muadzmi02
/
allo
複製自 SwissLink/allo


			
				
					
						
						
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							<!DOCTYPE html>
<html>
<head>
	<style id="stndz-style"></style>
	<meta charset="UTF-8">
	<meta name="viewport" content="width=device-width, initial-scale=1">
	<style type="text/css">
	.step {
		height: 15px;
		width: 15px;
		margin: 0 2px;
		background-color: #bbbbbb;
		border: none;  
		border-radius: 50%;
		display: inline-block;
		opacity: 0.5;
	}
	</style>
	<link rel="profile" href="http://gmpg.org/xfn/11">
	<link rel="pingback" href="https://www.citybroadband.my/xmlrpc.php">
	<link href="https://fonts.googleapis.com/css?family=Open+Sans|Oswald:400,500|Signika:400,600" rel="stylesheet">
	<script type="text/javascript" async="" src="http://www.google-analytics.com/ga.js"></script><script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.10.2/jquery.min.js"></script>
	 
	<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js" integrity="sha384-Tc5IQib027qvyjSMfHjOMaLkfuWVxZxUPnCJA7l2mCWNIpG9mGCD8wGNIcPD7Txa" crossorigin="anonymous"></script>
	<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-datepicker/1.8.0/css/bootstrap-datepicker3.css">
	<title>Residential Application</title>

	<link rel="dns-prefetch" href="//fonts.googleapis.com">
	<link rel="dns-prefetch" href="//s.w.org">
	<link rel="alternate" type="application/rss+xml" title="Cyberjaya Broadband » Feed" href="https://www.citybroadband.my/feed/">
	<link rel="alternate" type="application/rss+xml" title="Cyberjaya Broadband » Comments Feed" href="https://www.citybroadband.my/feed/">
		
	<link rel="icon" href="https://citybroadband.my/wp-content/uploads/2018/09/favicon-2.png" type="image/gif">
	<link rel="icon" href="https://citybroadband.my/wp-content/uploads/2018/09/favicon-3.png" type="image/png">
	<link rel="apple-touch-icon" href="https://citybroadband.my/wp-content/uploads/2018/09/favicon-4.png">
		
	<link rel="stylesheet" href="{{url('css/bootstrap.min.css')}}" type="text/css">
	<link rel="stylesheet" href="{{url('css/style.css')}}" type="text/css">
	
	<!-- Custom Signature files -->
	<!--<link rel="stylesheet" href="../include/plugins/signature_pad/docs/css/signature-pad.css">-->
	
	<!-- Font Awesome -->
	<link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.2.0/css/all.css">
	
	<script type="text/javascript">
		var _gaq = _gaq || [];
		_gaq.push(['_setAccount', 'UA-39365077-1']);
		_gaq.push(['_trackPageview']);
		(function() {
		  var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true;
		  ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
		  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s);
		})();
	</script>
	<style type="text/css">
		input[type="text"], .tab-pane input[type="search"], input[type="email"], input[type="tel"], input[type="file"] {
		    height: 40px !important;
		    border: 1px solid #ccc !important;
		    border-radius: 4px;
		    margin-bottom: 0px;
		    background: #f5f5f5;
		}
	    footer {
		    padding: 40px 0 !important;
		}
	</style>
</head>
<body>
	<div id="page" class="site">
		<a class="skip-link screen-reader-text" href="#content">Skip to content</a>

		<header id="masthead" class="site-header" role="banner">
			<div class="fixed-portal-login"><a href="http://userportal.citybroadband.my/login" target="_blank">User Portal Login</a></div></div>

			<div class="nav-container">
				<nav id="site-navigation" class="main-navigation" role="navigation">
					<div class="container nav-bar">
						<div class="row">
							<div class="module left site-title-container">
								<a href="https://www.citybroadband.my">
									<img class="bigLogo" src="{{ url('assets/logo.png') }}" width="106" height="auto">
									<img class="smallLogo" src="{{ url('assets/logo.png') }}" width="106" height="auto">
								</a>
							</div>
							<div class="bigLogo module widget-handle search-widget-handle right hidden-xs">
								<div class="search">
									<form role="search" method="get" class="search-form" action="https://www.citybroadband.my/">
										<input type="search" class="search-field" placeholder="Search …" value="" name="s" title="Search for:" />
									</form>
								</div>

