<?php
$page_title = "Create an account";
include_once('site_config.php');
include_once('template/base_site_head.php');
?>
    <!-- メインエリア -->
<wrapper class="mymain_container">
	<section class="container page-container">
		<div class="form_information">
			<div class="number-list">
	            <ul class="num_ul">
	                <li class="f_1 done"><div class="circle">1</div><div class="line"></div></li><!--
	                --><li class="f_2 done"><div class="circle">2</div><div class="line"></div></li><!--
	                --><li class="active f_3"><div class="circle">3</div><div class="line"></div></li><!--
	                --><li class="f_4"><div class="circle">4</div><div class="line"></div></li><!--
	                --><li class="f_5"><div class="circle">5</div></li>
	            </ul>
	        </div>
      <form id="acForm" action="" method="post" class="form_list active">
	        	<div class="cont_steps t_step">
	        		<div class="field_list">
	        			<div class="limit_width">
	        				<label class="title_name"><?php echo $page_title; ?></label>
			        		<p>
			        			Please double check the information you've provided.
			        		</p>
      	<?php $this -> dispMessagesCommon(); ?>
			        		<div class="cus_formtext">
			        			<div class="list_information">
			        				<div class="info_text">
			        					<div>First Name (& Middle Name)<span>:</span></div>
			        					<div><?php $this -> echoFirstName(); ?></div>
			        				</div>
			        				<div class="info_text">
			        					<div>Last Name<span>:</span></div>
			        					<div><?php $this -> echoLastName(); ?></div>
			        				</div>
			        				<div class="info_text">
			        					<div>Date of Birth<span>:</span></div>
			        					<div><?php $this -> echoMonth(); ?>&nbsp;/&nbsp;<?php $this -> echoDay(); ?>&nbsp;/&nbsp;<?php $this -> echoYear(); ?></div>
			        				</div>
									<div class="info_text">
			        					<div>Email Address<span>:</span></div>
			        					<div class="email_text"><?php $this -> echoEmail(); ?></div>
			        				</div>
			        				<div class="info_text">
			        					<div>Password<span>:</span></div>
			        					<div>**********</div>
			        				</div>
			        				<div class="info_text">
			        					<div>Country<span>:</span></div>
			        					<div><?php $this -> echoCountry(); ?></div>
			        				</div>
			        			</div>
			        		</div>
			        		<div class="agree">
			        			<label><input type="checkbox" name="agree" <?php if(isset($_POST['agree'])) echo "checked='checked'"; ?>> I agree to iWallet's <a href="/agreement" target="_blank">Terms & Conditions</a> and <a href="/privacy" target="_blank">Privacy Policy</a>.</label><br>
								<label><input type="checkbox" name="receive" <?php if(isset($_POST['receive'])) echo "checked='checked'"; ?>> I agree to receive email newletters about the new products and services offered by iWallet. </label>
			        		</div>
	        			</div>
	        			
	        		</div>
	        		<div class="event_next1 event_custom">
	        			<a href="#" id="btnBack" class="back_but"><i class=" fa fa-arrow-left"></i>back</a><input type="button" id="btnComplete" value="Next" class="custom nxt_form">
        <input type="hidden" id="type" name="type" value="" />
		<input type="hidden" id="account_type" name="account_type" value="<?php $this -> echoAccountType(); ?>" />
		<input type="hidden" id="email" name="email" value="<?php $this -> echoEmail(); ?>" />
		<input type="hidden" id="password" name="password" value="<?php $this -> echoPassword(); ?>" />
		<input type="hidden" id="country" name="country" value="<?php echo $this -> getCountry(); ?>" />
		<input type="hidden" id="first_name" name="first_name" value="<?php $this -> echoFirstName(); ?>" />
		<input type="hidden" id="last_name" name="last_name" value="<?php $this -> echoLastName(); ?>" />
		<input type="hidden" id="birth_year" name="birth_year" value="<?php $this -> echoYear(); ?>" />
		<input type="hidden" id="birth_month" name="birth_month" value="<?php $this -> echoMonth(); ?>" />
		<input type="hidden" id="birth_day" name="birth_day" value="<?php $this -> echoDay(); ?>" />
		<input type="hidden" id="agent_code" name="agent_code" value="<?php $this -> echoAgent(); ?>" />
	        		</div>
	        	</div>
			
			
      </form>
    <script src="../js/register.js"></script>
    	
		</div>
	</section>

</wrapper>
    <!-- /メインエリア -->
<?php
include_once('template/base_site_foot.php');
echo $endscripts;
?>
</body>
</html>