Created
May 7, 2012 15:03
-
-
Save ornerymoose/2628249 to your computer and use it in GitHub Desktop.
This file contains bidirectional Unicode text that may be interpreted or compiled differently than what appears below. To review, open the file in an editor that reveals hidden Unicode characters.
Learn more about bidirectional Unicode characters
= render :partial => "shared/sidebar_nav" | |
#about.static | |
.page-header | |
%h1 Please complete this form and submit it. Our CouponTrade team will connect with you regarding your order within 1 business day. | |
%section.content | |
.container | |
%h4 Please complete this form and submit it. Our CouponTrade team will connect with you regarding your order within 1 business day. | |
.billing-shipping-container | |
.billing | |
%h3 Billing Information | |
.date-cust | |
.billingDate | |
%label.textLabel{:for => "billingDate"} Date | |
%input#billingDate.textInput{:name => "billingDate", :type => "text"}/ | |
.custNumber | |
%label.textLabel{:for => "custNumber"} Cust.# | |
%input#custNumber.textInput{:name => "custNumber", :type => "number"}/ | |
.clear | |
%label.textLabel{:for => "billingCompany"} Company | |
%input#billingCompany.textInput{:name => "billingCompany", :type => "text"}/ | |
%label.textLabel{:for => "billingAddress"} Address: | |
%input#billingAddress.textInput{:name => "billingAddress", :type => "text"}/ | |
%label.textLabel{:for => "billingCity"} City: | |
%input#billingCity.textInput{:name => "billingCity", :type => "text"}/ | |
.billState | |
%label.textLabel{:for => "billingState"} State: | |
%input#billingState.textInput{:name => "billingState", :type => "text"}/ | |
.billZip | |
%label.textLabel{:for => "billingZip"} Zip: | |
%input#billingZip.textInput{:name => "billingZip", :type => "text"}/ | |
.clear | |
.billPhone | |
%label.textLabel{:for => "billingPhone"} Phone: | |
%input#billingPhone.textInput{:name => "billingPhone", :type => "text"}/ | |
.billFax | |
%label.textLabel{:for => "billingFax"} FAX: | |
%input#billingFax.textInput{:name => "billingFax", :type => "text"}/ | |
%label.textLabel{:for => "billingEmail"} E-Mail Address: | |
%input#billingEmail.textInput{:name => "billingEmail", :type => "email"}/ | |
.billing-shipping | |
%h3 Shipping Information | |
%label.textLabel{:for => "shippingName"} Name | |
%input#shippingName.textInput{:name => "shippingName", :type => "text"}/ | |
%label.textLabel{:for => "shippingCompany"} Company | |
%input#shippingCompany.textInput{:name => "shippingCompany", :type => "text"}/ | |
%label.textLabel{:for => "shippingAddress"} Address | |
%input#shippingAddress.textInput{:name => "shippingAddress", :type => "text"}/ | |
%label.textLabel{:for => "shippingCity"} City | |
%input#shippingCity.textInput{:name => "shippingCity", :type => "text"}/ | |
.shipState | |
%label.textLabel{:for => "shippingState"} State | |
%input#shippingState.textInput{:name => "shippingState", :type => "text"}/ | |
.shipZip | |
%label.textLabel{:for => "shippingZip"} Zip | |
%input#shippingZip.textInput{:name => "shippingZip", :type => "text"}/ | |
%label.textLabel{:for => "shippingPhone"} Phone | |
%input#shippingPhone.textInput{:name => "shippingPhone", :type => "text"}/ | |
.clear | |
.bottom-form | |
%h3 Is This For: | |
%input{:name => "employeeIncentives", :type => "checkbox", :value => "employeeIncentives"} | |
%label.textlabel{:for => "employeeIncentives"} Employee Incentives | |
%input{:name => "corporateLoyalty", :type => "checkbox", :value => "corporateLoyalty"} | |
%label.textlabel{:for => "corporateLoyalty"} Corporate Loyalty Program* | |
%input{:name => "nonProfit", :type => "checkbox", :value => "nonProfit"} | |
%label.textlabel{:for => "nonProfit"} Non-Profit Fundraiser | |
%input{:name => "corporateGifting", :type => "checkbox", :value => "corporateGifting"} | |
%label.textlabel{:for => "corporateGifting"} Corporate Gifting | |
%h3 Giftcard(s) - Tell us more about your bulk gift card purchase. | |
%textarea.textInput.inputbox{:name => "name", :row => "2"} | |
%h3 Payment Method | |
.payBycheck | |
%input{:name => "employeeIncentives", :type => "checkbox", :value => "employeeIncentives"} | |
%label.textlabel{:for => "employeeIncentives"} Check | |
.payableTo | |
%p | |
%strong Payable to: | |
%p CouponTrade, Inc. | |
%p 214 West Ohio Street, Suite 4 | |
%p Chicago, IL 60654 | |
.payment-side | |
%input{:name => "corporateLoyalty", :type => "checkbox", :value => "corporateLoyalty"} | |
%label.textlabel{:for => "corporateLoyalty"} **Credit Card | |
%br | |
%input{:name => "nonProfit", :type => "checkbox", :value => "nonProfit"} | |
%label.textlabel{:for => "nonProfit"} Visa | |
%input{:name => "corporateGifting", :type => "checkbox", :value => "corporateGifting"} | |
%label.textlabel{:for => "corporateGifting"} MC | |
%input{:name => "corporateGifting", :type => "checkbox", :value => "corporateGifting"} | |
%label.textlabel{:for => "corporateGifting"} AMEX | |
%input{:name => "corporateGifting", :type => "checkbox", :value => "corporateGifting"} | |
%label.textlabel{:for => "corporateGifting"} DISCOVER | |
%p Last Four Digits of Credit Card #: | |
.clear | |
.requested-brands | |
%h3 Requested Brands Unit Cost X Quantity = Total | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
.reqBrand | |
%input#reqBrand.textInput{:name => "reqBrand", :type => "text"}/ | |
.unitCost | |
%input#unitCost.textInput{:name => "unitCost", :type => "text"}/ | |
.quantity | |
%input#quantity.textInput{:name => "quantity", :type => "number"}/ | |
.brandTotal | |
%input#brandTotal.textInput{:name => "brandTotal", :type => "text"}/ | |
%br | |
%br | |
%br | |
.contact-information | |
%p COUPONTRADE CONTACT: | |
%p P. 888-838-5847 | |
%p F. 312-929-4666 | |
%p E. bulk@coupontrade.com | |
.subtotal | |
%p SUBTOTAL = ____________ | |
%br | |
%p | |
3.5% PROCESSING FEE | |
%br | |
%br | |
%br | |
%br | |
(FOR ORDERS $5000 OR LESS) = ____________ | |
%br | |
%p SHIPPING = ____________ | |
%br | |
%p TOTAL = | |
%br | |
.clear | |
Sign up for free
to join this conversation on GitHub.
Already have an account?
Sign in to comment