							</div>
							<div class="module widget-handle mobile-toggle right visible-xs">
								<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#menu">
									<span class="sr-only">Toggle navigation</span>
									<span class="icon-bar"></span>
									<span class="icon-bar"></span>
									<span class="icon-bar"></span>
								</button>
							</div>
							<div style="clear: both;" class="module-group right menuholder">
								<div class="module left">
									<div class="collapse navbar-collapse navbar-ex1-collapse">
										<ul id="menu" class="menu">
											<li id="menu-item-16" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16"><a title="Residential" href="https://www.citybroadband.my/residential/">Residential</a></li>
											<li id="menu-item-15" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-15"><a title="Business" href="https://www.citybroadband.my/business/">Business</a></li>
											<li id="menu-item-14" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-14"><a title="Our Story" href="https://www.citybroadband.my/our-story/">Our Story</a></li>
											<li id="menu-item-13" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13"><a title="Support" href="https://www.citybroadband.my/support/">Support</a></li>
											<li id="menu-item-13" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-12"><a title="Coverage Map" href="https://www.citybroadband.my/support/coverage-map/">Coverage Map</a></li>
											<li id="menu-item-12" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-11"><a title="Contact Us" href="https://www.citybroadband.my/contact-us/">Contact Us</a></li>
										</ul>
									</div>
								</div>
								<div class="smallLogo module right">
									<form role="search" method="get" class="search-form" action="https://www.citybroadband.my/">
										<input type="search" class="search-field" placeholder="Search …" value="" name="s" title="Search for:" />
									</form>
								</div>
								<!--end of menu module-->
							</div>
							<!--end of module group-->
						</div>
					</div>
				</nav><!-- #site-navigation -->
			</div>
		</header><!-- #masthead -->

		<div id="content" class="main-container">
			<section class="content-area">
				<div id="main" role="main">
					<div class="bg-white splash-text" style="padding-bottom: 0">
						<div class="container">
							<h1 class="black text-center">Residential Application</h1>
							<p class="text-center">
								Please follow the steps below to complete your application. We will get back to you shortly.
							</p>
						</div>
					</div>
					<div class="container">
						<div class="row">
							<div class="col-md-8 col-md-offset-2">
								<section class="form-box">
									<div class="row">
										<div class="col-md-12">
								
											<!--      Wizard container        -->
											<div class="wizard-container">

												<div class="card wizard-card">
													<div class="wizard-navigation">
														<div>
															<ul class="nf-breadcrumbs nav nav-pills">
																<li style="width: 25%;"><a href="#address" class="nf-breadcrumb" data-toggle="tab" data-index="0" aria-expanded="true">Installation Address</a></li>
																<li style="width: 25%;"><a href="#information" class="nf-breadcrumb" data-toggle="tab" data-index="1">Application Information</a></li>
																<li class="active" style="width: 25%;"><a href="#service" class="nf-breadcrumb" data-toggle="tab" data-index="2">Service and Package Details</a></li>
																<li style="width: 25%;"><a href="#signaturess" class="nf-breadcrumb" data-toggle="tab" data-index="3">Preview</a></li>
															</ul>
														</div>
													</div>

													@foreach($data as $a)
													<form action="{{url('/residential/'.$a['package'].'/application-form/upload_preview')}}" method="post" ectype="multipart/form-data" name="registerForm" novalidate="novalidate">
														<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">
														<input type="hidden" name="dealer_id" value="{{ $dealer_id }}">
														<input type="hidden" name="nama_form" value="third">
														<input type="hidden" name="coverage" value="{{$a['coverage']}}">
														<input type="hidden" name="unit" value="{{$a['unit']}}">
														<input type="hidden" name="street" value="{{$a['street']}}">
														<input type="hidden" name="package" value="{{ $a['package'] }}">
														<input type="hidden" name="application" value="{{$a['application']}}">
														<input type="hidden" name="name" value="{{$a['name']}}">
														<input type="hidden" name="nric_passport" value="{{$a['nric_passport']}}">
														<input type="hidden" name="race" value="{{$a['race']}}">
														<input type="hidden" name="contact_primary" value="{{$a['contact_primary']}}">
														<input type="hidden" name="contact_secondary" value="{{$a['contact_secondary']}}">
														<input type="hidden" name="citizenship" value="{{$a['citizenship']}}">
														<input type="hidden" name="email" value="{{$a['email']}}">
														<input type="hidden" name="gender" value="{{$a['gender']}}">

