417 lines
22 KiB
Plaintext
417 lines
22 KiB
Plaintext
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="UTF-8" />
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<meta name="viewport" content="width=device-width, initial-scale=1.0" />
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<title>VA Registration</title>
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<!-- Bootstrap -->
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<!-- <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/css/bootstrap.min.css" rel="stylesheet"> -->
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<link href="/public/css/va-register.css" rel="stylesheet">
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</head>
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<body>
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<!-- <section class="h-100 py-5">
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<div class="container">
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<div class="row justify-content-center align-items-center">
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<div class="col-lg-10 col-xl-9">
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<div class="card card-registration shadow-lg">
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<div class="row g-0">
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<div class="col-xl-5 d-none d-xl-block">
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<img
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src="https://mdbcdn.b-cdn.net/img/Photos/new-templates/bootstrap-registration/img4.webp"
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alt="Registration"
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class="img-fluid"
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/>
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</div>
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<div class="col-xl-7 bg-white">
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<div class="card-body text-black">
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<h3 class="text-center mb-4">DocTracker Clients Registration</h3>
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<form id="vaClientForm">
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<div class="mb-3">
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<label class="form-label" for="firstName">Client Name/Company *</label>
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<input type="text" id="firstName" name="userDetails[name]" class="form-control form-control-lg" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="email">Email *</label>
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<input type="email" id="email" name="userDetails[email]" class="form-control form-control-lg" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="dob">Date of Birth</label>
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<input type="date" id="dob" name="userDetails[dob]" class="form-control form-control-lg">
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</div>
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<h5>Bank Details</h5>
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<div class="mb-3">
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<label class="form-label" for="bankName">Bank Name</label>
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<input type="text" id="bankName" name="userDetails[bankName]" class="form-control form-control-lg" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="accountHolderName">Account Holder Name</label>
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<input type="text" id="accountHolderName" name="userDetails[accountHolderName]" class="form-control form-control-lg" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="accountNumber">Account Number</label>
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<input type="text" id="accountNumber" name="userDetails[accountNumber]" class="form-control form-control-lg" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="routingNumber">Routing Number</label>
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<input type="text" id="routingNumber" name="userDetails[routingNumber]" class="form-control form-control-lg" required>
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</div>
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<div class="d-flex justify-content-end gap-2 pt-3">
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<button type="reset" class="btn btn-light btn-lg">Reset</button>
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<button type="submit" class="btn btn-warning btn-lg">Submit</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</section> -->
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<div class="container">
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<!-- Sidebar for desktop -->
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<div class="sidebar">
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<div class="logo">
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<div class="logo-placeholder">
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<img
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src="https://images.docva.com/logo-colored-vertical.svg"
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/>
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</div>
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</div>
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<nav class="progress-steps">
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<div class="step active" data-step="1" onclick="goToStep(1)">
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<div class="step-number">1</div>
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<!-- <div class="step-number">✓</div> -->
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<div class="step-text">Create Your Account</div>
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<div class="step-connector"></div>
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</div>
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<div class="step" data-step="2" onclick="goToStep(2)">
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<div class="step-number">2</div>
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<div class="step-text">Business Information</div>
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<div class="step-connector"></div>
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</div>
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<div class="step" data-step="3" onclick="goToStep(3)">
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<div class="step-number">3</div>
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<div class="step-text">Billing Address</div>
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<div class="step-connector"></div>
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</div>
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<div class="step" data-step="4" onclick="goToStep(4)">
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<div class="step-number">4</div>
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<div class="step-text">Authorized Signatory</div>
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<div class="step-connector"></div>
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</div>
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<div class="step" data-step="5" onclick="goToStep(5)">
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<div class="step-number">5</div>
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<div class="step-text">Payment Details</div>
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<div class="step-connector"></div>
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</div>
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<div class="step" data-step="6" onclick="goToStep(6)">
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<div class="step-number">6</div>
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<div class="step-text">Done</div>
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</div>
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</nav>
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</div>
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<!-- Main content -->
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<div class="main-content">
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<!-- Mobile progress indicator -->
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<div class="mobile-progress">
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<ol>
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<li class="step active" data-step="1" onclick="goToStep(1)">
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<div class="step-number">1</div>
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<!-- <div class="step-number">✓</div> -->
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<div class="step-text">Create Account</div>
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</li>
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<li class="step" data-step="2" onclick="goToStep(2)">
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<div class="step-number">2</div>
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<div class="step-text">Business Info</div>
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</li>
