{form->rootpath_script}
{form->basepath_script}
{html->script_group_start name="{$compiled_js_path}/contentaffiliatesignup.js"}
{html->script src="{$common_frontend_js}/captcha.page.js"}
{html->script src="{$common_frontend_js}/affiliate.page.js"}
{html->script_group_end}
<script type="text/javascript">
$(document).ready(function(){
	$('#hidImageCaptchaCode').css('visibility', 'hidden');
});
</script>

  <div class="affiliate-form">
        {form->start name="forms" method="post" action="page/affiliateSignup/{$resContent.contentUrlKey}#formFocus"} <a name="formFocus"></a> {*form->hidden name="businessstatehidValue"*}
        <h3 class="bord-bottom-dot mt-3">{$language.lblSietInformation}</h3>
        <fieldset class="form-field04">
          <ul class="form1">
            <li class="row">
              <div class="col-sm-4 col-12 form-group">
                  <div class="label">
                    <label>{$language.lblWebsiteURL} </label>
                    <span class="text-secondary">*</span></div>
                
                  <div class="field"> {form->textbox name="affiliateReqWebsiteURL" tabindex="1" maxlength="450"  class="form-control" validate="requitext-secondary~*isUrl" validate_event="submit"  error=$language.errWebsiteUrl|cat:'~*'|cat:$language.errInvalidUrl} </div>
                
              </div>
              <div class="col-sm-4 col-12 form-group">
                  <div class="label ">
                    <label>{$language.lblWebsiteType} </label>
                    <span class="text-secondary">*</span></div>
                
                  <div class="field">{form->textbox name="affiliateReqTypeofWebsite" tabindex="2" maxlength="150"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errWebsiteType}</div>
              </div>
              <div class="col-sm-4 col-12 form-group"></div>
            </li>
          </ul>
        </fieldset>
        <div  class="top-spacing">
          <h3 class="bord-bottom-dot mt-3">{$language.lblAccounttInformation}</h3>
          <fieldset>
            <div>
              <ul class="form1">
                <li class="row">
                  <div class="col-sm-4 col-12 form-group">
                    <div class="clearfix">
                      <div class="label">
                        <label>{$language.lblFirstName} </label>
                        <span class="text-secondary">*</span></div>
                    
                      <div class="field">{form->textbox id="affiliateReqFirstName" name="affiliateReqFirstName" tabindex="3" maxlength="100"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errFirstName}</div>
                    </div>
                  </div>
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label ">
                        <label>{$language.lblLastName} </label>
                        <span class="text-secondary">*</span> </div>
                    
                      <div class="field">{form->textbox name="affiliateReqLastName" tabindex="4" maxlength="100" class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errLastName}</div>
                  </div>
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblCompany} </label>
                        <span class="text-secondary">*</span></div>
                    
                      <div class="field">{form->textbox name="affiliateCompanyName" tabindex="5" maxlength="450"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errCompany} </div>
                  </div>
                  
                </li>
                <li class="row">
                  
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblContactPerson} </label>
                        <span class="text-secondary">*</span> </div>
                    
                      <div class="field"> {form->textbox name="affiliateReqContactPerson" tabindex="6" maxlength="450"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errContactPerson}</div>
                  </div>
                
                  <div class="col-sm-4 col-12 form-group">
                    <div class="clearfix">
                      <div class="label">
                        <label>{$language.lblAddressLine1} </label>
                        <span class="text-secondary">*</span> </div>
                    
                      <div class="field"> {form->textbox name="affiliateReqAddress1" tabindex="7" maxlength="100"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errBusAddress1} </div>
                    </div>
                  </div>
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblAddressLine2} </label>
                      </div>
                    
                      <div class="field"> {form->textbox name="affiliateReqAddress2" tabindex="8" maxlength="100"  class="form-control"}</div>
                  </div>
                </li>
                <li class="clearfix">
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblCountry} </label>
                        <span class="text-secondary">*</span>
                      </div>
                    
                      <div class="field">{form->select id="affiliateReqCountryID" maxlength="50" tabindex="9" name="affiliateReqCountryID"  caption="->Select"   options=$resListCountry class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errBusCountry}</div>
                  </div>
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label ">
                        <label>{$language.lblStateProvince} </label>
                        <span class="text-secondary">*</span> 
                      </div>
                    
