Subversion Repositories SmartDukaan

<script src="<?=base_url().$this->config->item('current_client')?>/js/fos.js?version=<?php echo time();?><?//=$this->config->item('cdn_version');?>" type="text/javascript"></script>
<style>
input[type="checkbox"]{
  float:left;
  appearance:none;
  -webkit-appearance:none;
  width:25px;
  height:25px;
  background:url('../assets/images/checkbox.png')no-repeat center center;
  background-size:contain;
  margin-right:5px;
}
input[type="checkbox"]:checked{
  background:url('../assets/images/checkbox_selected.png')no-repeat center center;
  background-size:contain;
}
</style>
<div class="shipping-cont">
  <div id="error" class="error_msg" <?php if(isset($response['msg']) && !empty($response['msg'])){ ?>style="display:block" <?php } else {?> style="display:none" <?php }?>>
    <?php if(isset($response['msg']) && !empty($response['msg'])){
      echo $response['msg'];
      } ?>
  </div>   
  <form method="POST" action="<?php echo base_url().'fos/signupcounter';?>" onsubmit="return registerform()" class="address-form">
    <fieldset>
      <label>Outlet Name<span>*</span></label>
      <input type="text" id="countername" name="countername" maxlength="128"/>
      <label>Proprietor Name<span>*</span></label>
      <input type="text" id="name" name="name" maxlength="100"/>
      <label>Tin Number<span>*</span> <input type="checkbox" name="tinskipped" id="tinskipped" value="1" onclick="toggleTinValidity(this)"/></label>
      <input type="text" id="tin" name="tin" maxlength="20"/>
      <label>Address Line 1<span>*</span></label>
      <input type="text" id="line1" name="address1"/>
      <label>Address Line 2</label>
      <input type="text" id="line2" name="address2"/>
      <label>Area</label>
      <input type="text" id="area" name="area"/>
      <label>City<span>*</span></label>
      <select id="city" name="city">
        <option value="Hyderabad">Hyderabad</option>
        <option value="Secunderabad">Secunderabad</option>
      </select>
      <label>State<span>*</span></label>
      <select id="state" name="state">
        <option value="Telangana">Telangana</option>        
      </select>
      <label>Pincode<span>*</span></label>
      <input maxlength="6" type="number" id="pin" name="pincode"/>
      <label>Email<span>*</span></label>
      <input type="text" id="email" name="email"/>
      <label>Mobile Number<span>*</span></label>
      <input maxlength="10" type="number" id="phone" name="mobile"/>
      <label>Alternate Mobile Number<span>*</span></label>
      <input maxlength="10" type="number" id="alternatemobile" name="alternatemobile"/>
      <label>DOB</label>
      <input type="date" id="dob" name="dob"/>
      <label>Counter Size (SP)</label>
      <input type="number" id="spcountersize" name="spcountersize"/>
      <label>Counter Size (FP)</label>
      <input type="number" id="fpcountersize" name="fpcountersize"/>
      <input type="checkbox" id="striker" name="striker" value="1"/>
      <label>Striker</label>
      <div class="clearfix"/>
      <input type="submit" name="submit" value="save"/>
    </fieldset>
  </form>