107 lines
3.6 KiB
Text
107 lines
3.6 KiB
Text
<%- # License: AGPL-3.0-or-later WITH WTO-AP-3.0-or-later
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# Full license explanation at https://github.com/houdiniproject/houdini/blob/master/LICENSE -%>
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<div class='modal' id='identityVerificationModal'>
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<%= render 'common/modal_header', title: 'Identity Verification' %>
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<div class='modal-body'>
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<p>Please complete this form to verify your identity. This information serves
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as an extra security measure to prevent fraud, and is required by Stripe (our payment processor).</p>
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<p>You can find out more about Stripe's identity verification process <a href='https://stripe.com/docs/connect/identity-verification' target='_blank'>here</a>.</p>
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<p>All information submitted through this form is 256-bit SSL encrypted.</p>
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<form parsley-validate on-submit='submit_identity_verification'>
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<!--= on 'submit' (verify_identity form_object) -->
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<hr>
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<h6>Organization Info for <%= @nonprofit.name %></h6>
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<div>
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<fieldset class='col-6 '>
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<label>Organization Address</label>
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<input type='text' name='address.line1' required parsley-trigger='change' value='<%=@nonprofit.address%>'>
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</fieldset>
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<fieldset class='col-right-6 '>
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<label>City</label>
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<input type='text' name='address.city' required parsley-trigger='change' value='<%=@nonprofit.city%>'>
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</fieldset>
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</div>
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<div>
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<fieldset class='col-6 '>
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<label>State</label>
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<%= render 'common/states_dropdown', default: @nonprofit.state_code, name: 'address.state' %>
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</fieldset>
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<fieldset class='col-right-6 '>
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<label>Postal code</label>
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<input type='text' name='address.postal_code' required parsley-trigger='change' value='<%=@nonprofit.zip_code=%>'>
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</fieldset>
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</div>
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<div>
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<fieldset class='col-12 '>
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<label>EIN (Business Tax ID) of Organization (9 digits)</label>
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<input type='text' name='business_tax_id' required parsley-trigger='change' value='<%=@nonprofit.ein%>'>
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</fieldset>
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</div>
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<hr>
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<h6>Your Info</h6>
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<div>
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<fieldset class='col-6 '>
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<label>First name</label>
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<input type='text' name='first_name' required parsley-trigger='change'>
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</fieldset>
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<fieldset class='col-right-6 '>
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<label>Last Name</label>
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<input type='text' name='last_name' required parsley-trigger='change'>
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</fieldset>
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</div>
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<div>
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<fieldset class='col-6 '>
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<label>Date of birth</label>
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<select name='dob.month' style='width:34%' required>
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<option disabled selected>Month</option>
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<%(1..12).each do |d| %>
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<option value=<%=d%>><%=d%></option>
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<% end %>
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</select>
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<strong>/</strong>
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<select name='dob.day' style='width:26%' required>
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<option disabled selected>Day</option>
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<%(1..31).each do |d| %>
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<option value=<%=d%>><%=d%></option>
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<% end %>
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</select>
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<strong>/</strong>
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<select name='dob.year' style='width:28%' required>
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<option disabled selected>Year</option>
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<%(1900..2000).each do |d| %>
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<option value=<%=d%>><%=d%></option>
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<% end %>
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</select>
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</fieldset>
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<fieldset class='col-right-6 '>
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<!-- pikaday -->
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<label>Last 4 of social security number</label>
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<input parsley-type='number' type='text' name='ssn_last_4' parsley-trigger='change' required>
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</fieldset>
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</div>
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<hr>
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<p class='finePrint u-centered'>By clicking "Submit", you agree to <a target='_blank' href='https://stripe.com/connect/account-terms'>Stripe's Connected Account Agreement.</a></p>
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<%= render 'components/forms/submit_button', button_text: 'Submit', scope: 'identity_verification' %>
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</form>
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</div>
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</div>
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