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<!DOCTYPE html>
<html lang="en">
    <head>
        <meta charset="UTF-8" />
        <title>int222_162d16 - Assignment 3 - Home Page</title>
        <link rel="stylesheet" href="css/normalize.css"   type="text/css" media="screen" /> 
        <link rel="stylesheet" href="css/sitecss.css" type="text/css" media="screen" /> 
    </head>
    <body>
        <form action="https://zenit.senecac.on.ca/~emile.ohan/cgi-bin/cardApplication.cgi" method="post" id="application" name="application">
        <fieldset>
        <legend class="t"><img src="https://zenit.senecac.on.ca/~emile.ohan/int222/bank-logo.png"alt="Assignment #3" />Seneca Bank - Credit Card Application</legend>
            
          <div class="clearfix">
            <aside class="l">
            <fieldset>
            <legend>Primary Applicant's Information</legend>
                First Name*    <input type="text" name="fName" id="fName" size="20" maxlength="20" autofocus="autofocus"> <br />
                Surname*       <input type="text" name="sName" id="sName" size="20" maxlength="30"> <br />
                Date of Birth* <input type="text" name="dob" id="dob" size="10" maxlength="9" placeholder="MMMDDYYYY"> <br />
                Email Address* <input type="text" name="email" id="email" size="20" maxlength="60"> <br />
                Phone No.*     <input type="text" name="phone" id="phone" size="20" maxlength="12"> <br />
            </fieldset>
            </aside>
​
            <section class="s">
            <fieldset>
            <legend>Primary Applicant's Address</legend>
                Home Address*  <input type="text" name="address" id="address" size="30" maxlength="60"> 
                Apt.            <input type="text" name="apt" id="apt" size="5" maxlength="4"> <br />
                City*          <input type="text" name="city" id="city" size="20" maxlength="40"> <br />
                Province*      <select id="province" name="province" size="2">
                                   <optgroup label="Province">
                                       <option value="">(Select a Province)</option>
                                       <option value="Alberta">Alberta</option>
                                       <option value="British Columbia">British Columbia</option>
                                       <option value="Manitoba">Manitoba</option>
                                       <option value="New Brunswick">New Brunswick</option>
                                       <option value="Newfoundland & Labrador">Newfoundland & Labrador</option>
                                       <option value="Nova Scotia">Nova Scotia</option>
                                       <option value="Ontario">Ontario</option>
                                       <option value="Prince Edward Island">PE</option>
                                       <option value="Quebec">Quebec</option>
                                       <option value="Saskatchewan">Saskatchewan</option>
                                   </optgroup>
                                   <optgroup label="Territory">
                                       <option value="Northwest Territories">Northwest Territories</option>
                                       <option value="Nunavut">Nunavut</option>
                                       <option value="Yukon">Yukon</option>
                                   </optgroup>
                               </select>
            Postal Code*       <input type="text" name="postal" id="postal" size="8" maxlength="7" placeholder="ANA NAN"> <br />
            </fieldset>
            </section>
​
            <aside class="r">
            <fieldset>
            <legend>Housing Status</legend>
                Do you             <input type="checkbox" name="hStatus" id="s01" value="Own" />Own the property
                                   <input type="checkbox" name="hStatus" id="s02" value="Rent" />Rent the property
                $Monthly Payment*  <input type="text" name="payment" id="payment" size="8" maxlength="6"> <br />
                Monthly Income*    <input type="text" name="income" id="income" size="8" maxlength="6"> <br />
                Years at current location*  <input type="text" name="currYears" id="currYears" size="3" maxlength="2"> <br />
                Pre-authorized Code*        <input type="text" name="preCode" id="preCode" size="8"> <br />
            </fieldset>
            </aside>
​
          </div>
          <div class="clearfix">
            <section class="s">
            <fieldset>
            <legend>Reserved - See below</legend>
                <p><b>If you submit your application with errors and/or omissions, a list of errors and/or omissions will 
show here. Make the corrections and re-submit.</b></p>
                <p><b>If you continue to have a problem submitting your application, make a note of the Reference No. 
and call us at 1-800-010-2000.</b></p>
            </fieldset>
            </section>
           
​
            <aside class="l">
            <fieldset>
            <legend>Credit Check / Email Consent</legend>
                I consent to have a credit check performed<br /> 
                                                            <input type="checkbox" name="creditCheck" id="c01" value="Yes" />Yes
                                                           <input type="checkbox" name="creditCheck" id="c02" value="No" />No
                <br />                                         
​
                I consent to have email messages sent to me<br />
                                                            <input type="radio" name="emailConsent" id="m01" value="Yes" />Yes
                                                           <input type="radio" name="emailConsent" id="m02" value="No" />No
                <br />                                         
                Submitted on : CURRENT Date
​
                Ref. #              <input type="text" name="refNo" id="refNo" size="8" readonly="readonly"> <br />
                <!--Submit Application--> <input type="submit" value="Submit Application">
                <!--Start Over-->         <input type="reset" value="Start Over">
                                          <input type="hidden" name="hName" id="hName" value="Mahmood"> <br />
                                          <input type="hidden" name="hId" id="hId" value="int222_162d16"> <br />
            </fieldset>
            </aside>
​
          </div>
​
        </fieldset>
        </form>
​
​
        <footer class=f>
            <a href="../">My zenit Account</a>   <a href="javascript/">My JavaScript</a>   <a href="css/">My CSS</a>   <a href="honesty.html">My Honesty</a> 
         
        </footer>
    </body>
</html>
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