?><?php if (isset($_POST["firstname"])){echo $_POST["firstname"];}?>" id="firstname" style="width: 135px;" class="text"><br>
</div>
<div class="span-4">
<label class="span-2" for="lastname">Last Name <span style="color:red;">*</span></label><br>
<input type="text" name="lastname" value="<?php if (isset($_GET["lastname"])){echo $_GET["lastname"];} ?><?php if (isset($_POST["lastname"])){echo $_POST["lastname"];}?>" id="lastname" style="width: 140px;" class="text"><br>
</div>
<div class="span-8">
<label class="form-label" for="email">Billing Email Address <span style="color:red;">*</span></label><br>
<input type="text" name="email" value="<?php if (isset($_GET["email"])){echo $_GET["email"];} ?><?php if (isset($_POST["email"])){echo $_POST["email"];}?>" id="email" style="width: 300px!important;" class="text"><br>
</div>
<div class="span-8">
<label class="span-2" for="address1">Address</label><br>
<input type="text" name="address1" value="<?php if (isset($_GET["address"])){echo $_GET["address"];} ?><?php if (isset($_POST["address1"])){echo $_POST["address1"];}?>" id="address1" style="width: 300px!important;" class="text"><br>
</div>
<div class="span-4">
<label class="form-label" for="city">City</label><br>
<input type="text" name="city" value="<?php if (isset($_GET["city"])){echo $_GET["city"];} ?><?php if (isset($_POST["city"])){echo $_POST["city"];}?>" id="city" class="text"><br>
</div>
<div class="span-1">
<label class="form-label" for="state">State</label><br>
<input type="text" name="state" value="<?php if (isset($_GET["state"])){echo $_GET["state"];} ?><?php if (isset($_POST["state"])){echo $_POST["state"];}?>" id="state" style="width: 30px!important;" class="text"><br>
</div>
<div class="span-2">
<label class="form-label" for="zip">Zip</label><br>
<input type="text" name="zip" value="<?php if (isset($_GET["zip"])){echo $_GET["zip"];} ?><?php if (isset($_POST["zip"])){echo $_POST["zip"];}?>" id="zip" style="width: 80px!important;" class="text"><br>
</div>
<div class="span-4">
<label class="form-label" for="phone">Phone</label><br>
<input type="text" name="phone" value="<?php if (isset($_GET["phone"])){echo $_GET["phone"];} ?><?php if (isset($_POST["phone"])){echo $_POST["phone"];}?>" id="phone" style="width: 135px!important;" class="text">
</div>
<div class="span-4">
<label class="form-label" for="fax">Fax</label><br>
<input type="text" name="fax" value="<?php if (isset($_GET["fax"])){echo $_GET["fax"];} ?><?php if (isset($_POST["fax"])){echo $_POST["fax"];}?>" id="fax" style="width: 140px!important;" class="text">
</div>
</fieldset>
</div>
<div class="span-14">
<fieldset>
<legend><span class="order_num">2</span> Monitoring and Management</legend>
<table width="400">
<col style="width: 276px;" />
<col />
<col style="width: 40px;" />
<col style="width: 72px;" />
<tr>
<th align="left">
</th>
<th align="right" style="padding-right: 10px; text-align: right;">
</th>
<th align="right" style="text-align: right;">
Qty
</th>
<th align="right" style="text-align: right;" >
Total
</th>
</tr>
<tr>
<td valign="top">
<?php if ($item1url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item1name; ?></strong><?php if ($item1url) { echo '</a>'; } ?><br>
<?php echo $item1description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_1">$<?php echo $item1price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_1" id="qty_item_1" value="<?php if (isset($_GET[$item1get])){echo $_GET[$item1get];} ?><?php if (isset($_POST["qty_item_1"])){echo $_POST["qty_item_1"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_1">
</td>
</tr>
<?php if ($item2name) { ?>
<tr>
<td valign="top">
<?php if ($item2url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item2name; ?></strong><?php if ($item2url) { echo '</a>'; } ?><br>
<?php echo $item2description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_2">$<?php echo $item2price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_2" id="qty_item_2" value="<?php if (isset($_GET[$item2get])){echo $_GET[$item2get];} ?><?php if (isset($_POST["qty_item_2"])){echo $_POST["qty_item_2"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_2">
</td>
</tr>
<?php } ?>
<?php if ($item3name) { ?>
<tr>
<td valign="top">
<?php if ($item3url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item3name; ?></strong><?php if ($item3url) { echo '</a>'; } ?><br>
<?php echo $item3description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_3">$<?php echo $item3price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_3" id="qty_item_3" value="<?php if (isset($_GET[$item3get])){echo $_GET[$item3get];} ?><?php if (isset($_POST["qty_item_3"])){echo $_POST["qty_item_3"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_3">
</td>
</tr>
<?php } ?>
<?php if ($item4name) { ?>
<tr>
<td valign="top">
<?php if ($item4url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item4name; ?></strong><?php if ($item4url) { echo '</a>'; } ?><br>
