<?php include ("../php/connect.php");?>
<?php include ("../php/content.php");?>
<?php include ("php/nav.php");?>
<?php include ("php/cart.php");?>
<?php include ("php/training.php");?>
<?php include ("php/secure.php");?>
<?php
date_default_timezone_set("America/Chicago");
$Now = date('Y-m-d H:i:s');
$GetIP = $_SERVER['REMOTE_ADDR'];
$ip = $GetIP;
$Page = 'checkout.php';
$UserID = $_SESSION['MM_UserGroup'];
$todaydate = date("Y-m-d");
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "INSERT INTO SMBDU_Tracker (date, IP, page, userID) VALUES ('$Now', '$GetIP','$Page', '$UserID')");
$cid = $_SESSION['MM_UserGroup'];
$query_GetUser = "SELECT * FROM School_Users WHERE id='$cid'";
$GetUser = mysqli_query($SMB, $query_GetUser);
$row_GetUser = mysqli_fetch_assoc($GetUser);
$totalRows_GetUser = mysqli_num_rows($GetUser);
$GetCID = $row_GetUser['id'];
$GetName = $row_GetUser['first_name'];
$LastName = $row_GetUser['last_name'];
$Practice = $row_GetUser['practice'];
$Dentist = $row_GetUser['Dentist'];
$Address = $row_GetUser['address'];
$City = $row_GetUser['city'];
$State = $row_GetUser['state'];
$Zip = $row_GetUser['zip'];
$Email = $row_GetUser['email_address'];
$Phone = $row_GetUser['phone_number'];
// Get Gart
$query_ShoppingCart = "SELECT * FROM School_Cart WHERE cid = '$cid'";
$ShoppingCart = mysqli_query($SMB, $query_ShoppingCart);
$totalRows_ShoppingCart = mysqli_num_rows($ShoppingCart);
if($totalRows_ShoppingCart > 0) {
$Cart_Output .= '<div class="grid_100"><table width="100%" border="0" cellpadding="2" cellspacing="2" class="TbleBrd">
<tbody>
<tr bgcolor="#F7F7E6">
<td width="15%" height="50" align="left" valign="middle"> </td>
<td width="40%" align="left" valign="middle" class="CartHdr">Product Name</td>
<td width="25%" align="center" valign="middle" class="CartHdr">Access</td>
<td width="10%" align="center" valign="middle" class="CartHdr">Price</td>
<td width="10%" align="left" valign="middle"> </td>
</tr>';
while($row_ShoppingCart = mysqli_fetch_assoc($ShoppingCart)){
$ShoppingCart_Name = $row_ShoppingCart['product_name'];
$ShoppingCart_Price = $row_ShoppingCart['price'];
$ShoppingCart_id = $row_ShoppingCart['id'];
$ShoppingCart_CourseID = $row_ShoppingCart['CourseID'];
$ShoppingCart_BookID = $row_ShoppingCart['bookID'];
$ShoppingCart_ModuleID = $row_ShoppingCart['ModuleID'];
$ShoppingCart_image = $row_ShoppingCart['image'];
$ShoppingCart_duration = $row_ShoppingCart['durationDescription'];
$ShoppingCart_Promo = $row_ShoppingCart['promo_code'];
$ShoppingCart_Discount = $row_ShoppingCart['promo_discount'];
$TotalDiscount = $ShoppingCart_Discount + $TotalDiscount;
$SubTotal = $ShoppingCart_Price + $SubTotal;
if($ShoppingCart_Promo != ''){
$ShowPromoCode = $ShoppingCart_Promo;
}
if($ShoppingCart_BookID > 0){
$AddShip = 1;
}
else {
$AddShip = 0;
}
$AddShipping = $AddShip + $AddShipping;
if($ShoppingCart_BookID > 0){
$ImgExt = 'https://www.successfulmedicalbilling.com/images/';
}
else {
$ImgExt = 'https://www.successfulmedicalbilling.com/admin/school/img/';
}
$Cart_Output .= '<tr>
<td align="left" valign="middle"><img src="'.$ImgExt.''.$ShoppingCart_image.'" width="100" class="TbleBrdImg"/></td>
<td align="left" valign="middle">'.$ShoppingCart_Name.'</td>
<td align="center" valign="middle">'.$ShoppingCart_duration.'</td>
<td align="center" valign="middle">$'.$ShoppingCart_Price.'</td>
<td align="center" valign="middle"><a href="php/cart.php?delete='.$ShoppingCart_id.'"><img src="https://www.successfulmedicalbilling.com/admin/school/assets/trash-icon.png" width="20"/></a></td>
</tr>';
$CheckoutCart_Output .= '<tr>
<td align="left" valign="middle" width="20%" height="100"><img src="'.$ImgExt.''.$ShoppingCart_image.'" width="75"/></td>
<td align="left" valign="middle" width="60%">'.$ShoppingCart_Name.'</td>
<td align="right" valign="middle" width="20%">$'.$ShoppingCart_Price.'</td>
</tr>';
}