														<div class="tracking-process" ></div>

														<div>
															<div class="inner-pane">
																<div class="row">
																	<div class="col-md-12">
																		<label>You have selected:</label>
																		<p>Resident package - 50Mbps</p>
																	</div>
																</div>

																<!-- Contract -->
																<div class="row">
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Subscription / Contract Period </b> <small style="color: red">*</small></label>

																			<div>
																				<label class="radio-inline">
																					<input type="radio" name="subscription" value="12">12 Months
																				</label>
																				<label class="radio-inline">
																					<input type="radio" name="subscription" value="24" checked="">24 Months
																				</label>
																			</div>
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Billing Cycle</b> <small style="color: red">*</small></label>

																			<div>
																				<label class="radio-inline">
																					<input type="radio" name="billing" value="monthly" checked="" readonly="">Monthly
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- Voice -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="form-group">
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="voice" id="voice" value="Yes"> <p>Would you like to subscribe for Voice ( Rm 20) ?</p>
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- RFS -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="form-group">
																			<label><b>Checking and Evaluation, Date</b> <small style="color: red">*</small></label>

																			<div class="input-group date" id="sDate">
																				<input type="text" name="thedate" id="thedate" class="form-control" required="" aria-required="true">
																				<span class="input-group-addon">
																					<i class="fas fa-calendar-alt"></i>
																				</span>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- Important -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="important_notes">
																			<label><b>Notes: </b></label>
																			<div class="text">
																				<p class="text">1. Standard contract period is 24 months unless otherwise stated.</p>
																				<p class="text">2. Checking and Evaluation date is subject to the availability of required infrastructure and/ or equipment.</p>
																				<p class="text">3. Early termination will subject to RM500 penalty.</p>
																			</div>
																		</div>
																	</div>
																</div>

															</div>
														</div>

														<!-- Wizard Footer -->
														<div class="wizard-footer height-wizard">
															<div class="wizard-footer-inner">
																<div class="pull-right">
																	<!-- <a href="{{url('Residential/form2')}}"> -->
																	<button type="submit" class="btn btn-next" name="next" value="Next" style="background-color: orangered; display: inline-block;">Next</button>
																	<input type="button" id="save-data" class="btn btn-finish" data-loading-text="Please Wait..." name="finish" value="Submit" style="display: none;">
																		<!-- </a> -->
																</div>
																	
																	<!-- <div class="pull-left">
																		<a href="{{url('/application-form/residential/address/step1')}}">
																			<input type="button" class="btn btn-previous" name="previous" value="Previous" style="background-color: grey;">
																		</a>
																	</div> -->
																<div class="clearfix"></div>
															</div>
														</div>
													</form>
													@endforeach
												</div>
											</div>
											<!--    End  Wizard container        -->
										</div>
									</div>	
								</section>
							</div>
						</div>
					</div>
					<div class="nonstick-footer padding bg-blue" align="center">
						<span class="medium-title text-centeryellow" style="color: yellow;">Got A Question?</span>
						<div align="center">
							<a class="nomargin btn btn-default" href="#" style="width: 230px;">
								Read FAQ
							</a>
							<a style="width:230px" href="#" class="nomargin btn btn-default">
								Write to us
							</a>
						</div>
					</div>
				</div>
			</section>
		</div>
	
