Dogcows Code - chaz/p5-CGI-Ex/blob - samples/app/app1/tt/cust_info.html

   1 [% PROCESS "header.tt" title => "Account Information" %]
   2
   3 <span style="color:green">Congratulations! The test domain <b>[% domain %]</b> is available.</span><br>
   4
   5 Please enter your account information.
   6 <form name=[% form_name %] action=[% script_name %] method=post>
   7 <input type=hidden name=domain>
   8
   9 <table>
  10 <tr>
  11   <td><label>First Name:</label></td>
  12   <td><input type=text name=first_name></td>
  13   <td><span class=error id=first_name_error>[% first_name_error %]</span></td>
  14 </tr>
  15 <tr>
  16   <td><label>Last Name:</label></td>
  17   <td><input type=text name=last_name></td>
  18   <td><span class=error id=last_name_error>[% last_name_error %]</span></td>
  19 </tr>
  20 <tr>
  21   <td><label>Country:</label></td>
  22   <td>
  23     <select name=country>
  24       <option value="">Choose country</option>
  25       [%- FOR code IN countries.keys.sort %]
  26       <option value="[% code %]">[% countries.$code %]</option>
  27       [%- END %]
  28     </select>
  29   </td>
  30   <td><span class=error id=country_error>[% country_error %]</span></td>
  31 </tr>
  32 <tr>
  33   <td><label>Password:</label></td>
  34   <td><input type=text name=password></td>
  35   <td><span class=error id=password_error>[% password_error %]</span></td>
  36 </tr>
  37 <tr>
  38   <td><label>Password<br>Verify:</label></td>
  39   <td><input type=text name=password2></td>
  40   <td><span class=error id=password2_error>[% password2_error %]</span></td>
  41 </tr>
  42
  43 <tr>
  44   <td colspan=2 align=right>
  45     <input type=submit value="Bill me"><br>
  46   </td>
  47   <td>&nbsp;</td>
  48 </tr>
  49 </table>
  50
  51 </form>
  52 [% js_validation %]
  53
  54 [% PROCESS "footer.tt" %]