| Line 3... |
Line 3... |
| 3 |
<div id="error" class="error_msg" <?php if(isset($signup['msg']) && !empty($signup['msg'])){ ?>style="display:block" <?php } else {?> style="display:none" <?php }?>>
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3 |
<div id="error" class="error_msg" <?php if(isset($signup['msg']) && !empty($signup['msg'])){ ?>style="display:block" <?php } else {?> style="display:none" <?php }?>>
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| 4 |
<?php if(isset($signup['msg']) && !empty($signup['msg'])){
|
4 |
<?php if(isset($signup['msg']) && !empty($signup['msg'])){
|
| 5 |
echo $signup['msg'];
|
5 |
echo $signup['msg'];
|
| 6 |
} ?>
|
6 |
} ?>
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| 7 |
</div>
|
7 |
</div>
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| 8 |
<form method="POST" action="<?php base_url().'fos/signupcounter';?>" onsubmit="return counterform()" class="address-form" <?php if(isset($addresses->addresses) && !empty($addresses->addresses)) {?> style="display:none" <?php } else{?> style="display:block" <?php }?>>
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8 |
<form method="POST" action="<?php base_url().'fos/signupcounter';?>" onsubmit="return registerform()" class="address-form" <?php if(isset($addresses->addresses) && !empty($addresses->addresses)) {?> style="display:none" <?php } else{?> style="display:block" <?php }?>>
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| 9 |
<fieldset>
|
9 |
<fieldset>
|
| 10 |
<label>Name<span>*</span></label>
|
10 |
<label>Name<span>*</span></label>
|
| 11 |
<input type="text" id="name" name="name"/>
|
11 |
<input type="text" id="name" name="name" maxlength="100"/>
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| 12 |
<label>Counter Name<span>*</span></label>
|
12 |
<label>Counter Name<span>*</span></label>
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| 13 |
<input type="text" id="countername" name="countername"/>
|
13 |
<input type="text" id="countername" name="countername" maxlength="128"/>
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| 14 |
<label>Tin Number<span>*</span></label>
|
14 |
<label>Tin Number<span>*</span></label>
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| 15 |
<input type="text" id="tin" name="tin"/>
|
15 |
<input type="text" id="tin" name="tin" maxlength="20"/>
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| 16 |
<label>Address Line 1<span>*</span></label>
|
16 |
<label>Address Line 1<span>*</span></label>
|
| 17 |
<input type="text" id="line1" name="address1"/>
|
17 |
<input type="text" id="line1" name="address1"/>
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| 18 |
<label>Address Line 2</label>
|
18 |
<label>Address Line 2</label>
|
| 19 |
<input type="text" id="line2" name="address2"/>
|
19 |
<input type="text" id="line2" name="address2"/>
|
| 20 |
<label>Area</label>
|
20 |
<label>Area</label>
|
| Line 27... |
Line 27... |
| 27 |
<label>State<span>*</span></label>
|
27 |
<label>State<span>*</span></label>
|
| 28 |
<select id="state" name="state">
|
28 |
<select id="state" name="state">
|
| 29 |
<option value="Telangana">Telangana</option>
|
29 |
<option value="Telangana">Telangana</option>
|
| 30 |
</select>
|
30 |
</select>
|
| 31 |
<label>Pincode<span>*</span></label>
|
31 |
<label>Pincode<span>*</span></label>
|
| 32 |
<input type="number" id="pin" name="pincode"/>
|
32 |
<input maxlength="6" type="number" id="pin" name="pincode"/>
|
| 33 |
<label>Email<span>*</span></label>
|
33 |
<label>Email<span>*</span></label>
|
| 34 |
<input type="text" id="email" name="email"/>
|
34 |
<input type="text" id="email" name="email"/>
|
| 35 |
<label>Mobile Number<span>*</span></label>
|
35 |
<label>Mobile Number<span>*</span></label>
|
| 36 |
<input maxlength="12" type="number" id="phone" name="mobile"/>
|
36 |
<input maxlength="10" type="number" id="phone" name="mobile"/>
|
| 37 |
<label>Alternate Mobile Number<span>*</span></label>
|
37 |
<label>Alternate Mobile Number<span>*</span></label>
|
| 38 |
<input maxlength="12" type="number" id="alternatemobile" name="alternatemobile"/>
|
38 |
<input maxlength="10" type="number" id="alternatemobile" name="alternatemobile"/>
|
| 39 |
<label>DOB</label>
|
39 |
<label>DOB</label>
|
| 40 |
<input type="date" id="date" name="dob"/>
|
40 |
<input type="date" id="dob" name="dob"/>
|
| 41 |
<label>Counter Size (SP)</label>
|
41 |
<label>Counter Size (SP)</label>
|
| 42 |
<input type="number" id="spcountersize" name="spcountersize"/>
|
42 |
<input type="number" id="spcountersize" name="spcountersize"/>
|
| 43 |
<label>Counter Size (FP)</label>
|
43 |
<label>Counter Size (FP)</label>
|
| 44 |
<input type="number" id="fpcountersize" name="fpcountersize"/>
|
44 |
<input type="number" id="fpcountersize" name="fpcountersize"/>
|
| 45 |
<label>Striker</label>
|
45 |
<label>Striker</label>
|