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20403 amit.gupta 1
<style type="text/css">
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h5{font-weight: bold;text-decoration: underline;}
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h4{font-weight: bold;}
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#eng{background:#36BBD9;}
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#hin{background:white; }
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.btn{border: #555 1px solid;}
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#eng { color:white;}
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#hin { color:#36BBD9;}
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body{background:#fff;background-color:#fff !important;border: 5px solid #f5f5f5;}
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html{background-color:#0CA9F0;}
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</style>
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<script>
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$(document).ready(function(){
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	$("form").submit(function() {
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	    $(this).submit(function() {
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	        return false;
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	    });
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	    return true;
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	});
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});
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</script>
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<div class="container" style="background-color:white;padding: 0 0px 0 0px !important;margin-bottom:5px;">
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	<div class="row-fluid">
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		<div class="col-xs-12 bgwhite">
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			<div id="foreng">				
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			    <h4 style="background:#F7F79E;padding:5px;">Earn Extra income</h4>
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			    <div>   &bull; Become Spice Mudra agent to earn extra<br>
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			    		&bull; Mention Profitmandi to get discount of Rs.500 at SpiceMudra contact form.<br>
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				</div>
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				<form method="post" action="spicemudrainterest"> 
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				<div class="input-group col-xs-12 text-right searchres" style="padding:10px 0px 1px;">
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		            <input type="text" class="form-control" autocomplete="off" placeholder="PAN Number*" name="pan" style="width:98%;margin-bottom:12px" required pattern="[A-Za-z0-9]{10}" title="Valid PAN required"/>
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		            <input type="tel" pattern="\d{10}" class="form-control" autocomplete="off" placeholder="Mobile Number*" name="mobile" style="width:98%;margin-bottom:24px" title="Valid Mobile Number is required" required/>
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		            <input type="submit" value="I'm Interested" style="background-color:#58d936;color:white;width:98%;" class="btn"/>
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		        </div>
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	    	</form>
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			</div>
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		</div>
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		<!--  <img src="<?php //echo $base_url;?>app/webroot/img/tripfooter.jpg" width="100%">-->
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	</div>
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</div>