

<?php include('include/headscript.php'); ?>



<!DOCTYPE html>

<html lang="en">

	

<head>

        <meta charset="utf-8" />

        <title>TRF CIMAC </title>

        <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">

        <meta content="CIMAC TRF Portal" name="description" />

        <meta content="" name="author" />

        <meta http-equiv="X-UA-Compatible" content="IE=edge" />



        <!-- App favicon -->

        <link rel="shortcut icon" href="../images/favicon.ico">

	

		<!--Form Wizard-->

        <link href="../plugins/jquery-steps/jquery.steps.css" rel="stylesheet" type="text/css">



        <!-- App css -->

        <link href="assets/css/bootstrap.min.css" rel="stylesheet" type="text/css" />

        <link href="assets/css/jquery-ui.min.css" rel="stylesheet">

        <link href="assets/css/icons.min.css" rel="stylesheet" type="text/css" />

        <link href="assets/css/metisMenu.min.css" rel="stylesheet" type="text/css" />

        <link href="assets/css/app.min.css" rel="stylesheet" type="text/css" />



    </head>



    <body>

        

         <!-- Top Bar Start -->

         <?php include('include/topbar.php'); ?>

        <!-- Top Bar End -->



        

        <!-- Left Sidenav -->

        <?php include('include/leftsidenav.php'); ?>

    <!-- end left-sidenav-->



        <div class="page-wrapper">

            <!-- Page Content-->

            <div class="page-content">



                <div class="container-fluid">

                    <!-- Page-Title -->

                    <div class="row">

                        <div class="col-sm-12">

                            <div class="page-title-box">

                                <div class="float-right">

                                    <ol class="breadcrumb">

                                        <li class="breadcrumb-item"><a href="javascript:void(0);">CIMAC TRF</a></li>

                                        <li class="breadcrumb-item active">Starter</li>

                                    </ol>

                                </div>

                                <h4 class="page-title"><?php echo $titlewb; ?></h4>

                            </div><!--end page-title-box-->

                        </div><!--end col-->

                    </div>

					<div class="row">

                        <div class="col-sm-12">

                            <div class="card">

                                <div class="card-body">

                                    <h4 class="mt-0 header-title">Jquery Steps Wizard</h4>

                                    <p class="text-muted mb-3">A powerful jQuery wizard plugin that

                                        supports accessibility and HTML5</p>



                                    <form id="form-horizontal" class="form-horizontal form-wizard-wrapper">

                                        <h3>Seller Details</h3>

                                        <fieldset>

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtFirstNameBilling" class="col-lg-3 col-form-label">Contact Person</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtFirstNameBilling" name="txtFirstNameBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtLastNameBilling" class="col-lg-3 col-form-label">Mobile No.</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtLastNameBilling" name="txtLastNameBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCompanyBilling" class="col-lg-3 col-form-label">Landline No.</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCompanyBilling" name="txtCompanyBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtEmailAddressBilling" class="col-lg-3 col-form-label">Email Address</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtEmailAddressBilling" name="txtEmailAddressBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtAddress1Billing" class="col-lg-3 col-form-label">Address 1</label>

                                                        <div class="col-lg-9">

                                                            <textarea id="txtAddress1Billing" name="txtAddress1Billing" rows="4" class="form-control"></textarea>

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtAddress2Billing" class="col-lg-3 col-form-label">Warehouse Address</label>

                                                        <div class="col-lg-9">

                                                            <textarea id="txtAddress2Billing" name="txtAddress2Billing" rows="4" class="form-control"></textarea>

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCityBilling" class="col-lg-3 col-form-label">Company Type</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCityBilling" name="txtCityBilling" type="text" class="form-control">

                                                        </div>

                                                    </div>

                                                </div>

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtStateProvinceBilling" class="col-lg-3 col-form-label">Live Market A/C</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtStateProvinceBilling" name="txtStateProvinceBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->



                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtTelephoneBilling" class="col-lg-3 col-form-label">Product Category</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtTelephoneBilling" name="txtTelephoneBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtFaxBilling" class="col-lg-3 col-form-label">Product Sub Category</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtFaxBilling" name="txtFaxBilling" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                        </fieldset><!--end fieldset-->



