150 lines
3.8 KiB
PHP
150 lines
3.8 KiB
PHP
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<div class="container">
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<h3> REGISTER </h3>
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<form class="" method="post" action="" >
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<div class="">
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Name</h4></label>
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<input type="text" class="form-control" name="name" id = "name" value="<?= $post['name'] ?>">
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Mobile</h4></label>
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<input type="text" class="form-control" name="phone" id="phone" value="<?= $post['phone'] ?>">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Email</h4></label>
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<input type="text" class="form-control" name="email" id="email" value="<?= $post['email'] ?>">
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>PAN No</h4></label>
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<input type="text" class="form-control" name="pan" id="pan" value="<?= $post['pan'] ?>">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-8">
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<div class="form-group">
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<label for="first_name"><h4>Address</h4></label>
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<input type="text" class="form-control" name="address" id="address" value="<?= $post['address'] ?>">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="password2"><h4>Country</h4></label>
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<select name="country" id="country0" class="form-control ">
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<option value="<?=$post['country'] ?>"><?=$post['country'] ?></option>
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</select>
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="password2"><h4>State</h4></label>
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<select name="state" id="state0" class="form-control ">
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<option value="<?=$post['state'] ?>"><?=$post['state'] ?></option>
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</select>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="password2"><h4>City</h4></label>
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<select name="city" id="city0" class="form-control ">
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<option value="<?=$post['city'] ?>"><?=$post['city'] ?></option>
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</select>
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="password2"><h4>Pin Code</h4></label>
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<input type="text" class="form-control" name="pin_code" id="pin_code" value="<?= $post['pin_code'] ?>">
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</select>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4"></div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Date of Birth</h4></label>
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<input type="text" class="form-control" name="date_of_birth" id="txtDate" value="<?= $post['date_of_birth'] ?>">
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Gender</h4></label>
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<select class="form-control" name="gender" required>
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<option value="<?= $post['gender'] ?>"><?= $post['gender'] ?></option>
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<option value="Male">Male</option>
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<option value="Female">Female</option>
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</select>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>Org Name</h4></label>
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<input type="text" class="form-control" name="org_name" id="org_name" value="<?= $post['org_name'] ?>">
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</div>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="first_name"><h4>GSTIN</h4></label>
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<input type="text" class="form-control" name="gstin" id="gstin" value="<?= $post['gstin'] ?>">
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</div>
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</div>
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</div>
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</br>
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<div class="row">
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<div class="col-md-4">
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</div>
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<div class="col-md-8">
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<button type="submit" class="btn btn-primary">Update</button>
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</div>
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</div>
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</form>
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</div></div>
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