92 lines
2.6 KiB
PHP
92 lines
2.6 KiB
PHP
<div class="container">
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<div class="container register-form">
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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-4">
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<h2>GENERATE RECEIPTS</h2>
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</div></div></br>
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<div class="form">
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<div class="form-content">
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<form class="" method="post" action="<?= base_url()."/receipt"; ?>" >
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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>Date</h4></label>
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<input type="text" class="form-control" placeholder="dd/mm/yyyy" id="txtDate" name="date" value=""/>
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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>Select Donor</h4></label>
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<select name="donor_id" id="donor_id" class="form-control ">
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<option value="">Select Donor Id</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="first_name"><h4>Amount</h4></label>
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<input type="text" class="form-control" name="amount" value=""/>
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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>Receipt Mode</h4></label>
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<select class="form-control" name="mode_of_receipt" required>
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<option value="">Mode of Receipt</option>
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<option value="Cash">Cash</option>
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<option value="Check">Check</option>
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<option value="Card">Card</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="first_name"><h4>Receipt Details</h4></label>
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<input type="text" class="form-control" name="receipt_details" value=""/>
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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>Select Cause</h4></label>
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<select name="cause_id" id="cause_name" class="form-control ">
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<option value="">Select Cause Name</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="first_name"><h4>Remarks</h4></label>
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<input type="text" class="form-control" name="remarks" value=""/>
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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><div class="col-md-8">
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<button type="submit" class="btn btn-primary">Submit</button>
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</div></div>
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</form>
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</div>
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</div>
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</div>
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