<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
<link rel="stylesheet" href="/_css/pg.css" />
<script src="/_js/g.js" type="text/javascript"></script>
</head>

<body class="buyGuide">

<div>

  <div class="leftSide">
    <h2><?php echo $_GET["dest"]; ?> City Guides<!--<img src="/supp/popup/_img/price.png" width="71" height="71" />--></h2>
    <img class="buyGuideSteps" src="/supp/popup/_img/buy_guide_steps.png" width="211" height="158" /><br />
    <img class="guideCover" src="/<?php echo strtolower($_GET["dest"]); ?>/_img/<?php echo $_GET["day"]; ?>_day_guide_cover.png" width="147" height="190" />
  </div>
  <div class="rightSide">
    <h1>Personal and payment details</h1>
    <form action="/supp/popup/download_guide.php" method="get">
      <legend>Please fill in all of the following fields:</legend>
      <input type="hidden" name="listId" value="<?php echo $_GET["listId"]; ?>">
      <input type="hidden" name="dest" value="<?php echo $_GET["dest"]; ?>">
      <input type="hidden" name="day" value="<?php echo $_GET["day"]; ?>">
      <label>Name</label><br />
      <input type="text" name="fname" /><br />
      <label>Email address</label><br />
      <input type="text" name="email" /><br /><br />
      <label>Please select your preferred payment method:</label><br />
      <input type="radio" name="group" checked="checked" />
      <img class="payPal" src="/supp/popup/_img/paypal.png" width="95" height="41" />
      <input type="radio" name="group" />
      <img src="/supp/popup/_img/credit_card.png" width="113" height="41" /><br /><br />
      <label>Yes, I would like to buy PromptGuides' 1, 3 and 5-day <?php echo $_GET["dest"]; ?><br />City Guides for $1.99</label><br /><br />
      <input type="submit" value="Next" class="submitButton" /><br /><br />
      <p>Or, <a href="http://www.facebook.com/PromptGuides?sk=app_147466535326193" target="_blank" rel="nofollow" >Like Us on Facebook and Get the Guide for FREE</a></p>
    </form>
  </div>
  <div class="clear"></div>

</div>

</body>
</html>