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Registration form for Mibew Hosting.

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git-svn-id: https://webim.svn.sourceforge.net/svnroot/webim/trunk@546 c66351dc-e62f-0410-b875-e3a5c0b9693f
This commit is contained in:
Ed Kraus 2009-06-06 02:47:08 +00:00
parent c36dbbe60c
commit 8daefb9685
1 changed files with 60 additions and 0 deletions
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site/login/register-hosting.php Normal file
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<form id="loginForm" name="loginForm" method="post" action=".php">
<table width="300" border="0" align="center" cellpadding="2" cellspacing="0">
<tr>
<th>First Name </th>
<td><input name="fname" type="text" class="textfield" id="fname" /></td>
</tr>
<tr>
<th>Last Name </th>
<td><input name="lname" type="text" class="textfield" id="lname" /></td>
</tr>
<tr>
<th>City </th>
<td><input name="city" type="text" class="textfield" id="city" /></td>
</tr>
<tr>
<th>State </th>
<td><input name="state" type="text" class="textfield" id="state" /></td>
</tr>
<tr>
<th>Country </th>
<td><input name="country" type="text" class="textfield" id="country" /></td>
</tr>
<tr>
<th>Phone </th>
<td><input name="phone" type="text" class="textfield" id="phone" /></td>
</tr>
<tr>
<th>Email </th>
<td><input name="email" type="text" class="textfield" id="email" /></td>
</tr>
<tr>
<th width="124">Login</th>
<td width="168"><input name="login" type="text" class="textfield" id="login" /></td>
</tr>
<tr>
<th>Password</th>
<td><input name="password" type="text" class="textfield" id="password" /></td>
</tr>
<tr>
<th>Confirm Password </th>
<td><input name="cpassword" type="text" class="textfield" id="cpassword" /></td>
</tr>
<div align="center" ><font color="red">Please click the PayPal button before you click submit!</font></div>
<tr>
<td>&nbsp;</td>
<td><input type="submit" name="Submit" value="Register" /></td>
</tr>
</table>
<div align="center" >Your username will follow http://host.mibew.com/. </div>
<div align="center" ><font color="red">If you have any questions, please don't fill this out. Post a ticket <a href="http://support.openwebim.org"> Click here </a></font> </div>
</form>
<form align="center" action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input align="center" type="hidden" name="cmd" value="_s-xclick">
<input type="hidden" name="hosted_button_id" value="5951679">
<input type="image" src="https://www.paypal.com/en_US/i/btn/btn_buynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">
<img align="center" alt="" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif" width="1" height="1">
</form>