| Line 184... |
Line 184... |
| 184 |
<input placeholder = "Date Of Birth" id="dateOfBirth" name="dateOfBirth" type="text" value="" class="">
|
184 |
<input placeholder = "Date Of Birth" id="dateOfBirth" name="dateOfBirth" type="text" value="" class="">
|
| 185 |
</div>
|
185 |
</div>
|
| 186 |
|
186 |
|
| 187 |
</div>
|
187 |
</div>
|
| 188 |
<div class = "row">
|
188 |
<div class = "row">
|
| 189 |
<div class="col-lg-4 form-group">
|
189 |
<div class="col-lg-3 form-group">
|
| - |
|
190 |
<input placeholder="GST Number" id="gstNumber" name="gstNumber" type="text" value="" class="form-control input-sm">
|
| - |
|
191 |
</div>
|
| - |
|
192 |
<div class="col-lg-3 form-group">
|
| 190 |
<input placeholder="Alternate Phone Number" id="alternatePhone" name="alternatePhone" type="text" value="" class="form-control input-sm">
|
193 |
<input placeholder="Alternate Phone Number" id="alternatePhone" name="alternatePhone" type="text" value="" class="form-control input-sm">
|
| 191 |
</div>
|
194 |
</div>
|
| 192 |
<div class="col-lg-4 form-group">
|
195 |
<div class="col-lg-3 form-group">
|
| 193 |
<input placeholder="Address Line 1" id="line1" name="line1" type="text" size="50" value="" class="form-control input-sm">
|
196 |
<input placeholder="Address Line 1" id="line1" name="line1" type="text" size="50" value="" class="form-control input-sm">
|
| 194 |
</div>
|
197 |
</div>
|
| 195 |
<div class="col-lg-4 form-group">
|
198 |
<div class="col-lg-3 form-group">
|
| 196 |
<input placeholder="Address Line 2" id="line2" name="line2" type="text" value="" class="form-control input-sm">
|
199 |
<input placeholder="Address Line 2" id="line2" name="line2" type="text" value="" class="form-control input-sm">
|
| 197 |
</div>
|
200 |
</div>
|
| 198 |
</div>
|
201 |
</div>
|
| 199 |
<div class = "row">
|
202 |
<div class = "row">
|
| 200 |
<div class="col-lg-3 form-group">
|
203 |
<div class="col-lg-3 form-group">
|