if($AddShipping > 0) {
$Cart_Shipping = 8.00;
}
else {
$Cart_Shipping = 0.00;
}
$GrandTotal = (($SubTotal + $Cart_Shipping) - $TotalDiscount);
if($TotalDiscount > 0){
$ShowDiscount = '<tr>
<td height="30" colspan="2" align="left" valign="middle">Discount('.$ShoppingCart_Promo.'): </td>
<td align="right" valign="middle">- $'.number_format($TotalDiscount, 2).'</td>
</tr>';
}
else {
$ShowDiscount = '';
}
$Cart_Output .= '</tbody></table></div>';
$Cart_Total = '<div class="CartTotalDiv">
<h4>$'.number_format($GrandTotal, 2).'</h4>
<p>Tax and shipping included if applicable</p>
</div>';
$Chechout_Btn = '<div class="CheckoutDiv">
<a class="btn" href="checkout.php">Checkout</a>
</div>';
}
else {
$Cart_Output .='<h6>You do not have any items in your cart yet.</h6>';
$Cart_Total = '';
$Chechout_Btn = '';
}
// Add Promo to Cart
if ((isset($_POST["PromoCode"])) && ($_POST["PromoCode"] != "")) {
$PromoCode = $_POST['PromoCode'];
// Clear Discounts
$query_ServicePromo = "SELECT * FROM School_Cart WHERE cid = '$cid'";
$ServicePromo = mysqli_query($SMB, $query_ServicePromo);
$totalRows_ServicePromo = mysqli_num_rows($ServicePromo);
if($totalRows_ServicePromo > 0) {
$ServiceAdded = 1;
while($row_ServicePromo = mysqli_fetch_assoc($ServicePromo)){
$ServicePromo_id = $row_ServicePromo['id'];
$ServicePromo_Type = $row_ServicePromo['type'];
$ServicePromo_Price = $row_ServicePromo['price'];
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='', promo_discount='' WHERE id='$ServicePromo_id'");
}}
$query_Add_Promo = "SELECT * FROM SMBDU_Promo
WHERE promo = '$PromoCode' AND start_date <= '$todaydate' AND end_date >= '$todaydate'";
$Add_Promo = mysqli_query($SMB, $query_Add_Promo);
$totalRows_Add_Promo = mysqli_num_rows($Add_Promo);
if($totalRows_Add_Promo > 0){
while($row_Add_Promo = mysqli_fetch_assoc($Add_Promo)){
$Get_Promo_Code = $row_Add_Promo['promo'];
$Get_Promo_Percent = $row_Add_Promo['discount'];
$Get_Promo_Course = $row_Add_Promo['Course'];
$Get_Promo_Module = $row_Add_Promo['Module'];
$Get_Promo_Book = $row_Add_Promo['Book'];
$Get_Promo_Service = $row_Add_Promo['Service'];
if($Get_Promo_Course == 1){
// Update Cart Promo for Course
$query_CoursePromo = "SELECT * FROM School_Cart WHERE cid = '$cid' AND type='Course'";
$CoursePromo = mysqli_query($SMB, $query_CoursePromo);
$totalRows_CoursePromo = mysqli_num_rows($CoursePromo);
if($totalRows_CoursePromo > 0) {
$CourseAdded = 1;
while($row_CoursePromo = mysqli_fetch_assoc($CoursePromo)){
$CoursePromo_id = $row_CoursePromo['id'];
$CoursePromo_Type = $row_CoursePromo['type'];
$CoursePromo_Price = $row_CoursePromo['price'];
$GetPecentage = $Get_Promo_Percent/100;
$GetDiscount = number_format(($CoursePromo_Price * $GetPecentage), 2);
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='$Get_Promo_Code', promo_discount='$GetDiscount' WHERE id='$CoursePromo_id'");
}}
}
if($Get_Promo_Course == 0){
$CourseAdded = 0;
}
if($Get_Promo_Module == 1){
// Update Cart Promo for Course
$query_ModulePromo = "SELECT * FROM School_Cart WHERE cid = '$cid' AND type='Module'";
$ModulePromo = mysqli_query($SMB, $query_ModulePromo);
$totalRows_ModulePromo = mysqli_num_rows($ModulePromo);
if($totalRows_ModulePromo > 0) {
$ModuleAdded = 1;
while($row_ModulePromo = mysqli_fetch_assoc($ModulePromo)){
$ModulePromo_id = $row_ModulePromo['id'];
$ModulePromo_Type = $row_ModulePromo['type'];
$ModulePromo_Price = $row_ModulePromo['price'];
$GetPecentage = $Get_Promo_Percent/100;
$GetDiscount = number_format(($ModulePromo_Price * $GetPecentage), 2);
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='$Get_Promo_Code', promo_discount='$GetDiscount' WHERE id='$ModulePromo_id'");
}}
}
if($Get_Promo_Module == 0){
$ModuleAdded = 0;
}
if($Get_Promo_Book == 1){
// Update Cart Promo for Course
$query_BookPromo = "SELECT * FROM School_Cart WHERE cid = '$cid' AND type='Book'";
$BookPromo = mysqli_query($SMB, $query_BookPromo);