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<li class="step" data-step="3" onclick="goToStep(3)">
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<div class="step-number">3</div>
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<div class="step-text">Billing</div>
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</li>
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<li class="step" data-step="4" onclick="goToStep(4)">
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<div class="step-number">4</div>
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<div class="step-text">Signatory</div>
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</li>
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<li class="step" data-step="5" onclick="goToStep(5)">
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<div class="step-number">5</div>
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<div class="step-text">Payment</div>
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</li>
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<li class="step" data-step="6" onclick="goToStep(6)">
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<div class="step-number">6</div>
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<div class="step-text">Done</div>
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</li>
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</ol>
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</div>
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<!-- Form container -->
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<div class="form-container">
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<div class="form-card">
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<!-- Step 1: Create Account -->
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<div class="form-step active" id="step-1">
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<h2 class="form-title">Create Your Account</h2>
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<form id="account-form">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="company-name" class="input-field" placeholder=" " required>
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<label for="company-name" class="input-label">Company / Client Name *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="email" id="email" class="input-field" placeholder=" " required>
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<label for="email" class="input-label">Email *</label>
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</div>
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</div>
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<div class="form-actions">
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<div></div> <!-- Empty div for spacing -->
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<button type="button" class="btn btn-primary" onclick="nextStep(2)">Continue</button>
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</div>
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</form>
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</div>
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<!-- Step 2: Business Information -->
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<div class="form-step" id="step-2">
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<h2 class="form-title">Business Information</h2>
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<form id="business-form">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="address" class="input-field" placeholder=" " required>
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<label for="address" class="input-label">Address *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="city" class="input-field" placeholder=" " required>
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<label for="city" class="input-label">City *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<!-- <input type="text" id="state" class="input-field" placeholder=" " required> -->
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<select id="state" class="select-field" required>
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<option value=""></option>
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<!-- States will be populated by JavaScript -->
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</select>
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<label for="state" class="input-label">State *</label>
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<div class="location-loading" id="state-loading">Detecting your location...</div>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="zip" class="input-field" placeholder=" " required>
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<label for="zip" class="input-label">ZIP *</label>
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</div>
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</div>
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<div class="form-actions">
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<button type="button" class="btn btn-secondary" onclick="prevStep(1)">Back</button>
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<button type="button" class="btn btn-primary" onclick="nextStep(3)">Continue</button>
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</div>
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</form>
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</div>
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<!-- Step 3: Billing Address -->
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<div class="form-step" id="step-3">
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<h2 class="form-title">Billing Address</h2>
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<form id="billing-form">
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<div class="checkbox-group">
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<input type="checkbox" id="use-business-address">
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<label for="use-business-address">Use business details for billing address</label>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="billing-name" class="input-field" placeholder=" " required>
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<label for="billing-name" class="input-label">Name *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="billing-address" class="input-field" placeholder=" " required>
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<label for="billing-address" class="input-label">Address *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="billing-city" class="input-field" placeholder=" " required>
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<label for="billing-city" class="input-label">City *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<!-- <input type="text" id="billing-state" class="input-field" placeholder=" " required> -->
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<select id="billing-state" class="select-field" required>
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<option value=""></option>
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<!-- States will be populated by JavaScript -->
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</select>
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<label for="billing-state" class="input-label">State *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="billing-zip" class="input-field" placeholder=" " required>
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<label for="billing-zip" class="input-label">ZIP *</label>
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</div>
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</div>
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<div class="checkbox-group">
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<input type="checkbox" id="use-account-email">
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<label for="use-account-email">Use account email as primary billing contact</label>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="email" id="billing-email" class="input-field" placeholder=" " required>
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<label for="billing-email" class="input-label">Email Address *</label>
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</div>
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</div>
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<div class="form-actions">
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<button type="button" class="btn btn-secondary" onclick="prevStep(2)">Back</button>
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<button type="button" class="btn btn-primary" onclick="nextStep(4)">Continue</button>
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</div>
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</form>
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</div>
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<!-- Step 4: Authorized Signatory -->
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<div class="form-step" id="step-4">
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<h2 class="form-title">Authorized Signatory</h2>
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<p style="margin-bottom: 20px; color: #6b7280; font-size: 14px;">
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We will use the details below in the agreement that we will send to your prior to entering the project.
