326 lines
22 KiB
PHP
326 lines
22 KiB
PHP
|
|
<?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>
|