$totalRows_BookPromo = mysqli_num_rows($BookPromo);
if($totalRows_BookPromo > 0) {
$BookAdded = 1;
while($row_BookPromo = mysqli_fetch_assoc($BookPromo)){
$BookPromo_id = $row_BookPromo['id'];
$BookPromo_Type = $row_BookPromo['type'];
$BookPromo_Price = $row_BookPromo['price'];
$GetPecentage = $Get_Promo_Percent/100;
$GetDiscount = number_format(($BookPromo_Price * $GetPecentage), 2);
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='$Get_Promo_Code', promo_discount='$GetDiscount' WHERE id='$BookPromo_id'");
}}
}
if($Get_Promo_Book == 0){
$BookAdded = 0;
}
if($Get_Promo_Service == 1){
// Update Cart Promo for Course
$query_ServicePromo = "SELECT * FROM School_Cart WHERE cid = '$cid' AND type='AddOn'";
$ServicePromo = mysqli_query($SMB, $query_ServicePromo);
$totalRows_ServicePromo = mysqli_num_rows($ServicePromo);
if($totalRows_ServicePromo > 0) {
$ServiceAdded = 1;
while($row_ServicePromo = mysqli_fetch_assoc($ServicePromo)){
$ServicePromo_id = $row_ServicePromo['id'];
$ServicePromo_Type = $row_ServicePromo['type'];
$ServicePromo_Price = $row_ServicePromo['price'];
$GetPecentage = $Get_Promo_Percent/100;
$GetDiscount = number_format(($ServicePromo_Price * $GetPecentage), 2);
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='$Get_Promo_Code', promo_discount='$GetDiscount' WHERE id='$ServicePromo_id'");
}}
}
if($Get_Promo_Service == 0){
$ServiceAdded = 0;
}
if($TotalPromoAdded > 0){
$message = "success";
}
else {
$message = "fail";
}
}}
elseif($totalRows_Add_Promo < 1 ) {
$query_Add_Promo = "SELECT * FROM Universal_Promo
WHERE code = '$PromoCode' AND start_date <= '$todaydate' AND end_date >= '$todaydate'";
$Add_Promo = mysqli_query($SMB, $query_Add_Promo);
$totalRows_Add_Promo = mysqli_num_rows($Add_Promo);
if($totalRows_Add_Promo > 0){
while($row_Add_Promo = mysqli_fetch_assoc($Add_Promo)){
$Get_Promo_Code = $row_Add_Promo['code'];
$Get_Promo_Type = $row_Add_Promo['type'];
$Get_Promo_Percent = $row_Add_Promo['percent'];
$Get_Promo_Amount = $row_Add_Promo['amount'];
// Update Cart Promo
$query_ServicePromo = "SELECT * FROM School_Cart WHERE cid = '$cid'";
$ServicePromo = mysqli_query($SMB, $query_ServicePromo);
$totalRows_ServicePromo = mysqli_num_rows($ServicePromo);
if($totalRows_ServicePromo > 0) {
$ServiceAdded = 1;
while($row_ServicePromo = mysqli_fetch_assoc($ServicePromo)){
$ServicePromo_id = $row_ServicePromo['id'];
$ServicePromo_Type = $row_ServicePromo['type'];
$ServicePromo_Price = $row_ServicePromo['price'];
if($Get_Promo_Type == 'percent'){
$GetPecentage = $Get_Promo_Percent/100;
$GetDiscount = number_format(($ServicePromo_Price * $GetPecentage), 2);
}
else {
$GetDiscount = $Get_Promo_Amount;
}
// Connects to your Database
//Writes the information to the database
mysqli_query($SMB, "UPDATE School_Cart SET promo_code='$Get_Promo_Code', promo_discount='$GetDiscount' WHERE id='$ServicePromo_id'");
}}
}
if($totalRows_Add_Promo > 0){
$message = "success";
}
else {
$message = "fail";
}
}}
$insertGoTo = "checkout.php?promo=$message";
header("Location: $insertGoTo");
}
//Show Added Code Message
if ($_GET["promo"] == "success" && $TotalDiscount > 0) {
$PromoMessage = '<h6 style="color:green;"><strong>Promo Code Applied!</strong></h6>';
}
elseif ($_GET["promo"] == "fail" && $TotalDiscount > 0) {
$PromoMessage = '<h6 style="color:green;"><strong>Promo Code Applied!</strong></h6>';
}
elseif ($_GET["promo"] == "fail" && $TotalDiscount == 0) {
$PromoMessage = '<h6 style="color:red;"><strong>Not Vaild Promo Code</strong></h6>';
}
else {
$PromoMessage = '';
}
?>
<!DOCTYPE html>
<html lang="en">
<head>
<title>SMBDU - Successful Medical Billing and Digital University</title>
<meta charset="utf-8">
<meta name="format-detection" content="telephone=no"/>
<link rel="icon" href="../images/favicon.ico" type="image/x-icon">
<link rel="stylesheet" href="../css/grid.css">
