190 lines
11 KiB
PHP
190 lines
11 KiB
PHP
<hr>
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<div class="form-row custom_fields">
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<!-- Policy Period -->
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<div class="form-group col-md-3">
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<label for="policy_period">Policy Period</label>
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<select class="form-control" id="policy_period" name="policy_period">
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<?php for ($i = 1; $i <= 24; $i++) {
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$selected = (isset($lead_edit_data) && $lead_edit_data['policy_period'] == $i) ? 'selected' : '';
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?>
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<option value="<?= $i ?>" <?= $selected; ?>><?= $i ?> Month</option>
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<?php } ?>
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</select>
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</div>
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<!-- Commodity Type -->
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<div class="form-group col-md-3">
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<label for="commodity_type">Commodity Type</label>
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<select class="form-control" id="commodity_type" name="commodity_type">
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<option value="new_machinery_or_equipment_for_industrial_use"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'new_machinery_or_equipment_for_industrial_use') ? 'selected' : ''; ?>>
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New machinery or equipment for industrial use
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</option>
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<option value="iron_steel_rods_metal_pipes_tubes"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'iron_steel_rods_metal_pipes_tubes') ? 'selected' : ''; ?>>
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Iron & steel rods, metal pipes, tubes
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</option>
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<option value="electronic_and_white_goods"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'electronic_and_white_goods') ? 'selected' : ''; ?>>
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Electronic and white goods
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</option>
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<option value="automobiles"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'automobiles') ? 'selected' : ''; ?>>
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Automobiles
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</option>
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<option value="all_types_of_fmcg_commodities"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'all_types_of_fmcg_commodities') ? 'selected' : ''; ?>>
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All types of FMCG commodities
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</option>
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<option value="other"
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<?= (isset($lead_edit_data) && $lead_edit_data['commodity_type'] == 'other') ? 'selected' : ''; ?>>
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Other
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</option>
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</select>
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</div>
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<!-- Mode of Transit -->
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<div class="form-group col-md-3">
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<label for="mode_of_transit">Mode of Transit</label>
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<select class="form-control" id="mode_of_transit" name="mode_of_transit">
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<option value="air" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'air') ? 'selected' : ''; ?>>Air</option>
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<option value="courier" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'courier') ? 'selected' : ''; ?>>Courier</option>
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<option value="registered_post" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'registered_post') ? 'selected' : ''; ?>>Registered Post</option>
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<option value="rail" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'rail') ? 'selected' : ''; ?>>Rail</option>
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<option value="road" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'road') ? 'selected' : ''; ?>>Road</option>
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<option value="sea" <?= (isset($lead_edit_data) && $lead_edit_data['mode_of_transit'] == 'sea') ? 'selected' : ''; ?>>Sea</option>
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</select>
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</div>
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<!-- Coverage -->
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<div class="form-group col-md-3">
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<label for="coverage">Coverage</label>
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<select class="form-control" id="coverage" name="coverage">
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<option value="icc_a" <?= (isset($lead_edit_data) && $lead_edit_data['coverage'] == 'icc_a') ? 'selected' : ''; ?>>ICC A</option>
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<option value="srcc" <?= (isset($lead_edit_data) && $lead_edit_data['coverage'] == 'srcc') ? 'selected' : ''; ?>>SRCC</option>
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<option value="war" <?= (isset($lead_edit_data) && $lead_edit_data['coverage'] == 'war') ? 'selected' : ''; ?>>WAR</option>
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<option value="including_loading_and_unloading" <?= (isset($lead_edit_data) && $lead_edit_data['coverage'] == 'including_loading_and_unloading') ? 'selected' : ''; ?>>Including Loading and Unloading</option>
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<option value="itc_b" <?= (isset($lead_edit_data) && $lead_edit_data['coverage'] == 'itc_b') ? 'selected' : ''; ?>>ITC B</option>
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</select>
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</div>
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<!-- What type of cover do you want? -->
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<div class="form-group col-md-3">
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<label>What type of cover do you want?</label><br>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="cover_type" value="single_transit"
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<?= (isset($lead_edit_data) && $lead_edit_data['cover_type'] == 'single_transit') ? 'checked' : ''; ?>>
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<label class="form-check-label">Single Transit</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="cover_type" value="annual_open"
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<?= (isset($lead_edit_data) && $lead_edit_data['cover_type'] == 'annual_open') ? 'checked' : ''; ?>>
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<label class="form-check-label">Annual Open</label>
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</div>
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</div>
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<!-- Where will your goods be shipped? -->
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<div class="form-group col-md-3">