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</p>
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<form id="signatory-form">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="position" class="input-field" placeholder=" " required>
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<label for="position" class="input-label">Position (Owner / CEO / Manager / etc.) *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="signatory-name" class="input-field" placeholder=" " required>
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<label for="signatory-name" class="input-label">Name *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="email" id="signatory-email" class="input-field" placeholder=" " required>
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<label for="signatory-email" class="input-label">Email *</label>
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</div>
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</div>
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<div class="form-actions">
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<button type="button" class="btn btn-secondary" onclick="prevStep(3)">Back</button>
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<button type="button" class="btn btn-primary" onclick="nextStep(5)">Continue</button>
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</div>
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</form>
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</div>
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<!-- Step 5: Payment Details -->
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<div class="form-step" id="step-5">
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<h2 class="form-title">Payment Details</h2>
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<form id="payment-form">
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<div class="payment-option" onclick="selectPaymentOption('card')">
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<h4>Credit or Debit Card</h4>
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<p>Pay securely with your card</p>
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</div>
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<div id="card-details" class="payment-details">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="card-number" class="input-field" placeholder=" " required>
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<label for="card-number" class="input-label">Card Number *</label>
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</div>
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</div>
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<div class="row">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="expiry-date" class="input-field" placeholder=" " required>
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<label for="expiry-date" class="input-label">Expiry Date (MM/YY) *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="security-code" class="input-field" placeholder=" " required>
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<label for="security-code" class="input-label">Security Code *</label>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="card-zip" class="input-field" placeholder=" " required>
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<label for="card-zip" class="input-label">ZIP Code *</label>
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</div>
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</div>
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</div>
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<div class="payment-option" onclick="selectPaymentOption('bank')">
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<h4>Bank Account (ACR)</h4>
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<p>Direct bank transfer</p>
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</div>
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<div id="bank-details" class="payment-details">
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="bank-name" class="input-field" placeholder=" " required>
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<label for="bank-name" class="input-label">Bank Name *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="account-number" class="input-field" placeholder=" " required>
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<label for="account-number" class="input-label">Account Number *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="routing-number" class="input-field" placeholder=" " required>
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<label for="routing-number" class="input-label">Routing Number *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<select id="account-type" class="select-field" required>
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<option value=""></option>
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<option value="checking">Checking</option>
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<option value="savings">Savings</option>
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</select>
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<label for="account-type" class="input-label">Account Type *</label>
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</div>
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</div>
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<div class="form-group">
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<div class="input-container">
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<input type="text" id="account-holder-name" class="input-field" placeholder=" " required>
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<label for="account-holder-name" class="input-label">Account Holder Name *</label>
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</div>
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</div>
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</div>
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<div class="form-actions">
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<button type="button" class="btn btn-secondary" onclick="prevStep(4)">Back</button>
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<button type="button" class="btn btn-primary" onclick="submitForm()">Submit</button>
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</div>
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</form>
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</div>
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<!-- Step 6: Success -->
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<div class="form-step" id="step-6">
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<div class="success-message">
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<div class="success-icon">✓</div>
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<h3>Registration Complete!</h3>
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<p>Your account has been successfully created. You will receive a confirmation email shortly.</p>
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<button type="button" class="btn btn-primary" onclick="resetForm()">Create Another Account</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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<script src="/public/js/va-client-register.js"></script>
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</body>
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</html>
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