<link rel="stylesheet" href="../css/style.css">
<link rel="stylesheet" href="../css/search.css">
<link rel="stylesheet" href="../css/camera.css">
<link rel="stylesheet" href="../css/contact-form.css">
<link rel="stylesheet" href="../css/jquery.fancybox.css">
<script src="js/jquery-1.8.1.min.js"></script>
<script src="js/jquery.js"></script>
<script src="js/jquery-migrate-1.2.1.js"></script>
<!--[if lt IE 9]>
<html class="lt-ie9">
<div style=' clear: both; text-align:center; position: relative;'>
<a href="http://windows.microsoft.com/en-US/internet-explorer/..">
<img src="../images/ie8-panel/warning_bar_0000_us.jpg" border="0" height="42" width="820"
alt="You are using an outdated browser. For a faster, safer browsing experience, upgrade for free today."/>
</a>
</div>
<script src="js/html5shiv.js"></script>
<![endif]-->
<script src='js/device.min.js'></script>
</head>
<?php echo $PopUp_Link; ?>
<div class="page">
<!--========================================================
HEADER
=========================================================-->
<header>
<div id="UserHdr"><div class="container">
<div class="row">
<div class="grid_8">
<div class="Welcome">Welcome <?php echo $GetName; ?>! </div>
</div>
<div class="grid_4">
<ul class="list01">
<li><a class="fa-user" href="my-account.php"><span>My Account</span></a></li>
<li><a class="fa-sign-out" href="php/logout.php?logout=Yes"><span>Logout</span></a></li>
</ul>
</div>
</div></div></div>
<div id="stuck_container" class="stuck_container">
<div class="container">
<div class="row">
<div class="grid_8">
<div class="brand">
<a href="./">
<img src="../img/SMB_DigitalUniversity.jpg" alt="SMBDU" height="75"/>
</a>
</div>
</div>
<div class="grid_4">
<ul class="list01">
<li><a class="fa-video-camera" href="my-access.php"><span>MY Courses/Modules</span></a></li>
<li><a class="fa-shopping-cart" href="cart.php"><span><?php echo $totalRows_CartItems; ?> ITEMS</span></a></li>
</ul>
</div>
</div>
<?php echo $HomeNav; ?>
</div>
</div>
</header>
<!--========================================================
CONTENT
=========================================================-->
<main>
<section>
<div class="well-03">
<div class="container">
<div class="grid_6">
<h3 class="hdrRed">CHECKOUT</h3>
<p>Fill out the information below to process your order.</p>
<form action="php/process.php" method="post"><table width="100%" cellspacing="2" cellpadding="2">
<tbody>
<tr>
<td align="left" valign="middle"><h5>Practice Information</h5></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="practice" type="text" id="practice" placeholder="Practice Name" value="<?php echo $Practice; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="dentist" type="text" id="dentist" placeholder="Dentist Name" value="<?php echo $Dentist; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="address" type="text" id="address" placeholder="Practice Address" value="<?php echo $Address; ?>" required ></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="city" type="text" id="city" placeholder="Practice City" value="<?php echo $City; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><select name="state" size="1" class="font100-small" id="state" required>
<option selected value="">State...</option>
<option value="AL" <?php if ($State == "AL"): ?> selected="selected"<?php endif;?>>Alabama</option>
<option value="AK" <?php if ($State == "AK"): ?> selected="selected"<?php endif;?>>Alaska</option>
<option value="AZ" <?php if ($State == "AZ"): ?> selected="selected"<?php endif;?>>Arizona</option>
<option value="AR" <?php if ($State == "AR"): ?> selected="selected"<?php endif;?>>Arkansas</option>
<option value="CA" <?php if ($State == "CA"): ?> selected="selected"<?php endif;?>>California</option>
<option value="CO" <?php if ($State == "CO"): ?> selected="selected"<?php endif;?>>Colorado</option>