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<label>Where will your goods be shipped?</label><br>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="shipping_location" value="inland_domestic"
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<?= (isset($lead_edit_data) && $lead_edit_data['shipping_location'] == 'inland_domestic') ? 'checked' : ''; ?>>
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<label class="form-check-label">Inland (Domestic)</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="shipping_location" value="export"
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<?= (isset($lead_edit_data) && $lead_edit_data['shipping_location'] == 'export') ? 'checked' : ''; ?>>
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<label class="form-check-label">Export</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="shipping_location" value="import"
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<?= (isset($lead_edit_data) && $lead_edit_data['shipping_location'] == 'import') ? 'checked' : ''; ?>>
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<label class="form-check-label">Import</label>
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</div>
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</div>
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<!-- Type of Goods in Transit -->
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<div class="form-group col-md-3">
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<label>Please select the type of goods in transit</label><br>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="goods_type" value="new_goods"
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<?= (isset($lead_edit_data) && $lead_edit_data['goods_type'] == 'new_goods') ? 'checked' : ''; ?>>
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<label class="form-check-label">New Goods</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="goods_type" value="old_goods"
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<?= (isset($lead_edit_data) && $lead_edit_data['goods_type'] == 'old_goods') ? 'checked' : ''; ?>>
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<label class="form-check-label">Old Goods</label>
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</div>
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</div>
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<!-- Standard of Packing -->
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<div class="form-group col-md-3">
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<label>Standard of Packing</label><br>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="packing_standard" value="standard_packing"
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<?= (isset($lead_edit_data) && $lead_edit_data['packing_standard'] == 'standard_packing') ? 'checked' : ''; ?>>
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<label class="form-check-label">Standard Packing</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="packing_standard" value="customary_packing"
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<?= (isset($lead_edit_data) && $lead_edit_data['packing_standard'] == 'customary_packing') ? 'checked' : ''; ?>>
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<label class="form-check-label">Customary Packing</label>
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</div>
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</div>
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<!-- Estimated Annual Sales -->
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<div class="form-group col-md-3">
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<label for="annual_sales">Estimated Annual Sales</label>
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<input value="<?= isset($lead_edit_data['annual_sales']) ? $lead_edit_data['annual_sales'] : '' ?>" type="text" class="form-control" id="annual_sales" name="annual_sales">
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</div>
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<!-- Limit Per Location -->
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<div class="form-group col-md-3">
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<label for="limit_per_location">Limit Per Location</label>
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<input value="<?= isset($lead_edit_data['limit_per_location']) ? $lead_edit_data['limit_per_location'] : '' ?>" type="text" class="form-control" id="limit_per_location" name="limit_per_location">
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</div>
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<!-- Single Carrying Limit -->
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<div class="form-group col-md-3">
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<label for="single_carrying_limit">Single Carrying Limit</label>
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<input value="<?= isset($lead_edit_data['single_carrying_limit']) ? $lead_edit_data['single_carrying_limit'] : '' ?>" type="text" class="form-control" id="single_carrying_limit" name="single_carrying_limit">
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</div>
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<!-- Basis of Valuation -->
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<div class="form-group col-md-3">
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<label for="basis_of_valuation">Basis of Valuation</label>
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<input value="<?= isset($lead_edit_data['basis_of_valuation']) ? $lead_edit_data['basis_of_valuation'] : '' ?>" type="text" class="form-control" id="basis_of_valuation" name="basis_of_valuation">
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</div>
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<!-- Description of Cargo -->
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<div class="form-group col-md-3">
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<label for="cargo_description">Description of Cargo</label>
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<input value="<?= isset($lead_edit_data['cargo_description']) ? $lead_edit_data['cargo_description'] : '' ?>" type="text" class="form-control" id="cargo_description" name="cargo_description">
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</div>
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<!-- Excess -->
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<div class="form-group col-md-3">
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<label for="excess">Excess</label>
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<input value="<?= isset($lead_edit_data['excess']) ? $lead_edit_data['excess'] : '' ?>" type="text" class="form-control" id="excess" name="excess">
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</div>
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<!-- Address -->
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<div class="form-group col-md-3">
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<label for="pinCode">Pin Code</label>
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<input type="text" class="form-control" id="pinCode" name="pincode" value="<?= isset($lead_edit_data['pincode']) ? htmlspecialchars($lead_edit_data['pincode']) : ''; ?>">
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</div>
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<div class="form-group col-md-3">
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<label for="address">Address</label>
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<textarea class="form-control" id="address" name="address" rows="1">value="<?= isset($lead_edit_data['address']) ? $lead_edit_data['address'] : '' ?>"</textarea>
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</div>
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</div>
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