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tejus.loha |
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<section class="wrapper">
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<form name="brandFeeCollectionForm" id="brandFeeCollectionForm" style="align-content: center">
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<div class="row">
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<div class="col-lg-3"><label>Amount :</label>
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| 35971 |
aman |
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<input type="number" name="collectedAmount" class="form-control" placeholder="Enter amount" required>
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| 33507 |
tejus.loha |
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</div>
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</div>
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<div class="row">
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<div class="col-lg-3"><label>Payment Mode :</label>
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<select class="form-control" name="paymentMode" required>
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| 35971 |
aman |
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<option value="" selected>Select mode</option>
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| 33507 |
tejus.loha |
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<option value="UPI">UPI</option>
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<option value="Cheque">Cheque</option>
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<option value="IMPS">IMPS</option>
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<option value="NEFT">NEFT</option>
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<option value="RTGS">RTGS</option>
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</select></div>
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</div>
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<div class="row">
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<div class="col-lg-3"><label>Reference No :</label>
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| 35971 |
aman |
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<input type="text" name="paymentReferenceNo" class="form-control" placeholder="Enter reference no"
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required>
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| 33507 |
tejus.loha |
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</div>
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</div>
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<div class="row">
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<div class="col-lg-3">
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<button type="button" class="btn-primary " id="addBrandFeePayment" value="$loiId">Add Payment</button>
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</div>
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</div>
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</form>
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</section>
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