<option value="CT" <?php if ($State == "CT"): ?> selected="selected"<?php endif;?>>Connecticut</option>
<option value="DE" <?php if ($State == "DE"): ?> selected="selected"<?php endif;?>>Delaware</option>
<option value="FL" <?php if ($State == "FL"): ?> selected="selected"<?php endif;?>>Florida</option>
<option value="GA" <?php if ($State == "GA"): ?> selected="selected"<?php endif;?>>Georgia</option>
<option value="HI" <?php if ($State == "HI"): ?> selected="selected"<?php endif;?>>Hawaii</option>
<option value="ID" <?php if ($State == "ID"): ?> selected="selected"<?php endif;?>>Idaho</option>
<option value="IL" <?php if ($State == "IL"): ?> selected="selected"<?php endif;?>>Illinois</option>
<option value="IN" <?php if ($State == "IN"): ?> selected="selected"<?php endif;?>>Indiana</option>
<option value="IA" <?php if ($State == "IA"): ?> selected="selected"<?php endif;?>>Iowa</option>
<option value="KS" <?php if ($State == "KS"): ?> selected="selected"<?php endif;?>>Kansas</option>
<option value="KY" <?php if ($State == "KY"): ?> selected="selected"<?php endif;?>>Kentucky</option>
<option value="LA" <?php if ($State == "LA"): ?> selected="selected"<?php endif;?>>Louisiana</option>
<option value="ME" <?php if ($State == "ME"): ?> selected="selected"<?php endif;?>>Maine</option>
<option value="MD" <?php if ($State == "MD"): ?> selected="selected"<?php endif;?>>Maryland</option>
<option value="MA" <?php if ($State == "MA"): ?> selected="selected"<?php endif;?>>Massachusetts</option>
<option value="MI" <?php if ($State == "MI"): ?> selected="selected"<?php endif;?>>Michigan</option>
<option value="MN" <?php if ($State == "MN"): ?> selected="selected"<?php endif;?>>Minnesota</option>
<option value="MS" <?php if ($State == "MS"): ?> selected="selected"<?php endif;?>>Mississippi</option>
<option value="MO" <?php if ($State == "MO"): ?> selected="selected"<?php endif;?>>Missouri</option>
<option value="MT" <?php if ($State == "MT"): ?> selected="selected"<?php endif;?>>Montana</option>
<option value="NE" <?php if ($State == "NE"): ?> selected="selected"<?php endif;?>>Nebraska</option>
<option value="NV" <?php if ($State == "NV"): ?> selected="selected"<?php endif;?>>Nevada</option>
<option value="NH" <?php if ($State == "NH"): ?> selected="selected"<?php endif;?>>New Hampshire</option>
<option value="NJ" <?php if ($State == "NJ"): ?> selected="selected"<?php endif;?>>New Jersey</option>
<option value="NM" <?php if ($State == "NM"): ?> selected="selected"<?php endif;?>>New Mexico</option>
<option value="NY" <?php if ($State == "NY"): ?> selected="selected"<?php endif;?>>New York</option>
<option value="NC" <?php if ($State == "NC"): ?> selected="selected"<?php endif;?>>North Carolina</option>
<option value="ND" <?php if ($State == "ND"): ?> selected="selected"<?php endif;?>>North Dakota</option>
<option value="OH" <?php if ($State == "OH"): ?> selected="selected"<?php endif;?>>Ohio</option>
<option value="OK" <?php if ($State == "OK"): ?> selected="selected"<?php endif;?>>Oklahoma</option>
<option value="OR" <?php if ($State == "OR"): ?> selected="selected"<?php endif;?>>Oregon</option>
<option value="PA" <?php if ($State == "PA"): ?> selected="selected"<?php endif;?>>Pennsylvania</option>
<option value="RI" <?php if ($State == "RI"): ?> selected="selected"<?php endif;?>>Rhode Island</option>
<option value="SC" <?php if ($State == "SC"): ?> selected="selected"<?php endif;?>>South Carolina</option>
<option value="SD" <?php if ($State == "SD"): ?> selected="selected"<?php endif;?>>South Dakota</option>
<option value="TN" <?php if ($State == "TN"): ?> selected="selected"<?php endif;?>>Tennessee</option>
<option value="TX" <?php if ($State == "TX"): ?> selected="selected"<?php endif;?>>Texas</option>
<option value="UT" <?php if ($State == "UT"): ?> selected="selected"<?php endif;?>>Utah</option>
<option value="VT" <?php if ($State == "VT"): ?> selected="selected"<?php endif;?>>Vermont</option>
