33 lines
1.8 KiB
PHP
33 lines
1.8 KiB
PHP
<hr>
|
|
|
|
<div class="form-row custom_fields">
|
|
|
|
<!-- Risk Location -->
|
|
<div class="form-group col-md-6">
|
|
<label>Risk Location</label><br>
|
|
<div class="form-check form-check-inline">
|
|
<input class="form-check-input" type="radio" name="risk_location" value="single" <?= isset($lead_edit_data['risk_location']) && $lead_edit_data['risk_location'] == 'single' ? 'checked' : ''; ?>>
|
|
<label class="form-check-label">Single</label>
|
|
</div>
|
|
<div class="form-check form-check-inline">
|
|
<input class="form-check-input" type="radio" name="risk_location" value="multi_with_floter" <?= isset($lead_edit_data['risk_location']) && $lead_edit_data['risk_location'] == 'multi_with_floter' ? 'checked' : ''; ?>>
|
|
<label class="form-check-label">Multi with Floater</label>
|
|
</div>
|
|
<div class="form-check form-check-inline">
|
|
<input class="form-check-input" type="radio" name="risk_location" value="multi_without_floter" <?= isset($lead_edit_data['risk_location']) && $lead_edit_data['risk_location'] == 'multi_without_floter' ? 'checked' : ''; ?>>
|
|
<label class="form-check-label">Multi without Floater</label>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Address -->
|
|
<div class="form-group col-md-3">
|
|
<label for="pinCode">Pin Code</label>
|
|
<input type="text" class="form-control" id="pinCode" name="pincode" value="<?= isset($lead_edit_data['pincode']) ? htmlspecialchars($lead_edit_data['pincode']) : ''; ?>">
|
|
</div>
|
|
<div class="form-group col-md-3">
|
|
<label for="address">Address</label>
|
|
<textarea class="form-control" id="address" name="address" rows="1"><?= isset($lead_edit_data['address']) ? htmlspecialchars($lead_edit_data['address']) : ''; ?></textarea>
|
|
</div>
|
|
|
|
</div>
|