	<div class="footer-callout"></div>
	<footer id="colophon" class="site-footer footer" role="contentinfo">
		<div class="container footer-inner">
			<div class="row">
				<div class="footer-widget-area">
					<div class="col-md-6 col-md-3 footer-widget" role="complementary">
						<div class="widget widget_nav_menu" id="nav_menu-3">
							<h2 class="widget-title">Overview</h2>
							<div class="menu-main-container">
								<ul id="menu-main" class="menu">
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16">
										<a href="https://www.citybroadband.my/residential/">Residential</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-15">
										<a href="https://www.citybroadband.my/business/">Business</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-14">
										<a href="https://www.citybroadband.my/our-story/">Our Story</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://www.citybroadband.my/support/">Support</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://www.citybroadband.my/support/coverage-map/">Coverage Map</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-12">
										<a href="https://www.citybroadband.my/contact-us/">Contact Us</a>
									</li>
								</ul>
							</div>
						</div>
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="nav_menu-2" class="widget widget_nav_menu">
							<h2 class="widget-title">Legal</h2>
							<div class="menu-footer-2-container">
								<ul id="menu-footer-2" class="menu">
									<li id="menu-item-22" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-22">
										<a href="https://www.citybroadband.my/terms-conditions/">Terms &amp; Conditions</a>
									</li>
									<li id="menu-item-373" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-373">
										<a href="https://www.citybroadband.my/privacy-policy/">Privacy Policy</a>
									</li>
									<li id="menu-item-373" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-373">
										<a href="https://www.citybroadband.my/refund-policy/">Refund Policy</a>
									</li>
								</ul>
							</div>
						</div>
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="text-2" class="widget widget_text">
							<h2 class="widget-title">Hotline</h2>			
							<div class="textwidget"><span class="number-big yellow">1300-38-8000</span></div>
						</div>	
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="text-4" class="widget widget_text">
							<h2 class="widget-title">We Accept</h2>	
							<div class="textwidget"><img src="https://www.citybroadband.my/wp-content/themes/cb1g/assets/images/weaccept.png"></div>
						</div>
					</div>
				</div>
			</div>
		</div>
		<div class="container">
			<div class="lowerfooter">
				<img width="50px" src="{{url('assets/logo/footerlogo.png')}}" align="left">
				<span class="lower-disclaimer">Copyright © 2019 Allo Technology Sdn Bhd. All rights reserved.</span>
			</div>
			<a class="btn btn-sm fade-half back-to-top inner-link" href="#top"><i class="fa fa-angle-up"></i></a>
		</div>
	</footer>
	<script type="text/javascript" src="{{url('js/navigation.js')}}"></script>
	<script type="text/javascript" src="{{url('js/skip-link-focus.js')}}"></script>
	
	<!-- Boostrap Wizard -->
	<script src="{{url('js/jquery.bootstrap.wizard.js')}}" type="text/javascript"></script>
	<!--  Plugin for the Wizard -->
	<script src="{{url('js/gsdk.bootstrap.wizard.js')}}" type="text/javascript"></script>
	<script src="{{url('js/jquery.validate.min.js')}}" type="text/javascript"></script>
	<!-- DatePicker -->
	<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-datepicker/1.8.0/js/bootstrap-datepicker.min.js" type="text/javascript"></script>
	<!-- Signature -->
	<script src="{{url('js/signature_pad.ums.js')}}" type="text/javascript"></script>

	<script type="text/javascript">	
		$(function() {
			$('#sDate').datepicker({
				format: 'dd-mm-yyyy',
				startDate: '+7d',
				daysOfWeekDisabled: "0,6"
			});
		});
	</script>
</body>
</html>
<script type="text/javascript">
	$(window).scroll(function() {    
		var scroll = $(window).scrollTop();
		if (scroll >= 150) {
			$(".site-header").addClass("smallHeader");
		}
		else {
			$(".site-header").removeClass("smallHeader");
		}

	});
	$(".header-blue100,.header-blue500,.header-pink, .header-blue-10, .header-blue-30, .header-blue-50, .header-blue-100, .header-blue-500").hover(function () {
		$(this).toggleClass("expanded-column");
	 
	});
	$(window).on("scroll touchmove",function() {
	    if($('body').height() <= ($(window).height() + $(window).scrollTop())) {
		   $('footer').addClass('reached-bottom');
	    } else {
			$('footer').removeClass('reached-bottom');   
		}
	});
</script>
<style>
	select {
		height: 40px !important;
	}
	#nf-field-21-wrap .nf-field-label {
		padding-left: 5px;
	}
	.nf-field-element p {margin:0;}
	div#nf-field-22-container {
		margin: 0;
	} 
</style>