<option value="VA" <?php if ($State == "VA"): ?> selected="selected"<?php endif;?>>Virginia</option>
<option value="WA" <?php if ($State == "WA"): ?> selected="selected"<?php endif;?>>Washington</option>
<option value="WV" <?php if ($State == "WV"): ?> selected="selected"<?php endif;?>>West Virginia</option>
<option value="WI" <?php if ($State == "WI"): ?> selected="selected"<?php endif;?>>Wisconsin</option>
<option value="WY" <?php if ($State == "WY"): ?> selected="selected"<?php endif;?>>Wyoming</option>
</select></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="zip" type="text" id="zip" placeholder="Practice Zip Code" value="<?php echo $Zip; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><h5>User Information</h5></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="first_name" type="text" id="first_name" placeholder="First Name" value="<?php echo $GetName; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="last_name" type="text" id="last_name" placeholder="Last Name" value="<?php echo $LastName; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="email_address" type="text" id="email_address" placeholder="Email Address" value="<?php echo $Email; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="phone_number" type="text" id="phone_number" placeholder="Phone Number" value="<?php echo $Phone; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><h5>Billing Information: </h5></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="billing_address" type="text" id="billing_address" placeholder="Address" value="<?php echo $Address; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="billing_city" type="text" id="billing_city" placeholder="City" value="<?php echo $City; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><select name="billing_state" size="1" class="font100-small" id="billing_state" required>
<option selected value="">State...</option>
<option value="AL" <?php if ($State == "AL"): ?> selected="selected"<?php endif;?>>Alabama</option>
<option value="AK" <?php if ($State == "AK"): ?> selected="selected"<?php endif;?>>Alaska</option>
<option value="AZ" <?php if ($State == "AZ"): ?> selected="selected"<?php endif;?>>Arizona</option>
<option value="AR" <?php if ($State == "AR"): ?> selected="selected"<?php endif;?>>Arkansas</option>
<option value="CA" <?php if ($State == "CA"): ?> selected="selected"<?php endif;?>>California</option>
<option value="CO" <?php if ($State == "CO"): ?> selected="selected"<?php endif;?>>Colorado</option>
<option value="CT" <?php if ($State == "CT"): ?> selected="selected"<?php endif;?>>Connecticut</option>
<option value="DE" <?php if ($State == "DE"): ?> selected="selected"<?php endif;?>>Delaware</option>
<option value="FL" <?php if ($State == "FL"): ?> selected="selected"<?php endif;?>>Florida</option>
<option value="GA" <?php if ($State == "GA"): ?> selected="selected"<?php endif;?>>Georgia</option>
<option value="HI" <?php if ($State == "HI"): ?> selected="selected"<?php endif;?>>Hawaii</option>
<option value="ID" <?php if ($State == "ID"): ?> selected="selected"<?php endif;?>>Idaho</option>
<option value="IL" <?php if ($State == "IL"): ?> selected="selected"<?php endif;?>>Illinois</option>
<option value="IN" <?php if ($State == "IN"): ?> selected="selected"<?php endif;?>>Indiana</option>
<option value="IA" <?php if ($State == "IA"): ?> selected="selected"<?php endif;?>>Iowa</option>
<option value="KS" <?php if ($State == "KS"): ?> selected="selected"<?php endif;?>>Kansas</option>
<option value="KY" <?php if ($State == "KY"): ?> selected="selected"<?php endif;?>>Kentucky</option>
<option value="LA" <?php if ($State == "LA"): ?> selected="selected"<?php endif;?>>Louisiana</option>
<option value="ME" <?php if ($State == "ME"): ?> selected="selected"<?php endif;?>>Maine</option>
