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| 184 |
<div class="col-lg-3 form-group">
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184 |
<div class="col-lg-3 form-group">
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| 185 |
<input placeholder="City" id="city" name="city" type="text" value="" class="form-control input-sm">
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<input placeholder="City" id="city" name="city" type="text" value="" class="form-control input-sm">
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| 186 |
</div>
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186 |
</div>
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| 187 |
<div class="col-lg-4 form-group">
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187 |
<div class="col-lg-4 form-group">
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| 188 |
<select class="form-control input-sm" name = "state" placeholder="State">
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188 |
<select class="form-control input-sm" name = "state" placeholder="State">
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| 189 |
<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
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189 |
<option value="Andaman & Nicobar Islands">Andaman and Nicobar Islands</option>
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| 190 |
<option value="Andhra Pradesh">Andhra Pradesh</option>
|
190 |
<option value="Andhra Pradesh">Andhra Pradesh</option>
|
| 191 |
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
|
191 |
<option value="Arunachal Pradesh">Arunachal Pradesh</option>
|
| 192 |
<option value="Assam">Assam</option>
|
192 |
<option value="Assam">Assam</option>
|
| 193 |
<option value="Bihar">Bihar</option>
|
193 |
<option value="Bihar">Bihar</option>
|
| 194 |
<option value="Chandigarh">Chandigarh</option>
|
194 |
<option value="Chandigarh">Chandigarh</option>
|
| 195 |
<option value="Chhattisgarh">Chhattisgarh</option>
|
195 |
<option value="Chhattisgarh">Chhattisgarh</option>
|
| 196 |
<option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
|
196 |
<option value="Dadra & Nagar Haveli">Dadra and Nagar Haveli</option>
|
| 197 |
<option value="Daman and Diu">Daman and Diu</option>
|
197 |
<option value="Daman & Diu">Daman and Diu</option>
|
| 198 |
<option value="Delhi">Delhi</option>
|
198 |
<option value="Delhi">Delhi</option>
|
| 199 |
<option value="Goa">Goa</option>
|
199 |
<option value="Goa">Goa</option>
|
| 200 |
<option value="Gujarat">Gujarat</option>
|
200 |
<option value="Gujarat">Gujarat</option>
|
| 201 |
<option value="Haryana">Haryana</option>
|
201 |
<option value="Haryana">Haryana</option>
|
| 202 |
<option value="Himachal Pradesh">Himachal Pradesh</option>
|
202 |
<option value="Himachal Pradesh">Himachal Pradesh</option>
|
| 203 |
<option value="Jammu and Kashmir">Jammu and Kashmir</option>
|
203 |
<option value="Jammu & Kashmir">Jammu and Kashmir</option>
|
| 204 |
<option value="Jharkhand">Jharkhand</option>
|
204 |
<option value="Jharkhand">Jharkhand</option>
|
| 205 |
<option value="Karnataka">Karnataka</option>
|
205 |
<option value="Karnataka">Karnataka</option>
|
| 206 |
<option value="Kerala">Kerala</option>
|
206 |
<option value="Kerala">Kerala</option>
|
| 207 |
<option value="Lakshadweep">Lakshadweep</option>
|
207 |
<option value="Lakshadweep">Lakshadweep</option>
|
| 208 |
<option value="Madhya Pradesh">Madhya Pradesh</option>
|
208 |
<option value="Madhya Pradesh">Madhya Pradesh</option>
|