
<div class="b2b-register">
    <form class="b2b-register__map-form form js-cf-form" action="https://elitameble.mda.pl/wp-admin/admin-post.php" method="post" >
        <input type="hidden" name="action" value="cf_submit_form">
        <input type="hidden" name="form_id" value="17576"/>

        <div class="row">
            <div class="col-12">
                
                <div id="cf_output_container" class="form__output js-form-output"></div>

                <div class="form-section">
                    <h4>
                        Company info:
                    </h4>
                    <div class="row">
                        <div class="input col-md-8">
                            <label for="company_name" class="input__label">Company full name *</label>
                            <input type="text" id="company_name" name="company_name" class="input__text" placeholder="enter the name of the company" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="company_vat_number" class="input__label">VAT number *</label>
                            <input type="text" id="company_vat_number" name="company_vat_number" class="input__text" maxlength="20" placeholder="input Tax ID" required>
                        </div>
                    </div>
                </div>
                

                <div class="form-section">
                    <h4>
                        Data of the owner / person authorized to represent the company in order to update data to B2B Elita accounts:
                    </h4>
                    <div class="row">
                        <div class="input col-16">
                            <label for="name" class="input__label">First name and last name *</label>
                            <input type="text" id="name" name="name" class="input__text" placeholder="enter name and surname" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="phone" class="input__label">Phone number *</label>
                            <input type="tel" id="phone" name="phone" maxlength="15" class="input__text" placeholder="type phone number" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="email" class="input__label">E-mail *</label>
                            <input type="email" id="email" name="email" class="input__text" placeholder="type email address" required>
                        </div>
                    </div>
                </div>

                <div class="form-section">
                    <h4>
                        Data on access to the B2B Elita platform:
                    </h4>
                    <div class="row">
                        <div class="input col-16">
                            <label for="employee_name" class="input__label">Employee first and last name *</label>
                            <input type="text" id="employee_name" name="employee_name" class="input__text" placeholder="type first and last employee name" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="employee_office" class="input__label">Specialization (e. g. purchaser, designer, etc.) * </label>
                            <input type="text" id="employee_office" name="employee_office" class="input__text" placeholder="type your specialization" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="employee_phone" class="input__label">Phone number *</label>
                            <input type="tel" id="employee_phone" name="employee_phone" maxlength="15" class="input__text" placeholder="phone number" required>
                        </div>
                        <div class="input col-md-8">
                            <label for="employee_email" class="input__label">Notification email *</br>(order confirmations, complaints, change of the access password)</label>
                            <input type="email" id="employee_email" name="employee_email" class="input__text" placeholder="email address" required>
                        </div>
                        <div class="input col-md-8">
                            <!-- <label for="employee_access" class="input__label">Access</label> -->
                            <fieldset required>
                                <legend class="input__legend">Access *</legend>
                                
                                <div>
                                    <input type="checkbox" value="yes" id="access_warehouse" name="access_warehouse" />
                                    <label for="access_warehouse" class="input-checkbox__label input-checkbox__label--long">Stock level & product information module</label>
                                </div>
                                
                                <div>
                                    <input type="checkbox" value="yes" id="access_orders" name="access_orders" />
                                    <label for="access_orders" class="input-checkbox__label input-checkbox__label--long">Orders module</label>
                                </div>

                                <div>
                                    <input type="checkbox" value="yes" id="access_complaints" name="access_complaints" />
                                    <label for="access_complaints" class="input-checkbox__label input-checkbox__label--long">Complaints module</label>
                                </div>
                                
                                <div>
                                    <input type="checkbox" value="yes" id="access_payments" name="access_payments" />
                                    <label for="access_payments" class="input-checkbox__label input-checkbox__label--long">Payments module</label>
                                </div>

                                <button type="button" value="true" id="access_full" name="access_full js-form" class="button button--small button--white js-toggle-all-checkboxes">
                                    <span class="js-toggle-all-checkboxes-select">Select all</span>
                                    <span class="js-toggle-all-checkboxes-unselect d-none">Unselect all</span>
                                </button>

                                <p class="d-none alert alert-warning js-warning mt-3">
                                    At least one field have to be selected                                </p>
                            </fieldset>
                        </div>
                    </div>
                </div>

                <div class="form-section pb-3">
                    <div class="row">
                        <div class="b2b-register__contents-text col-16 cmb-1">
                                                    </div>
                        <div class="col-16">
                                                        <div class="input">
                                <div class="input-checkbox input-checkbox--big">
                                    <input class="input-checkbox__check" id="constent_0" type="checkbox" value="yes" name="constent_0"/>
                                    <label for="constent_0" class="input-checkbox__label input-checkbox__label--long">
                                        <p>I agree to receive marketing information by e-mail, phone or post, such as dedicated offers, promotions, sale off and any other information created by company Elita Sp. z o.o. This agreement can be cancelled anytime by sending an e-mail with subject “DO NOT AGREE” to <a class="email" href="mailto:b2b@elitameble.pl">b2b@elitameble.pl</a></p>
<p>In case of any changes in contact details I commit to send an update information each time (name of worker, new phone number, new e-mail address) to <a class="email" href="mailto:b2b@elitameble.pl">b2b@elitameble.pl</a> in order to prevent any unauthorized access to the B2B ELITA Platform.</p>
                                    </label>
                                </div>
                            </div>
                                                    </div>
                    </div>
                </div>

                <div class="form-footer">
                    <div class="row  align-items-center">
                        <div class="col-16 pb-3">
                            <div class="form-footer__info">
                                <p><span style="font-size: 13.3333px;">* </span>the details should be specified for only one account (one person, one e-mail address). In case you need additional account for more employees please fill in separate registration form for each account.</p>
                            </div>
                        </div>
                        <div class="col-16 d-flex justify-content-center justify-content-md-end">
                            <button class="button button--large js-send-form-button"><span>Send application</span></button>
                        </div>
                    </div>
                </div>
            </div>

            <div class="form__overlay">
                <div class="form__progress">
                    <progress id="js-progress-bar" class="form__progress-bar" value="0" max="1"></progress>
                    <div class="form__progress-info">Sending</div>
                </div>
            </div>

            </div>
        </div>
    </form>

</div>

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