<option value="MD" <?php if ($State == "MD"): ?> selected="selected"<?php endif;?>>Maryland</option>
<option value="MA" <?php if ($State == "MA"): ?> selected="selected"<?php endif;?>>Massachusetts</option>
<option value="MI" <?php if ($State == "MI"): ?> selected="selected"<?php endif;?>>Michigan</option>
<option value="MN" <?php if ($State == "MN"): ?> selected="selected"<?php endif;?>>Minnesota</option>
<option value="MS" <?php if ($State == "MS"): ?> selected="selected"<?php endif;?>>Mississippi</option>
<option value="MO" <?php if ($State == "MO"): ?> selected="selected"<?php endif;?>>Missouri</option>
<option value="MT" <?php if ($State == "MT"): ?> selected="selected"<?php endif;?>>Montana</option>
<option value="NE" <?php if ($State == "NE"): ?> selected="selected"<?php endif;?>>Nebraska</option>
<option value="NV" <?php if ($State == "NV"): ?> selected="selected"<?php endif;?>>Nevada</option>
<option value="NH" <?php if ($State == "NH"): ?> selected="selected"<?php endif;?>>New Hampshire</option>
<option value="NJ" <?php if ($State == "NJ"): ?> selected="selected"<?php endif;?>>New Jersey</option>
<option value="NM" <?php if ($State == "NM"): ?> selected="selected"<?php endif;?>>New Mexico</option>
<option value="NY" <?php if ($State == "NY"): ?> selected="selected"<?php endif;?>>New York</option>
<option value="NC" <?php if ($State == "NC"): ?> selected="selected"<?php endif;?>>North Carolina</option>
<option value="ND" <?php if ($State == "ND"): ?> selected="selected"<?php endif;?>>North Dakota</option>
<option value="OH" <?php if ($State == "OH"): ?> selected="selected"<?php endif;?>>Ohio</option>
<option value="OK" <?php if ($State == "OK"): ?> selected="selected"<?php endif;?>>Oklahoma</option>
<option value="OR" <?php if ($State == "OR"): ?> selected="selected"<?php endif;?>>Oregon</option>
<option value="PA" <?php if ($State == "PA"): ?> selected="selected"<?php endif;?>>Pennsylvania</option>
<option value="RI" <?php if ($State == "RI"): ?> selected="selected"<?php endif;?>>Rhode Island</option>
<option value="SC" <?php if ($State == "SC"): ?> selected="selected"<?php endif;?>>South Carolina</option>
<option value="SD" <?php if ($State == "SD"): ?> selected="selected"<?php endif;?>>South Dakota</option>
<option value="TN" <?php if ($State == "TN"): ?> selected="selected"<?php endif;?>>Tennessee</option>
<option value="TX" <?php if ($State == "TX"): ?> selected="selected"<?php endif;?>>Texas</option>
<option value="UT" <?php if ($State == "UT"): ?> selected="selected"<?php endif;?>>Utah</option>
<option value="VT" <?php if ($State == "VT"): ?> selected="selected"<?php endif;?>>Vermont</option>
<option value="VA" <?php if ($State == "VA"): ?> selected="selected"<?php endif;?>>Virginia</option>
<option value="WA" <?php if ($State == "WA"): ?> selected="selected"<?php endif;?>>Washington</option>
<option value="WV" <?php if ($State == "WV"): ?> selected="selected"<?php endif;?>>West Virginia</option>
<option value="WI" <?php if ($State == "WI"): ?> selected="selected"<?php endif;?>>Wisconsin</option>
<option value="WY" <?php if ($State == "WY"): ?> selected="selected"<?php endif;?>>Wyoming</option>
</select></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="billing_zip" type="text" id="billing_zip" placeholder="Zip Code" value="<?php echo $Zip; ?>" required></td>
</tr>
<tr>
<td align="left" valign="middle"><h5>Payment Information</h5></td>
</tr>
<tr>
<td align="left" valign="middle"><img src="https://www.successfulmedicalbilling.com/images/CC-logos.png" alt="" width="300"/></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="cc_number" type="text" id="cc_number" placeholder="Credit Card Number" required></td>
</tr>
<tr>
<td align="left" valign="middle"><select name="exp_month" size="1" class="font100-small" id="exp_month" required>
<option selected value="">Exp Month...</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select></td>
