visa_app/application/views/register.php
venbatechnologies@gmail.com 769edb667b profile
2018-08-09 10:27:59 +05:30

173 lines
7.5 KiB
PHP
Executable File

<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<title>Visa | Log in</title>
<!-- Tell the browser to be responsive to screen width -->
<meta content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no" name="viewport">
<!-- Bootstrap 3.3.7 -->
<link rel="stylesheet" href="assets/bower_components/bootstrap/dist/css/bootstrap.min.css">
<!-- Font Awesome -->
<link rel="stylesheet" href="assets/bower_components/font-awesome/css/font-awesome.min.css">
<!-- Ionicons -->
<link rel="stylesheet" href="assets/bower_components/Ionicons/css/ionicons.min.css">
<!-- Theme style -->
<link rel="stylesheet" href="assets/dist/css/AdminLTE.min.css">
<!-- iCheck -->
<link rel="stylesheet" href="assets/plugins/iCheck/square/blue.css">
<style>
.input-group .input-group-addon {
border:0;
}
.input-group .form-control, .input-group-addon, .input-group-btn{
border-right: 0;
border-left: 0;
border-top: 0;
}
.input-group {
margin-bottom:15px;
}
.box-title-box{
color: #fff;
margin-left: 18px;
background: linear-gradient(60deg,#ec407a,#d81b60);
box-shadow: 0 4px 20px 0 rgba(0,0,0,.14), 0 7px 10px -5px rgba(233,30,99,.4);
display: inline-block;
border-radius: 3px;
padding: 13px;
margin-top: -50px;
margin-right: 15px;
float: left;
}
.nav-tabs-custom>.nav-tabs>li.active{
border-top-color:#dc2265 !important;
}
.btn-success.focus, .btn-success:focus{
background-color: #dd2366;
border-color: #dd2366;
box-shadow:0 4px 20px 0 rgba(0,0,0,.14), 0 7px 10px -5px rgba(233,30,99,.4);
}
.btn-success:hover, .btn-success:active, .btn-success.hover {
background-color: rgba(219, 34, 101, 0.64);
border-color: #dd2366;
box-shadow:0 4px 20px 0 rgba(0,0,0,.14), 0 7px 10px -5px rgba(233,30,99,.4);
}
.btn-success {
background-color: #dd2366;
border-color: #dd2366;
box-shadow:0 4px 20px 0 rgba(0,0,0,.14), 0 7px 10px -5px rgba(233,30,99,.4);
}
</style>
</head>
<body class="hold-transition login-page" style="background-image: url(assets/dist/img/loginbg.jpg);
background-size: cover;
background-position: top center;margin-top:150px;">
<div class="row">
<div class="col-md-offset-3 col-md-6">
<div class="box box-solid" style="box-shadow:0 1px 4px 0 rgba(0,0,0,.14);padding: 20px;">
<div class="box-body">
<div class="row">
<h3 class="box-title-box"><i class="fa fa-users" style="padding-right:5px;"></i>Register</h3>
</div>
<form action="<?php echo base_url() ?>Add_Register" method="post">
<div class="row">
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-user"></i></span>
<input type="text" class="form-control" placeholder="Name" name="Name" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-mobile"></i></span>
<input type="number" class="form-control" placeholder="Phone No" name="PhoneNo" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-envelope"></i></span>
<input type="mail" class="form-control" placeholder="Email ID" name="Email" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-envelope"></i></span>
<input type="mail" class="form-control" placeholder="Alternate Email ID" name="AlternateEmail" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-lock"></i></span>
<input type="password" class="form-control" placeholder="Password" name="Password" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-lock"></i></span>
<input type="password" class="form-control" placeholder="Re-password" name="Re-password" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-building"></i></span>
<input type="text" class="form-control" placeholder="Company Name" name="CompanyName" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-briefcase "></i></span>
<input type="text" class="form-control" placeholder="Designation" name="Designation" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-map-signs"></i></span>
<input type="text" class="form-control" placeholder="City" name="CityName" required />
</div>
</div>
<div class="col-md-6">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-globe"></i></span>
<input type="text" class="form-control" placeholder="Country" name="CountryName" required />
</div>
</div>
<div class="col-md-12">
<div class="input-group">
<span class="input-group-addon"><i class="fa fa-address-card"></i></span>
<input type="text" class="form-control" placeholder="Full Address" name="Address" required />
</div>
</div>
</div>
<div class="row">
<div class="col-xs-offset-4 col-xs-4">
<input type="Submit" class="btn btn-block btn-success btn-sm" value="Lets Go">
</div>
</div>
</form>
</div>
<!--//////////////////-->
<!-- /.box-body -->
</div>
<!-- /.box -->
</div>
<!-- ./col -->
</div>
<!-- /.row -->
<!-- jQuery 3 -->
<script src="assets/bower_components/jquery/dist/jquery.min.js"></script>
<!-- Bootstrap 3.3.7 -->
<script src="assets/bower_components/bootstrap/dist/js/bootstrap.min.js"></script>
<!-- iCheck -->
<script src="assets/plugins/iCheck/icheck.min.js"></script>
</body