                      <div class="field"> <span id="spanState"> {form->select id="affiliateReqStateID" name="affiliateReqStateID" class="form-control"  caption="->Select" tabindex="10" validate="stateSelectedType->isequal->state~*requitext-secondary" validate_event="submit" error=$language.errBusState} </span> <span id="spanStateProvince" style="display:none;"> {form->textbox id="stateProvince" maxlength="100" name="affiliateReqProvince" class="form-control" validate="stateSelectedType->isequal->province~*requitext-secondary" validate_event="submit" error=$language.errBusProvince tabindex="10"} </span> {form->hidden id="stateSelectedType" name="stateSelectedType" value=""}
                        {form->hidden id="stateSelectedID" name="stateSelectedID"} </div>
                  </div>
                
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblCity} </label>
                        <span class="text-secondary">*</span>
                      </div>
                    
                      <div class="field">{form->textbox id="affiliateReqCity" name="affiliateReqCity" maxlength="100" tabindex="11" class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errBusCity}</div>
                  </div>
                  </li>
                  <li class="row">
                    <div class="col-sm-4 col-12 form-group">
                      <div class="label ">
                        <label>{$language.lblZipPostalCode} </label>
                        <span class="text-secondary">*</span> 
                        </div>
                    
                      <div class="field">{form->textbox name="affiliateReqZipcode"  maxlength="20" tabindex="12" class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errBusZip} </div>
                    </div>
                
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblPhoneNumber} </label>
                        <span class="text-secondary">*</span>
                      </div>
                    
                      <div class="field">{form->textbox name="affiliateReqPhone" tabindex="13" maxlength="20"  class="form-control" validate="requitext-secondary"  validate_event="submit" error=$language.errPhone}</div>
                  </div>
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label ">
                        <label>{$language.lblFax} </label>
                      </div>
                    
                      <div class="field">{form->textbox name="affiliateReqFax" tabindex="14" maxlength="50"  class="form-control"} </div>
                  </div>
                </li>
                <li class="row">
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblEmail} </label>
                        <span class="text-secondary">*</span>
                      </div>
                    
                      <div class="field">{form->textbox name="affiliateReqEmail" tabindex="15" maxlength="50"  class="form-control" validate="requitext-secondary~*email"  validate_event="submit" error=$language.errBusEmail|cat: "~*"|cat:$language.errValidEmail}</div>
                  </div>
                  {if $enable_captcha}
                  <div class="col-sm-4 col-12 form-group">
                      <div class="label">
                        <label>{$language.lblSecurityCode} </label>
                        <span class="text-secondary">*</span>
                      </div>
                    
                      <div class="field row captcha">
                        <div class="col-6">
                         <img id="captchaCode"/ class="float-left">   <img id="reload_icon_captcha" src="{$view_images}/reload_icon_captcha.png" style="cursor:pointer;"  marginheight="0px" marginwidth="0px"  vspace="19" />
                        </div>
                       <div class="col-6">
                        		
						{form->textbox id="affiliateRequestSecurityCode"  validate_event="submit" autocomplete="off" name="affiliateRequestSecurityCode" tabindex="17" class="form-control" maxlength="12" validate="hidImageCaptchaCode->compare->value~*requitext-secondary" error=$language.errSecurityCode
                        value=$affiliateRequestSecurityCode|default:''}
                        
                        {form->hidden id="hiden_image_captcha"  name="hiden_image_captcha"}
						 {form->textbox id="hidImageCaptchaCode"  name="hidImageCaptchaCode" class="hidden-variable"}
                        </div>
                        <div class="clear"></div>
                      </div>
                  </div>
                  {/if} </li>
				 <li class="clearfix">
                  <div class="affiliate-agree form-group"> 
                  {form->checkbox  validate_event="submit" class="checkbox" name="agree"  value="1"}<label for="agree">{$language.lblIAgree}
                  {if ""|dynamic_menu:'url':'affiliate-terms-and-conditions'}
                   {html->anchor target="blank" rel="howitswork" href="#"|dynamic_menu:'hrefurl':'affiliate-terms-and-conditions' caption=$language.lblAffilaiteTermsAndConditions|dynamic_menu:'caption':'affiliate-terms-and-conditions'}
                   {/if}
                   </label>
                  {form->validate name="validateAgree" validate="agree->requitext-secondary"  error=$language.errAgreement} 
                  
                  </div>
                </li>
                <li class="clearfix">
                  <div class="label"></div>
                  <div class="dot"></div>
                  <div class="field"> 
                  {form->submit name="submitForms"  id="button" class="btn btn-primary" form="forms" validate_submit="yes"  value="{$language.lblSubmit}" tabindex="18"} </div>
                </li>
              </ul>
              <div class="clear"></div>
            </div>
          </fieldset>
        </div>
        {form->close}  
        </div>
{form->validate_script form="forms"}