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<?php $path="admin/orna/"; require_once('admin/orna/db.php'); ?> <!DOCTYPE html> <html lang="en"> <head> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <meta name="description" content=""> <meta name="author" content=""> <meta name="keyword" content=""> <title>New Customer</title> <script src="assets/js/now.js"></script> <!-- Bootstrap core CSS --> <link href="assets/css/bootstrap.css" rel="stylesheet"> <link href="assets/css/orna.css" rel="stylesheet"> <!--external css--> <link href="assets/font-awesome/css/font-awesome.css" rel="stylesheet" /> <link rel="stylesheet" type="text/css" href="assets/js/gritter/css/jquery.gritter.css" /> <!-- Custom styles for this template --> <link href="assets/css/style.css" rel="stylesheet"> <link href="assets/css/style-responsive.css" rel="stylesheet"> <!-- HTML5 shim and Respond.js IE8 support of HTML5 elements and media queries --> <!--[if lt IE 9]> <script src="https://oss.maxcdn.com/libs/html5shiv/3.7.0/html5shiv.js"></script> <script src="https://oss.maxcdn.com/libs/respond.js/1.4.2/respond.min.js"></script> <![endif]--> </head> <body> <section id="container"> <!--header start--> <?php require_once('inc-core/header.inc')?> <!--header end--> <!--sidebar start--> <?php require_once('inc-core/side-bar.inc');?> <!--sidebar end--> <!--main content start--> <section id="main-content"> <section class="wrapper site-min-height"> <table class="table table-striped table-advance table-hover"> <thead> <tr> <th class="col-md-12"> <a href="#"> <button class="btn btn-theme btn-xs" id="sv"><i class="fa fa-save"></i> Save</button> </a> </th> <th class="col-md-10"></th> </tr> </thead> </table> <!--content-start--> <div id="title"> <div class="row"> <div class="col-sm-12"> <h1>Customer Registration</h1> <p>Please fill all the required fields!</p> </div> </div> </div> <div id="form-wrapper"> <form class="form-inline" id="form" role="form" action="admin/ajax/php/sv.php?t_name1=cust_sup&count=1&row=single&file=false&flimit=0&acc_nm_s=multival&no_reply=true&title=" method="POST"> <div class="row"> <div class="col-sm-1"> Title: <select type="text" class="form-control" name="title" required> <option value="Mr.">Mr.</option> <option value="Miss.">Miss.</option> <option value="Ms.">Ms.</option> <option value="Mrs.">Mrs.</option> </select> </div> <div class="col-sm-3"> Full Name: <input type="text" class="form-control" placeholder="Customer Name" name="nm" id="acc_title" required pattern=".{4,150}"> </div> <div class="col-sm-3"> Father Name: <input type="text" class="form-control" placeholder="Father Name" name="father_name" required pattern=".{4,150}"> </div> <div class="col-sm-2"> Suffix: <input type="text" class="form-control" placeholder="Suffix" name="suffix"> </div> <div class="col-sm-3"> CNIC: <input type="text" class="form-control" placeholder="Computerized National Identity Card #" name="cnic" id="cnic" maxlength="15" required> </div> <div class="clearfix"></div> <div class="col-sm-3"> Date of Birth: <input type="date" max="<?php echo date('Y-m-d');?>" class="form-control" name="dob"> </div> <div class="col-sm-3"> Gender: <select type="text" class="form-control" name="gender" required> <option value="male">Male</option> <option value="female">Female</option> <option value="unspecified">Unspecified</option> </select> </div> <div class="col-sm-3"> Marital Status: <select type="text" class="form-control" name="marital_status" required> <option value="married">Married</option> <option value="single">Single</option> <option value="divorced">Divorced</option> <option value="widowed">Widowed</option> </select> </div> <div class="col-sm-3"> Customer Type: <select class="form-control" name="cust_type" id="cust_type" readonly> <option value="credit" selected="selected">Credit Customer</option> </select> <input type="hidden" id="acc_nm_cash" value="<?php echo ccm;?