                                        <h3>Company Document</h3>

                                        <fieldset>

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtFirstNameShipping" class="col-lg-3 col-form-label">PAN Card</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtFirstNameShipping" name="txtFirstNameShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtLastNameShipping" class="col-lg-3 col-form-label">VAT/TIN No.</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtLastNameShipping" name="txtLastNameShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCompanyShipping" class="col-lg-3 col-form-label">CST No.</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCompanyShipping" name="txtCompanyShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtEmailAddressShipping" class="col-lg-3 col-form-label">Service Tax No.</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtEmailAddressShipping" name="txtEmailAddressShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->



                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCityShipping" class="col-lg-3 col-form-label">Company UIN</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCityShipping" name="txtCityShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtStateProvinceShipping" class="col-lg-3 col-form-label">Declaration</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtStateProvinceShipping" name="txtStateProvinceShipping" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                        </fieldset><!--end fieldset-->



                                        <h3>Bank Details</h3>

                                        <fieldset>

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtNameCard" class="col-lg-3 col-form-label">Name on Card</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtNameCard" name="txtNameCard" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="ddlCreditCardType" class="col-lg-3 col-form-label">Credit Card Type</label>

                                                        <div class="col-lg-9">

                                                            <select id="ddlCreditCardType" name="ddlCreditCardType" class="form-control">

                                                                <option value="">--Please Select--</option>

                                                                <option value="AE">American Express</option>

                                                                <option value="VI">Visa</option>

                                                                <option value="MC">MasterCard</option>

                                                                <option value="DI">Discover</option>

                                                            </select>

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCreditCardNumber" class="col-lg-3 col-form-label">Credit Card Number</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCreditCardNumber" name="txtCreditCardNumber" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtCardVerificationNumber" class="col-lg-3 col-form-label">Card Verification Number</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtCardVerificationNumber" name="txtCardVerificationNumber" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                            <div class="row">

                                                <div class="col-md-6">

                                                    <div class="form-group row">

                                                        <label for="txtExpirationDate" class="col-lg-3 col-form-label">Expiration Date</label>

                                                        <div class="col-lg-9">

                                                            <input id="txtExpirationDate" name="txtExpirationDate" type="text" class="form-control">

                                                        </div>

                                                    </div><!--end form-group-->

                                                </div><!--end col-->

                                            </div><!--end row-->

                                        </fieldset><!--end fieldset-->



                                        <h3>Confirm Detail</h3>

                                        <fieldset>

                                            <div class="p-3">

                                                <label class="custom-control custom-checkbox">

                                                    <input type="checkbox" class="custom-control-input">

                                                    <span class="custom-control-indicator"></span>

                                                    <span class="custom-control-description">I agree with the Terms and Conditions.</span>

                                                </label>

                                            </div>

                                        </fieldset><!--end fieldset-->

                                    </form><!--end form-->

                                </div><!--end card-body-->

                            </div><!--end card-->

                        </div><!--end col-->

                    </div>

                    <!-- end page title end breadcrumb -->

                    



                </div><!-- container -->

<!-- footer start -->

              <?php include('include/footer.php'); ?>

                </footer><!--end footer-->

            </div>

            <!-- end page content -->

        </div>

        <!-- end page-wrapper -->



        





        <!-- jQuery  -->

        <script src="assets/js/jquery.min.js"></script>

        <script src="assets/js/bootstrap.bundle.min.js"></script>

        <script src="assets/js/metismenu.min.js"></script>

        <script src="assets/js/waves.js"></script>

        <script src="assets/js/feather.min.js"></script>

        <script src="assets/js/jquery.slimscroll.min.js"></script>

        <script src="assets/js/jquery-ui.min.js"></script>

	

	        <script src="../plugins/jquery-steps/jquery.steps.min.js"></script>

        <script src="assets/pages/jquery.form-wizard.init.js"></script>



        <!-- App js -->

        <script src="assets/js/app.js"></script>

        

    </body>



</html>