106 lines
5.7 KiB
PHP
106 lines
5.7 KiB
PHP
<div class="tab-pane fade active show" id="general-q-tab">
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<div class="row">
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<div class="col-12">
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<div class="card-body">
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<form role="form" class="parsley-examples" method="post" id="UserForm" action=""
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enctype="multipart/form-data">
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<input type="hidden" value="<?= csrf_hash() ?>" name="<?= csrf_token() ?>" />
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<input type="hidden" name="PrimaryKey" id="UserId" />
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<div class="form-group">
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<div class="form-row">
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<div class="form-group col-md-4">
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<label for="emp_code">Entity Type <span
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class="text-danger">*</span></label>
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<select class="form-control" id="role" name="role" required>
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<option value="">Select Entity</option>
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<?php foreach($entity as $value) { ?>
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<option value="<?= $value['id'] ?>"><?= $value['name'] ?></option>
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<?php } ?>
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</select>
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</div>
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<div class="form-group col-md-4">
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<label for="first_name">Client Name<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="first_name"
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placeholder="Enter Client Name" name="first_name" required>
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</div>
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<div class="form-group col-md-4">
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<label for="last_name">Client Short Name<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="last_name"
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placeholder="Enter Short Name" name="last_name" required>
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-md-4">
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<label for="email">PAN<span class="text-danger">*</span></label>
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<input type="text" class="form-control" id="email"
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placeholder="Enter PAN Number" name="email" required>
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</div>
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<div class="form-group col-md-4">
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<label for="mobile">GST<span class="text-danger">*</span></label>
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<input type="text" class="form-control" id="mobile"
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placeholder="Enter GST Number" name="mobile" required>
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</div>
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</div>
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<hr>
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<div class="form-row">
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<div class="form-group col-md-6">
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<label for="email">Address 1<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="email"
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placeholder="Enter Address 1" name="email" required>
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</div>
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<div class="form-group col-md-6">
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<label for="mobile">Address 2<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="mobile"
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placeholder="Enter Address 2" name="mobile" required>
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-md-4">
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<label for="first_name">City<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="first_name"
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placeholder="Enter City" name="first_name" required>
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</div>
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<div class="form-group col-md-4">
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<label for="last_name">State<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="last_name"
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placeholder="Enter State" name="last_name" required>
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</div>
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<div class="form-group col-md-4">
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<label for="last_name">Pincode<span
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class="text-danger">*</span></label>
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<input type="text" class="form-control" id="last_name"
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placeholder="Enter Pincode" name="last_name" required>
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</div>
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</div>
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</div>
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<div class="form-group text-right m-b-0">
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<button type="submit" class="btn btn-primary waves-effect waves-light mr-1"
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id="btnSubmit">Submit</button>
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<button type="button" class="btn btn-secondary waves-effect btnBack"
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id="btnBack">Cancel</button>
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</div>
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</form>
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</div>
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</div> <!-- end col-->
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</div>
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</div>
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<!-- end -->
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<script>
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$(document).ready(function () {
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});
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</script>
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