</tr>
<tr>
<td align="left" valign="middle"><select name="exp_year" size="1" class="font100-small" id="exp_year" required>
<option selected value="">Exp Year...</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2028</option>
</select></td>
</tr>
<tr>
<td align="left" valign="middle"><input name="ccv" type="text" id="ccv" placeholder="CCV (Example: 123, 0234)" required></td>
</tr>
<tr>
<td align="left" valign="middle"><input type="submit" name="submit" id="myButton" value="CHECKOUT" class="submitBtn"></td>
</tr>
<tr>
<td><input name="OrderTotal" type="hidden" id="OrderTotal" value="<?php echo number_format($GrandTotal, 2); ?>">
<input name="Process" type="hidden" id="Process" value="Yes">
<input name="shipping" type="hidden" id="shipping" value="<?php echo $Cart_Shipping;?>">
<input name="cid" type="hidden" id="cid" value="<?php echo $GetCID; ?>">
<input name="promo_discount" type="hidden" id="promo_discount" value="<?php echo number_format($TotalDiscount, 2); ?>">
<input name="promo_code" type="hidden" id="promo_code" value="<?php echo $ShowPromoCode; ?>"></td>
</tr>
<tr>
<td></td>
</tr>
</tbody>
</table>
</form>
</div>
<div class="grid_5">
<div class="grid_5_Div">
<table width="100%" border="0" cellspacing="2" cellpadding="2">
<tbody>
<tr>
<td colspan="3" align="center" height="75"><h4>MY CART</h4></td>
</tr>
<?php echo $CheckoutCart_Output; ?>
<tr>
<td height="50" colspan="3" align="left" valign="middle" class="borderTop">
<?php echo $PromoMessage; ?>
<div class="promoDiv"><form action="checkout.php" method="post" name="form1" id="form1">
<input name="PromoCode" type="text" id="PromoCode" placeholder="Promo Code">
<input type="submit" name="submit" id="submit" value="Apply">
</form></div></td>
</tr>
<tr>
<td height="30" colspan="2" align="left" valign="middle" class="borderTop">SubTotal: </td>
<td align="right" valign="middle">$<?php echo number_format($SubTotal, 2); ?></td>
</tr>
<?php echo $ShowDiscount; ?>
<tr>
<td height="30" colspan="2" align="left" valign="middle">Shipping: </td>
<td align="right" valign="middle">$<?php echo number_format($Cart_Shipping, 2); ?></td>
</tr>
<tr>
<td height="150" colspan="3" align="right" valign="middle" class="borderTop"><h4>$<?php echo number_format($GrandTotal, 2); ?></h4></td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
</section>
</main>
<!--========================================================
FOOTER
=========================================================-->
<footer>
<div class="bkg-02">
<div class="footer-well">
<div class="container">
<div class="row">
<div class="grid_4">
<div class="copyright">
<h6>Copyright</h6>
<a class="footer-brand" href="./"><img src="../images/logo.png" alt="SMBDU" height="50"/></a>
<p>© <span id="copyright-year"></span>
<a href="#">Privacy policy</a></p>
Website: <a rel="nofollow" href="http://www.savvysitedesigns.com" target="_blank">Savvy Site Designs</a>
</div>
</div>
<div class="grid_4">
<div class="about-us">
<h6><?php echo $Footer_LoginHdr; ?></h6>
<?php echo $Footer_LoginContent; ?>
</div>
</div>
<div class="grid_4">
<div class="contact-us">
<h6>Contact Us</h6>
<p><a href="mailto:info@smbdu.com">info@smbdu.com</a></p>
</div>
</div>
</div>
</div>
</div>
</div>
</footer>
</div>
<script type="text/javascript" src="js/jquery.popdown.js"/></script>
<script type="text/javascript">
$(document).ready(function(){
$('.popdown').popdown();
});
</script>
<script src="//code.jquery.com/jquery-1.10.2.js"></script>
<script src="//code.jquery.com/ui/1.11.4/jquery-ui.js"></script>
<?php echo $PopUp_Link; ?>
<script src="js/script.js"></script>
<script src="https://cdn.jsdelivr.net/jquery.validation/1.15.0/jquery.validate.min.js"></script>
<script src="https://cdn.jsdelivr.net/jquery.validation/1.15.0/additional-methods.min.js"></script>
<script src="js/cart.js"></script>
</body>
</html> |