46 lines
3.0 KiB
PHP
46 lines
3.0 KiB
PHP
<script src="<?= base_url()."/public"; ?>/assets/member_js/ajax.js"></script>
|
|
<form id="member_address" >
|
|
<div class="row">
|
|
<div class="col-lg-12 d-flex align-items-center mb-3">
|
|
|
|
</div>
|
|
<input type="hidden" value="<?= $userAddress[0]['id']; ?>" name="id" >
|
|
<div class="col-lg-6 mb-3">
|
|
<label for="first_name">First Name</label>
|
|
<input type="text" value="<?= $userAddress[0]['first_name']; ?>" name="first_name" id="first_name">
|
|
</div>
|
|
<div class="col-lg-6 mb-3">
|
|
<label for="last_name">Last Name</label>
|
|
<input type="text" value="<?= $userAddress[0]['last_name']; ?>" name="last_name" id="last_name">
|
|
</div>
|
|
|
|
<div class="col-lg-12 mb-3">
|
|
<label for="address">Street Address</label>
|
|
<input type="text" value="<?= $userAddress[0]['street_address']; ?>" name="street_address" id="address">
|
|
</div>
|
|
<div class="col-lg-4 mb-3">
|
|
<label for="apartment_number">Apartment Number</label>
|
|
<input type="text" value="<?= $userAddress[0]['apartment_number']; ?>" name="apartment_number" id="apartment_number">
|
|
</div>
|
|
<div class="col-lg-4 mb-3">
|
|
<label for="state">State</label>
|
|
<select id="state" name="state">
|
|
<option value="<?= $userAddress[0]['state']; ?>"><?= $userAddress[0]['']; ?></option>
|
|
<option value="AN">Andaman and Nicobar Islands</option>
|
|
</select>
|
|
</div>
|
|
<div class="col-lg-4 mb-3">
|
|
<label for="zipcode">Zip Code</label>
|
|
<input type="text" value="<?= $userAddress[0]['zip_code']; ?>" name="zip_code" id="zipcode">
|
|
</div>
|
|
</div>
|
|
<div class="row form-button">
|
|
<div class="col-lg-2 col-4">
|
|
<button>Cancel</button>
|
|
</div>
|
|
<div class="col-lg-3 col-4">
|
|
<input type="button" class="submit" value="Save">
|
|
</div>
|
|
<div class="col-lg-7 col-4"></div>
|
|
</div>
|
|
</form>
|