<form name="compStartForm" method="post" style="margin:0px;" action="index.php">

{include file="shared:layouts/comp_create_navbar.tpl"}

<table border=0 cellpadding=0 cellspacing=0 width="100%">
   <tr>
	<td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table1_header_bg.gif);background-repeat:repeat-x;"><img src="{$skinFolder}images/ehc/containers/grayTable/table1_header_left.gif"></td>
        <td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table1_header_bg.gif);background-repeat:repeat-x;">A. Competition Fee Payment</td>
        <td><img src="{$skinFolder}images/ehc/containers/grayTable/table1_header_right2.gif"></td>
   </tr>
   <tr> 
        <td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table_body_left.gif);background-repeat:repeat-y;"></td>
        <td nowrap>

<b>Competition title</b><br />
Etc.<br />
etc.<br />

<table width="100%">
<tr>
  <td valign="top"><b>Billing Information:</b>
	<p>Enter the billing information for the credit card owner.<br />
	<small>(* indicates a required field)</small></p>
	
	<div id="billInfo" style="text-align:right;">
	*First Name:
	<input type="text" name="bill[firstname]" value="{$smarty.request.bill.firstname|default:$userInfo.firstName}" class="textInput" style="width:200px;" /><br />
	*Last Name:
	<input type="text" name="bill[lastname]" value="{$smarty.request.bill.lastname|default:$userInfo.lastName}" class="textInput" style="width:200px;" /><br />

	Company:
	<input type="text" name="bill[company]" value="{$smarty.request.bill.company|default:$userInfo.company}" class="textInput" style="width:200px;" /><br />

	*Address:
	<input type="text" name="bill[address1]" value="{$smarty.request.bill.address1|default:$userInfo.address1}" class="textInput" style="width:200px;" /><br />
	Line 2:
	<input type="text" name="bill[address2]" value="{$smarty.request.bill.address2|default:$userInfo.address2}" class="textInput" style="width:200px;" /><br />

	*City:
	<input type="text" name="bill[city]" value="{$smarty.request.bill.city|default:$userInfo.city}" class="textInput" style="width:200px;" /><br />

	*State, *Zip:
	<input type="text" name="bill[state]" value="{$smarty.request.bill.state|default:$userInfo.state}" class="textInput" style="width:30px;" maxlength="2" />
	<input type="text" name="bill[zip]" value="{$smarty.request.bill.zip|default:$userInfo.zip}" class="textInput" style="width:50px;" /><br />

	*Country:
	<input type="text" name="bill[country]" value="{$smarty.request.bill.country|default:$userInfo.country}" class="textInput" style="width:200px;" maxlength="30" /><br />

	*Phone:<small>(xxx-xxx-xxxx)
	<input type="text" name="bill[phone]" value="{$smarty.request.bill.phone|default:$userInfo.phone}" class="textInput" style="width:200px;" maxlength="80" /><br />
	</div>
</div>
</td>
  <td valign="top"><b>Payment Information:</b>

	<script language="javascript">{literal}
	function verifyFormatCcnum(obj) {
		if (obj.value.match(/[^\d]/)) {
			alert('The Credit Card Number should contain no dashes or spaces.\n\nI.E.  4007000000027');
			obj.value = obj.value.replace(/[^\d]/g, '');
			obj.focus();
		}
	}
	function verifyFormatCcexp(obj) {
		if (obj.value.match(/[^\d]/)) {
			alert('The format for Credit Card expiration date is MMYY with no slash.\n\nI.E.  0606  for June, 2006');
			obj.value = obj.value.replace(/[^\d]/g, '');
			obj.focus();
		}
	}
	{/literal}</script>

        <div style="text-align:right;">
	Payment Method:
	<select name="bill[paymentMethod]" size="1">
		<option value="visa"{if $smarty.request.bill.paymentMethod eq "visa"} selected{/if}>Visa</option>
		<option value="mastercard"{if $smarty.request.bill.paymentMethod eq "mastercard"} selected{/if}>Mastercard</option>
		<option value="american express"{if $smarty.request.bill.paymentMethod eq "american express"} selected{/if}>American Express</option>
		<option value="discover"{if $smarty.request.bill.paymentMethod eq "discover"} selected{/if}>Discover</option>
	</select><br />

	Card Number:
	<input type="text" name="bill[ccnum]" value="" class="textInput" style="width:200px;" onchange="verifyFormatCcnum(this);" onkeyup="verifyFormatCcnum(this);" /><br />

	Expiration Date: <small>(MMYY)</small>
	<input type="text" name="bill[ccexp]" value="" class="textInput" maxlength="4" style="width:50px;" onchange="verifyFormatCcexp(this);" onkeyup="verifyFormatCcexp(this);" /><br />
        </div>
</td>
</tr>
</table>
        </td>
        <td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table_body_right2.gif);background-repeat:repeat-y;"></td>
   </tr>
   <tr>
        <td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table_bottom_bg.gif);background-repeat:repeat-x;"><img src="{$skinFolder}images/ehc/containers/grayTable/table_bottom_corner_left.gif"></td>
        <td style="background-image:url({$skinFolder}images/ehc/containers/grayTable/table_bottom_bg.gif);background-repeat:repeat-x;" ></td>
        <td><img src="{$skinFolder}images/ehc/containers/grayTable/table_bottom_corner_right.gif"></td>
   </tr>
</table>

</form>