>"> <input type="hidden" name="acc_nm" value="0001-0001-0001"> <!--jsut for insert query dummy value//--> </div> <div class="col-sm-3"> Choose Category: <select class="form-control" name="acc_sub" required> <?php $sql_sub="select * from `".$MySQL_database."`.acc_sub where acc_nm_s in ".rec." order by title ASC"; $query_sub = mysqli_query($connection,$sql_sub); while($sub=mysqli_fetch_assoc($query_sub)){ print "<option value='".$sub['acc_nm_s']."'>".strtoupper($sub['title'])."</option>"; } ?> </select> </div> <div class="col-sm-3"> Email: <input type="email" class="form-control" placeholder="Email" name="eml"> </div> <div class="col-sm-3"> Mobile Number: <input type="text" class="form-control" placeholder="Mobile Number" name="cell" required pattern="03[0-9]{2}(?!1234567)(?!1111111)(?!7654321)[0-9]{7}"> </div> <div class="col-sm-3"> Phone / Landline Number (optional): <input type="text" class="form-control" placeholder="Landline Number" name="phone" pattern="03[0-9]{2}(?!1234567)(?!1111111)(?!7654321)[0-9]{7}"> </div> <div class="col-sm-3"> City: <select class="form-control" name="cty" required> <?php $sql_city="select * from `".$MySQL_database."`.cities where country_id='161' order by city ASC"; $query_city = mysqli_query($connection,$sql_city); while($city=mysqli_fetch_assoc($query_city)){ print "<option value='".$city['id']."'>".$city['city']."</option>"; } ?> </select> </div> <div class="clearfix"></div> <div class="col-sm-6"> Permanent Address: <textarea class="form-control" placeholder="Permanent Address" name="adrs" required></textarea> </div> <div class="col-sm-6"> Mailing Address: <textarea class="form-control" placeholder="Current Address" name="descp" required></textarea> </div> <div class="clearfix"></div> <h4>Next of Kin</h4> <hr> <div class="col-sm-1"> Title: <select type="text" class="form-control" name="nok_title" required> <option value="Mr.">Mr.</option> <option value="Miss.">Miss.</option> <option value="Ms.">Ms.</option> <option value="Mrs.">Mrs.</option> </select> </div> <div class="col-sm-4"> Full Name: <input type="text" class="form-control" placeholder="Next of Kin's Name" name="nok_nm" id="nok_nm" required pattern="^[a-zA-Z][a-zA-Z0-9-_\.]{4,150}$"> </div> <div class="col-sm-4"> Father Name: <input type="text" class="form-control" placeholder="Next of Kin's Father Name" name="nok_father_name" required pattern="^[a-zA-Z][a-zA-Z0-9-_\.]{4,150}$"> </div> <div class="col-sm-3"> Relation: <select type="text" class="form-control" name="nok_relation" required> <option value="">Select Option</option> <option value="Father">Father</option> <option value="Mother">Mother</option> <option value="Son">Son</option> <option value="Daughter">Daughter</option> <option value="Sister">Sister</option> <option value="Brother">Brother</option> <option value="Spouse">Spouse</option> <option value="Children">Children</option> <option value="Siblings">Siblings</option> <option value="Grandchildren">Grandchildren</option> <option value="Nieces/Nephews">Nieces/Nephews</option> <option value="Aunts/Uncles">Aunts/Uncles</option> <option value="Great Grandchildren">Great Grandchildren</option> <option value="Great Grandparents">Great Grandparents</option> <option value="Great Nieces/Great Nephews">Great Nieces/Great Nephews</option> <option value="First Cousins">First Cousins</option> <option value="Great Aunts/Great Uncles">Great Aunts/Great Uncles</option> <option value="Great-Great Grandchildren">Great-Great