1. Personal
2. Business
3. Phone Setup
4. Preferences

Yes No




`;// Set the serialized HTML into hidden input document.getElementById('eulaHtml').value = htmlContent; } function getCurrentDateFormatted() { const today = new Date(); const day = String(today.getDate()).padStart(2, '0'); const year = today.getFullYear();// Array of abbreviated month names const months = [ "Jan", "Feb", "Mar", "Apr", "May", "Jun", "Jul", "Aug", "Sep", "Oct", "Nov", "Dec" ]; const monthName = months[today.getMonth()];return `${day}-${monthName}-${year}`; }const formattedDate = getCurrentDateFormatted();(function () { const form = document.querySelector('form'); const modal = document.getElementById('agreement-modal'); const checkbox = document.getElementById('agree-checkbox'); const acceptBtn = document.getElementById('agreement-accept'); const nameField = document.querySelector('input[name="text-1"]'); // Registered Business Name// 1. Intercept submit to pop up modal form.addEventListener("submit", function (e) {clearError();for (let i = 1; i <= 4; i++) { const [valid, fields] = isStepValid(i); if (!valid) { e.preventDefault(); goToStep(i); showError("Please complete all mandatory fields before submitting:
  • " + fields.join("
  • ") + "
"); return false; } }const issues = [ document.getElementById('issue-1').value.trim(), document.getElementById('issue-2').value.trim(), document.getElementById('issue-3').value.trim() ]; document.getElementById('text-23').value = issues.join(', '); const captchaResponse = hcaptcha.getResponse(); if (!captchaResponse) { alert("Please complete the CAPTCHA to continue."); e.preventDefault(); return; }// if modal not yet shown or not yet agreed if (!checkbox.checked && modal.style.display !== 'flex') { e.preventDefault();// Inject business name into each placeholder const clientSpans = modal.querySelectorAll('[data-client-name]'); clientSpans.forEach(span => { span.textContent = nameField.value || '[Client Name]'; });const dateSpans = modal.querySelectorAll('[data-agreement-date]'); dateSpans.forEach(span => { span.textContent = formattedDate || '[Agreement Date]'; });const nameFNField = document.querySelector('input[name="name-1-first-name"]').value; // Customer First Name const nameLNField = document.querySelector('input[name="name-1-last-name"]').value; // Customer Last Name var FullName = nameFNField + " " + nameLNField;const clientRepSpans = modal.querySelectorAll('[data-client-rep]'); clientRepSpans.forEach(span => { span.textContent = FullName || '[Client Rep Name]'; });const address = document.querySelector('input[name="text-3"]').value; // Customer Address const clientaddressSpans = modal.querySelectorAll('[data-client-address]'); clientaddressSpans.forEach(span => { span.textContent = address || '[Client Address]'; });// show modal modal.style.display = 'flex'; return false; } });// 2. Enable “Continue” when checked checkbox.addEventListener('change', () => { acceptBtn.disabled = !checkbox.checked; });// 3. On Continue, close modal and re-submit form acceptBtn.addEventListener('click', () => { prepareEulaHtml(); modal.style.display = 'none'; // ✅ Show the loader document.getElementById('loader-modal').style.display = 'flex'; form.submit(); }); })();

Demo / Intake form