<div class="field">
<label>Card Number<span class="obligated">*</span></label>
<?php
echo frontend_input("x_card_num", null, array("class" => "medium {$errcard}"));
?>
</div>
<div class="field">
<label>Exp date<span class="obligated">*</span></label>
<?php
$current_year = date("Y");
$years = array("" => "---- Year ----");
for ($i = 0; $i < 12; $i++) {
$years[$current_year + $i] = $current_year + $i;
}
echo frontend_select("exp_month", null, array("" => "---- Month ----", "01" => "Jan", "02" => "Feb", "03" => "Mar", "04" => "Apr", "05" => "May", "06" => "Jun", "07" => "Jul", "09" => "Aug", "10" => "Sept", "11" => "Oct", "12" => "Dec"));
echo frontend_select("exp_year", null, $years);
?>
</div>
<div class="field">
<label>CCV<span class="obligated">*</span></label>
<?php
echo frontend_input("x_card_code", null, array('class' => 'medium'));
?>
<p class="extra inform">Look for a three-digit, non-embossed number printed on the signature panel on the back of your card.It immediately follows your account number</p>
</div>
<div class="field">
<div class="terms">
<div>
<h1>Terms of use</h1>
<p>Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.
Why do we use it?</p>
<label for="name3">Тип: </label>
<?php
echo frontend_select("field-Kind", null, UtilsHelper::loadTrademarkTypes(array("" => "Моля изберете")));
?>
</div>
<div class="qfTwoCol qfTwoCol02">
<label for="name4">Срок: </label>
<?php
echo frontend_input("field-ExpiresOn");
?>
<label for="name5">Държави в които е в сила: </label>
<?php
echo frontend_select("field-DesignatedContractingParty", null, array("" => "Моля изберете") + $countries);
?>
<label for="name5">Статус: </label>
<?php
echo frontend_input("field-Status");
?>
<label for="name5">Дата на регистриране: </label>
<?php
echo frontend_input("field-RegistrationDate", null, array("readonly" => "readonly"));
?>
</div>
</div>
</div>
<?php
echo frontend_date("date_open", null, array('class' => 'small', 'rich' => 'true'));
?>
</div>
<div class="field">
<label>Date of Closing </label>
<?php
echo frontend_date("date_close", null, array('class' => 'small', 'rich' => 'true'));
?>
</div>
<div class="field">
<label>Service Request <span class="obligated">*</span></label>
<?php
echo frontend_select("service", null, Lists::getListitemsForSelect("requests", array("" => "Quote")), array("class" => "serv"));
?>
</div>
<div class="field">
<label></label><img src="/user/captcha">
</div>
<div class="field">
<label>Security </label>
<?php
echo frontend_input("captcha", null, array('class' => 'small'));
?>
<p style="margin-left:125px">Please, do smth that will prove you are not a robot</p>
</div>
?>
<input name="city" type="text" value="<?php
echo $user ? $user->getCity() : '';
?>
" style="<?php
echo $errcity;
?>
"/>
</td>
</tr>
-->
<tr>
<th align="right" valign="top"><strong>Education </strong></th>
<td>
<?php
echo frontend_select('education', $user, Lists::getListitemsForSelect('educations', array('' => $select_none)), array('style' => $erreducation), "getEducation");
?>
</td>
</tr>
<tr>
<th align="right" valign="top"><strong>Job type </strong></th>
<td>
<?php
if (isset($user)) {
?>
<input id="jobtypes" name="jobtypes" type="hidden" value="<?php
echo $user->getJobType();
?>
"/>
<?php