40 lines
2.1 KiB
PHP
40 lines
2.1 KiB
PHP
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<div class="form-row custom_fields">
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<!-- Risk Location -->
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<div class="form-group col-md-5">
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<label>Risk Location</label><br>
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<?php $risk_location = isset($lead_edit_data['risk_location']) ? $lead_edit_data['risk_location'] : ''; ?>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="risk_location" value="single" <?= ($risk_location == 'single') ? 'checked' : ''; ?>>
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<label class="form-check-label">Single</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="risk_location" value="multi_with_floter" <?= ($risk_location == 'multi_with_floter') ? 'checked' : ''; ?>>
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<label class="form-check-label">Multi with Floater</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="risk_location" value="multi_without_floter" <?= ($risk_location == 'multi_without_floter') ? 'checked' : ''; ?>>
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<label class="form-check-label">Multi without Floater</label>
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</div>
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</div>
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<!-- Business Description -->
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<div class="form-group col-md-3">
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<label for="business_description">Business Description</label>
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<textarea class="form-control" id="business_description" name="business_description" rows="1"><?= isset($lead_edit_data['business_description']) ? htmlspecialchars($lead_edit_data['business_description']) : ''; ?></textarea>
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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-4">
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<label for="address">Address</label>
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<textarea class="form-control" id="address" name="address" rows="1"><?= isset($lead_edit_data['address']) ? htmlspecialchars($lead_edit_data['address']) : ''; ?></textarea>
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</div>
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</div>
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