templates/tenants/tenant1/parts/premium-form.html.twig line 1

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  1. <form id="twoStepForm">
  2.     <div id="stepDonorship" class="form-aside {% if route in ['become_premium', 'sign_up_premium', 'sign_up_society'] %}form-aside_flow{% endif %}">
  3.         {{ include('tenants/tenant1/parts/premium-form/frequencyBlock.html.twig') }}
  4.         {{ include('tenants/tenant1/parts/premium-form/headerBlock.html.twig') }}
  5.         <div class="form-aside__main">
  6.             {{ include('tenants/tenant1/parts/premium-form/amountBlock.html.twig') }}
  7.             <div class="form-aside__row">
  8.                 <div class="form-aside__input input-wrapper">
  9.                     <label class="input-wrapper__label" for="email">Email address *</label>
  10.                     <input autocomplete="off" id="email" type="text" name="email" placeholder="" class="input" {% if route in ['become_premium', 'user_profile'] %} value="{{ app.user.email }}" disabled {% endif %}>
  11.                 </div>
  12.                 <div id="emailErrorMessage" class="form-error-message"></div>
  13.             </div>
  14.         </div>
  15.         <div class="form-aside__footer footer-aside">
  16.             <button id="submitDonorship" class="footer-aside__button button" type="button">Next</button>
  17.             <div class="footer-aside__text">
  18.                 <p>JNS Donor Societies: You can join a&nbsp;select group of&nbsp;like-minded friends and colleagues and inspire each other to&nbsp;make a&nbsp;difference for Israel and the Jewish people. Which society is&nbsp;right for you? <a href="{{ path('sign_up_society') }}">Learn more</a></p>
  19.             </div>
  20.         </div>
  21.         <input id="finalAmount" type="hidden" value="{{ monthlyMin }}">
  22.         <input id="planName" type="hidden" value="Premium">
  23.     </div>
  24.     <div id="stepBilling" class="form-aside {% if route in ['become_premium', 'sign_up_premium', 'sign_up_society'] %}form-aside_top-line form-aside_flow{% endif %}" style="display: none;">
  25.         <div class="form-aside__header form-aside__header_back">
  26.             <button class="form-aside__back" type="button" id="backToDonorship">Back</button>
  27.             <h3 class="form-aside__title">Billing</h3>
  28.         </div>
  29.         <div class="form-aside__grid grid-form">
  30.             <div class="grid-form__item input-wrapper">
  31.                 <label class="input-wrapper__label" for="nameOnCard">Name on Card *</label>
  32.                 <input data-validation="exclude" autocomplete="off" id="nameOnCard" type="text" name="nameOnCard" placeholder="" class="input">
  33.                 <div id="nameOnCardErrorText" class="form-error-message"></div>
  34.             </div>
  35.             <div class="grid-form__item input-wrapper">
  36.                 <label class="input-wrapper__label" for="taxReceiptName">Tax Receipt Name *</label>
  37.                 <input data-validation="exclude" autocomplete="off" id="taxReceiptName" type="text" name="taxReceiptName" placeholder="" class="input">
  38.                 <div id="taxReceiptNameErrorText" class="form-error-message"></div>
  39.             </div>
  40.             <div id="card-element" class="grid-form__item grid-form__item_big input-wrapper">
  41.                 <!-- card-element -->
  42.             </div>
  43.             <div class="grid-form__item input-wrapper">
  44.                 <label class="input-wrapper__label" for="country">Country *</label>
  45.                 <select name="country" id="country" class="form-inp" data-scroll>
  46.                     {% for countryCode, countryName in countries %}
  47.                         <option value="{{ countryCode }}" {% if 'us' == countryCode %}selected{% endif %}>{{ countryName }}</option>
  48.                     {% endfor %}
  49.                 </select>
  50.                 <div id="countryErrorText"></div>
  51.             </div>
  52.             <div class="grid-form__item input-wrapper">
  53.                 <label class="input-wrapper__label" for="zipCode">Zip code *</label>
  54.                 <input data-validation="exclude" autocomplete="off" id="zipCode" type="text" name="zipCode" placeholder="" class="input">
  55.                 <div id="zipCodeErrorText" class="form-error-message"></div>
  56.             </div>
  57.         </div>
  58.         <div class="form-aside__footer footer-aside">
  59.             <button id="payButton" class="footer-aside__button button button_center button_red" type="button">Pay $<span>{{ monthlyMin }}</span></button>
  60.             <div class="footer-aside__checkbox checkbox">
  61.                 <input id="iAgree" class="checkbox__input" type="checkbox" value="1" name="iAgree" checked>
  62.                 <label for="iAgree" class="checkbox__label"><span class="iAgreeText checkbox__text">You will be charged monthly. You can cancel this recurring payment at any time.</span></label>
  63.                 <input id="iAgree2" class="checkbox__input" type="checkbox" value="1" name="iAgree2" checked>
  64.                 <label for="iAgree2" class="checkbox__label"><span class="iAgreeText2 checkbox__text">I agree to receive communications from JNS and its partners and advertisers.</span></label>
  65.             </div>
  66.             <div id="GeneralErrorText" class="form-error-message"></div>
  67.             <div class="footer-aside__text">
  68.                 <p>JNS Donor Societies: You can join a&nbsp;select group of&nbsp;like-minded friends and colleagues and inspire each other to&nbsp;make a&nbsp;difference for Israel and the Jewish people. Which society is&nbsp;right for you? <a href="{{ path('sign_up_society') }}">Learn more</a></p>
  69.             </div>
  70.         </div>
  71.     </div>
  72. </form>