<?php echo $item4description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_4">$<?php echo $item4price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_4" id="qty_item_4" value="<?php if (isset($_GET[$item4get])){echo $_GET[$item4get];} ?><?php if (isset($_POST["qty_item_4"])){echo $_POST["qty_item_4"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_4">
</td>
</tr>
<?php } ?>
<?php if ($item5name) { ?>
<tr>
<td valign="top">
<?php if ($item5url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item5name; ?></strong><?php if ($item5url) { echo '</a>'; } ?><br>
<?php echo $item5description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_5">$<?php echo $item5price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_5" id="qty_item_5" value="<?php if (isset($_GET[$item5get])){echo $_GET[$item5get];} ?><?php if (isset($_POST["qty_item_5"])){echo $_POST["qty_item_5"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_5">
</td>
</tr>
<?php } ?>
</table>
<legend><span class="order_num">3</span> Support</legend>
<table width="400">
<col style="width: 276px;" />
<col />
<col style="width: 40px;" />
<col style="width: 72px;" />
<?php if ($item6name) { ?>
<tr>
<td valign="top">
<?php if ($item6url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item6name; ?></strong><?php if ($item6url) { echo '</a>'; } ?><br>
<?php echo $item6description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_6">$<?php echo $item6price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_6" id="qty_item_6" value="<?php if (isset($_GET[$item6get])){echo $_GET[$item6get];} ?><?php if (isset($_POST["qty_item_6"])){echo $_POST["qty_item_6"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_6">
</td>
</tr>
<?php } ?>
<?php if ($item7name) { ?>
<tr>
<td valign="top">
<?php if ($item7url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item7name; ?></strong><?php if ($item7url) { echo '</a>'; } ?><br>
<?php echo $item7description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_7">$<?php echo $item7price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_7" id="qty_item_7" value="<?php if (isset($_GET[$item7get])){echo $_GET[$item7get];} ?><?php if (isset($_POST["qty_item_7"])){echo $_POST["qty_item_7"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_7">
</td>
</tr>
<?php } ?>
<?php if ($item8name) { ?>
<tr>
<td valign="top">
<?php if ($item8url) { echo '<a style="color:black; text-decoration: none;" target=_blank href="' . $item1url . '">';} ?><strong><?php echo $item8name; ?></strong><?php if ($item8url) { echo '</a>'; } ?><br>
<?php echo $item8description; ?>
</td>
<td valign="top" align="right" style="padding-right: 10px; text-align: right;">
<span id="price_item_8">$<?php echo $item8price; ?></span>
</td>
<td valign="top" align="center" style="text-align: right;">
<input type="text" name="qty_item_8" id="qty_item_8" value="<?php if (isset($_GET[$item8get])){echo $_GET[$item8get];} ?><?php if (isset($_POST["qty_item_8"])){echo $_POST["qty_item_8"];}?>" size="2" style="text-align: right;"/>
</td>
<td valign="top" style="text-align: right;" align="right" id="total_item_8">
</td>
</tr>
<?php } ?>
<tr>
<td valign="bottom" colspan="3" align="right" style="text-align: right;" class="bvalign">
<span style="font-size: 17px; ">Monthly Total</span>
</td>
<td valign="bottom" align="right" class="bvalign">
<input type="text" style="width: 72px; text-align: right; font-size: 15px; border: none; background-color: transparent!important;" READONLY name="grandTotal" value="" id="grandTotal"/>
</td>
</tr>
</td>
<td valign="bottom" align="right" class="bvalign">
<br>
</td>
</tr>
<tr>
<td valign="bottom" colspan="1" align="left" style="text-align: left;" class="bvalign">
<span style="font-size: 10px;"><input type="checkbox" style="" name="billAnnually" value=<?php echo 1 - ($annualdiscountpercent / 100); ?> id="billAnnually"/>If you would prefer to pay annually,<br>we offer a <?php echo $annualdiscountpercent; ?>% convenience discount.</span>
</td>
<td valign="middle" colspan="2" align="right" style="text-align: right;" class="bvalign" id="annually_spot">
<span id="annually_total_label" style="font-size: 17px; ">Annual Total</span>
</td>
<td valign="bottom" align="right" class="bvalign" id="annually_placeholder">
<input type="text" style="width: 72px; text-align: right; font-size: 15px; border: none; background-color: transparent!important;" READONLY name="annuallyTotal" id="annuallyTotal" value="0.00" />
</table>
<input id="the_email" value="" type="text">
<!-- V - Height adjustment below submit button -->
<p class="right" style="margin-bottom: 85px;">
<input type="submit" id="thesubmitbutton" value="Submit Agreement Request →" class="order">
</p>
</fieldset>
</div>
</form><br />
</div><!-- close: content -->
<div id="footer">
<!-- Footer Stuff -->
</div><!-- close: footer -->
<!-- close: kontainer -->
</body>
</html>
<?php } ?>