clockwerk-www – Rev 57

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<!DOCTYPE html>
<html>
<head>
<title>Clockwerk</title>
<link rel="stylesheet" href="css/gray.css" type="text/css" />
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
</head>
<body class="dark-grey">
<div>
<div class="center">
<img src="img/clockwerk-logo.png" alt="logo">
<h1><?php print gethostname(); ?></h1>
<hr>
</div>
<script type="text/javascript" src="lib/jquery.min.js"></script>
<form class="dark-grey" style="color:#000;text-shadow:none;text-align:left;max-width:480px;min-width:150px" method="post" action="applyiar.php" enctype="multipart/form-data"><div class="title"></div>
        <div class="element-input" ><label class="title">Agent First Name<span class="required"></span></label><input class="large" type="text" name="first" required="required"/></div>
        <div class="element-input" ><label class="title">Agent Last Name<span class="required"></span></label><input class="large" type="text" name="last" required="required"/></div>
        <div class="element-file" ><label class="title">IAR File</label><label class="large" ><div class="button">Choose File</div><input type="file" class="file_input" name="file" /><div class="file_text">No file selected</div></label></div>
        <div class="element-password" ><label class="title">Password<span class="required"></span></label><input class="large" type="password" name="password" value="" required="required"/></div>
        <div class="element-recaptcha" ><label class="title">Captcha</label><script type="text/javascript">var RecaptchaOptions = {theme : "clean"};</script>
<script type="text/javascript" src="http://www.google.com/recaptcha/api/challenge?k=6Lcz9ukSAAAAAPu4CYSJCjPiZeQJgG0ywy4wL_Fj&theme=clean"></script>
<noscript><iframe src="http://www.google.com/recaptcha/api/noscript?k=6Lcz9ukSAAAAAPu4CYSJCjPiZeQJgG0ywy4wL_Fj&hl=en" height="300" width="500" frameborder="0"></iframe></br>
<textarea name="recaptcha_challenge_field" rows="3" cols="40"></textarea><input type="hidden" name="recaptcha_response_field" value="manual_challenge"></noscript>
<script type="text/javascript">if (/#invalidcaptcha$/.test(window.location)) (document.getElementById("recaptcha_widget_div")).className += " error"</script></div>

<div class="submit">
<input type="submit" value="Upload">
<input type="button" onclick="parent.location='welcome.php'" value="Cancel">
</div>
</form>
<script type="text/javascript" src="lib/gray.js"></script>

</div>
</body>
</html>