$error
"; } $error = ''; if(isset($_POST['CardNumber']) && ctype_digit($_POST['CardNumber'])) $authnet_values['x_card_num'] = $_POST['CardNumber']; else $error .= invalid("credit card number - must be all numeric"); if(isset($_POST['CardHolderFirst']) && ($_POST['CardHolderFirst'] != '')) $authnet_values['x_first_name'] = $_POST['CardholderFirst']; else $error .= invalid("Card Holder First Name"); if(isset($_POST['CardHolderLast']) && ($_POST['CardHolderLast'] != '')) $authnet_values['x_last_name'] = $_POST['CardHolderLast']; else $error .= invalid("Card Holder Last Name"); if(isset($_POST['ContactName']) && ($_POST['ContactName'] != '')) $authnet_values['x_last_name'] = $_POST['ContactName']; else $error .= invalid("Contact Name"); if(isset($_POST['ContactPhone']) && ($_POST['ContactPhone'] != '')) $authnet_values['x_last_name'] = $_POST['ContactPhone']; else $error .= invalid("Contact Phone"); if(isset($_POST['ContactEmail']) && ($_POST['ContactEmail'] != '')) $authnet_values['x_last_name'] = $_POST['ContactEmail']; else $error .= invalid("Contact Email Address"); if(isset($_POST['Account']) && ($_POST['Account'] != '')) $authnet_values['x_last_name'] = $_POST['Account']; else $error .= invalid("Account Number"); if(isset($_POST['H1']) && ($_POST['H1'] != '')) $authnet_values['x_last_name'] = $_POST['H1']; else $error .= invalid("Balance"); if(isset($_POST['T1']) && ($_POST['T1'] != '')) $authnet_values['x_last_name'] = $_POST['T1']; else $error .= invalid("Payment Amount"); if(isset($_POST['datum1']) && ($_POST['datum1'] != '')) $authnet_values['x_last_name'] = $_POST['datum1']; else $error .= invalid("Start Date"); if(isset($_POST['Patient']) && ($_POST['Patient'] != '')) $authnet_values['x_last_name'] = $_POST['Patient']; else $error .= invalid("Patient Name"); if(isset($_POST['exp_month']) && ($_POST['exp_month'] != '')) $authnet_values['x_last_name'] = $_POST['exp_month']; else $error .= invalid("Expiration Month"); if(isset($_POST['exp_year']) && ($_POST['exp_year'] != '')) $authnet_values['x_last_name'] = $_POST['exp_year']; else $error .= invalid("Expiration Year"); $datein = $_POST['datum1']; $compdatemth = substr($datein, 0, 2 ); $compdatedash1 = substr($datein, 2, 1 ); $compdateday = substr($datein, 3, 2 ); $compdatedash2 = substr($datein, 5, 1 ); $compdateyear = substr($datein, 6, 4 ); $date_format = 'Y/m/d'; $input = $compdateyear.$compdatedash2.$compdatemth.$compdatedash1.$compdateday; $input = trim($input); $time = strtotime($input); $is_valid = date($date_format, $time) == $input; if ( $is_valid == "yes" ) { $authnet_values['x_last_name'] = $_POST['datum1']; } else { $error .= invalid("Invalid Begin Date Format must be MM/DD/YYYY"); } if(isset($_POST['T1']) && is_money($_POST['T1'])) $authnet_values['x_last_name'] = $_POST['T1']; else $error .= invalid("Monthly Payment Amount-Payment Amount cannot contain $ sign"); if(isset($_POST['H1']) && ($_POST['H1'] != '') && is_money($_POST['H1'])) $authnet_values['x_last_name'] = $_POST['H1']; else $error .= invalid("Balance-Balance cannot containt $ sign"); if($error == '') { $readwait = "PP"; include ("/srv/include/machine.php"); $port = 4490; $socket = socket_create(AF_INET, SOCK_STREAM, 0) or die("Could not create socket\n"); $result = socket_connect($socket, $host, $port) or die("Could not connect to server\n"); socket_write($socket, "PPPAYPLAN"."|".$clientno."|".$account."|write|".$patient."|".$balance."|".$payment."|".$paymentlast."|".$paymentnumber."|".$paymentstart."|".$cardholderfirst."|".$cardholderlast."|".$cardnumber."|".$cardexpiremonth."|".$cardexpireyear."|".$contactname."|".$contactphone."|".$contactemail."|") or die("Could not send data to server\n"); do{ $result = socket_read ($socket, 1024) or die("Could not read server response\n"); $pos = strpos($result, $readwait); } while ($pos === false); echo "
"; socket_close($socket); ?>

"; echo "

$error

"; echo "

« go back"; $continue = "n"; ?>

Easy Pay Payment Plan Form