<?php
require("includes/.htconfig.php");

if( !empty($_POST) )
{
	$ssn=trim($_REQUEST['ssn']);
	$landPhone=trim($_REQUEST['landPhone']);
	$mobilePhone=trim($_REQUEST['mobilePhone']);
  
  if (empty($ssn))
  {
    $errmsgs.="<BR>We need your Social Security Number in order to authenticate the identity you're asserting.";
  }
  else
    $_SESSION['ssn']=$ssn;
	
	if(empty($landPhone))
  {
    $errmsgs.="<BR>We need a phone number to authenticate your identity claims.";
  }
  else
	{
		$_SESSION['landPhone']=$landPhone;
	}
  
	if(!empty($mobilePhone))
	{
		$_SESSION['mobilephone']=$mobilePhone;
	}
  if (strlen($errmsgs) == 0) advancePage($newby);
}
?>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<link href="./style/design.css" rel="stylesheet" type="text/css" />

<style type="text/css">
<!--
.style1 {font-size: 0.8em}
-->
</style>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Personally Identifiable Information</title>
<script language="JavaScript" src="includes/js/common.js"></script>
<!--script language='javascript' src='datepicker/popcalendar.js'></script-->
<link rel="stylesheet" type="text/css" media="all" href="cal/calendar-win2k-cold-1.css" title="win2k-cold-1"><!-- main calendar program -->  
  <script type="text/javascript" src="cal/calendar.js"></script><!-- language for the calendar -->  
  <script type="text/javascript" src="cal/calendar-en.js"></script><!-- the following script defines the Calendar.setup helper function, which makes
       adding a calendar a matter of 1 or 2 lines of code. -->  
  <script type="text/javascript" src="cal/calendar-setup.js"></script>
<script language="JavaScript">
  function validate()
  {
  var is_valid=true

  is_valid = blank_check( document.frm.ssn.value, "We need your social security number to authenticate your identity" )
  if( is_valid == false ) { document.frm.ssn.focus(); return is_valid }

  is_valid = blank_check( document.frm.landPhone.value, "PLEASE INPUT A PHONE NUMBER" )
  if( is_valid == false ) { document.frm.landPhone.focus(); return is_valid }

  ##is_valid = blank_check( document.frm.mobilePhone.value, "PLEASE INPUT MOBILE NUMBER" )
  ##	if( is_valid == false ) { document.frm.mobilePhone.focus(); return is_valid }

  ##is_valid = blank_check( document.frm.userImage.value, "PLEASE UPLOAD YOUR IMAGE" )
  ##	if( is_valid == false ) { document.frm.userImage.focus(); return is_valid }
  }
</script>
</head>
  <body>
    <table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
      <tr>
        <td align="center" valign="top">

          <?php
      include_once("includes/header.php");
      ?>
          <form name="frm" method="post" action="" enctype="multipart/form-data" onSubmit="return validate()">
            <table width="90%" border="0" align="center" cellpadding="0" cellspacing="0">
              <tr>
                <td width="30%" valign="top">
                  <div class="bodySubHeader">
                    <span class="bsht03">Personal Information</span>
                  </div>
                </td>
              </tr>
            </table>
            <table width="40%" border="0" align="center" cellpadding="0" cellspacing="0" class="DarkLightBox">
              <tr>
                <td align="left" valign="top" colspan="8">&nbsp;</td>
              </tr>
              <tr>
                <?PHP
              echo inputcells("Social Security Number$redstar","ssn");
            ?>
              </tr>
              <tr>
                <?PHP
              echo inputcells("Primary Phone Number$redstar","landPhone");
            ?>
              </tr>
              <tr>
                <?PHP
              echo inputcells("Cell Phone Number$redstar","mobilePhone");
            ?>
              </tr>

              <tr>
                <td height="35" align="left" valign="bottom" colspan="7">&nbsp;</td>
                <td height="35" align="left" valign="bottom">
                  <input name="command" type="submit" value="Next" />
                </td>
              </tr>
            </table>
          </form>
          <?php
include_once("includes/footer.php");
?>
        </td>
      </tr>
    </table>
  </body>
</html>