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<script src="<?=base_url().$this->config->item('current_client')?>/js/fos.js?version=<?=$this->config->item('cdn_version');?>" type="text/javascript"></script>
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<script src="<?=base_url().$this->config->item('current_client')?>/js/fos.js?version=<?=$this->config->item('cdn_version');?>" type="text/javascript"></script>
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<style>
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input[type="checkbox"]{
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float:left;
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appearance:none;
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-webkit-appearance:none;
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width:25px;
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height:25px;
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background:url('../assets/images/checkbox.png')no-repeat center center;
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background-size:contain;
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margin-right:5px;
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}
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input[type="checkbox"]:checked{
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background:url('../assets/images/checkbox_selected.png')no-repeat center center;
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background-size:contain;
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}
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</style>
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<div class="shipping-cont">
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<div class="shipping-cont">
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<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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<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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<?php if(isset($signup['msg']) && !empty($signup['msg'])){
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<?php if(isset($signup['msg']) && !empty($signup['msg'])){
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echo $signup['msg'];
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echo $signup['msg'];
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} ?>
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} ?>
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</div>
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</div>
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<form method="POST" action="<?php base_url().'fos/signupcounter';?>" onsubmit="return registerform()" class="address-form" <?php if(isset($addresses->addresses) && !empty($addresses->addresses)) {?> style="display:none" <?php } else{?> style="display:block" <?php }?>>
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<form method="POST" action="<?php base_url().'fos/signupcounter';?>" onsubmit="return registerform()" class="address-form" <?php if(isset($addresses->addresses) && !empty($addresses->addresses)) {?> style="display:none" <?php } else{?> style="display:block" <?php }?>>
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<fieldset>
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<fieldset>
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<label>Name<span>*</span></label>
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<input type="text" id="name" name="name" maxlength="100"/>
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<label>Counter Name<span>*</span></label>
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<label>Outlet Name<span>*</span></label>
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<input type="text" id="countername" name="countername" maxlength="128"/>
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<input type="text" id="countername" name="countername" maxlength="128"/>
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<label>Proprietor Name<span>*</span></label>
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<input type="text" id="name" name="name" maxlength="100"/>
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<label>Tin Number<span>*</span></label>
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<label>Tin Number<span>*</span></label>
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<input type="text" id="tin" name="tin" maxlength="20"/>
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<input type="text" id="tin" name="tin" maxlength="20"/>
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<label>Address Line 1<span>*</span></label>
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<label>Address Line 1<span>*</span></label>
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<input type="text" id="line1" name="address1"/>
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<input type="text" id="line1" name="address1"/>
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<label>Address Line 2</label>
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<label>Address Line 2</label>
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<input type="date" id="dob" name="dob"/>
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<input type="date" id="dob" name="dob"/>
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<label>Counter Size (SP)</label>
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<label>Counter Size (SP)</label>
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<input type="number" id="spcountersize" name="spcountersize"/>
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<input type="number" id="spcountersize" name="spcountersize"/>
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<label>Counter Size (FP)</label>
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<label>Counter Size (FP)</label>
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<input type="number" id="fpcountersize" name="fpcountersize"/>
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<input type="number" id="fpcountersize" name="fpcountersize"/>
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<label>Striker</label>
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<input type="checkbox" id="striker" name="striker" value="1"/>
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<input type="checkbox" id="striker" name="striker" value="1"/>
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<label>Striker</label>
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<div class="clearfix"/>
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<div class="clearfix"/>
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<input type="submit" name="submit" value="save"/>
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<input type="submit" name="submit" value="save"/>
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</fieldset>
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</fieldset>
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</form>
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</form>
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