Grandchildren</option> <option value="Great-Great Grandparents">Great-Great Grandparents</option> <option value="Great-Great Nieces/Great-Great Nephews">Great-Great Nieces/Great-Great Nephews</option> <option value="First Cousins">First Cousins</option> <option value="Second Cousins">Second Cousins</option> </select> </div> <div class="clearfix"></div> <div class="col-sm-3"> CNIC: <input type="text" class="form-control" placeholder="Computerized National Identity Card #" name="nok_cnic" id="nok_cnic" maxlength="15" required> </div> <div class="col-sm-3"> Date of Birth: <input type="date" max="<?php echo date('Y-m-d');?>" class="form-control" name="nok_dob"> </div> <div class="col-sm-3"> Gender: <select type="text" class="form-control" name="nok_gender" required> <option value="male">Male</option> <option value="female">Female</option> <option value="unspecified">Unspecified</option> </select> </div> <div class="col-sm-3"> Email (Optional): <input type="email" class="form-control" placeholder="Email" name="nok_eml"> </div> <div class="col-sm-3"> Mobile Number: <input type="text" class="form-control" placeholder="Mobile Number" name="nok_cell" required pattern="03[0-9]{2}(?!1234567)(?!1111111)(?!7654321)[0-9]{7}"> </div> <div class="col-sm-3"> Phone / Landline Number (optional): <input type="text" class="form-control" placeholder="Landline Number" name="nok_phone" pattern="03[0-9]{2}(?!1234567)(?!1111111)(?!7654321)[0-9]{7}"> </div> <div class="col-sm-3"> City: <select class="form-control" name="nok_cty" required> <?php $sql_city="select * from `".$MySQL_database."`.cities where country_id='161' order by city ASC"; $query_city = mysqli_query($connection,$sql_city); while($city=mysqli_fetch_assoc($query_city)){ print "<option value='".$city['id']."'>".$city['city']."</option>"; } ?> </select> </div> <div class="clearfix"></div> <div class="col-sm-12"> Address: <textarea class="form-control" placeholder="Permanent Address" name="nok_adrs" required></textarea> </div> </div> <input type="hidden" name="type" value="cust"> </form> </div> <!--content-end--> </section> <!--/wrapper --> </section><!-- /MAIN CONTENT --> <!--main content end--> <!--footer start--> <footer class="site-footer"> <div class="text-center"> <?php echo date("Y");?> - ProFinance <a href="#" class="go-top"> <i class="fa fa-angle-up"></i> </a> </div> </footer> <!--footer end--> </section> <!-- js placed at the end of the document so the pages load faster --> <script src="assets/js/jquery.js"></script> <script src="assets/js/bootstrap.min.js"></script> <script src="assets/js/jquery-ui-1.9.2.custom.min.js"></script> <script src="assets/js/jquery.ui.touch-punch.min.js"></script> <script class="include" type="text/javascript" src="assets/js/jquery.dcjqaccordion.2.7.js"></script> <script src="assets/js/jquery.scrollTo.min.js"></script> <script src="assets/js/jquery.nicescroll.js" type="text/javascript"></script> <!--script for this page--> <script type="text/javascript" src="assets/js/gritter/js/jquery.gritter.js"></script> <script src="admin/ajax/js/cust_sup.js" type="text/javascript"></script> <!--common script for all pages--> <script src="assets/js/common-scripts.js"></script> <script> $('#cnic').keydown(function() { //allow backspace, tab, ctrl+A, escape, carriage return if (event.keyCode == 8 || event.keyCode == 9 || event.keyCode == 27 || event.keyCode == 13 || (event.keyCode == 65 && event.ctrlKey === true)) return; if ((event.keyCode < 48 || event.keyCode > 57)) event.preventDefault(); var length = $(this).val().length; if (length == 5 || length == 13) $(this).val($(this).val() + '-'); }); </script> </body> </html>
Free Space : 77942734848 Byte