Your IP : 216.73.216.26

Current Path : /home2/wtmwscom/www/member/
Upload File :
Current File : /home2/wtmwscom/www/member/lead_add.php

<?php
$title= "New Lead";
include 'header.php';
$uid = $_SESSION['userid'];
?>
<style type="text/css">
    form {
        font:13px Georgia, "Times New Roman", Times, serif;
        background:#eee;
        margin:20px;
        padding:10px 20px;
        width:90%;	
    }

    form ul {
        list-style:none;
        margin:0;
        padding:0;
    }

    form li {
        padding:6px;
        background:#e1e1e1;
        margin-bottom:1px;
    }

    form li#send {
        background:none;
        margin-top:6px;
    }

    form label {
        float:left;
        width:205px;
        text-align:right;	
        margin-right:7px;
        color:#0066CC;
        line-height:23px; /* This will make the labels vertically centered with the inputs */
    }
    
    form label span {
        color: brown;
    }

    form input, form select,
    form textarea {
        padding:4px;
        font:13px Georgia, "Times New Roman", Times, serif;
        border:1px solid #999999;
        width:200px;
    }

    form input:focus, form select:focus,
    form textarea:focus {
        border:1px solid #666;
        background:#e3f1f1;
    }

    form li#send button {
        background:#003366;
        border:none;
        padding:4px 8px 4px 8px;
        border-radius:15%; /* Don't expect this to work on IE6 or 7 */
        -moz-border-radius:15%;
        -webkit-border-radius:15%;			
        color:#fff;
        margin-left:137px; /* Total width of the labels + their right margin */
        cursor:pointer;
    }

    form li#send button:hover { 
        background-color:#006633;
    }
    .heading{
        color:#FFFFFF; 
        background-color:#666666; 
        border:1px solid #CCCCCC; 
        border-collapse:collapse; 
        text-align:left; 
        vertical-align:middle;
    }
</style>
    
    <h1>Add Lead</h1>
    <?php echo getMessage();?>
    <section>
        <form action="lead_add_model.php" name="form" id="form" method="post"  enctype="multipart/form-data"> 
            <ul>
                
                <li class="heading">Personal Details</li>

                <li>
                    <label for="name">Name <span>*</span></label>
                    <input name="name" id="name" type="text" pattern="[a-zA-Z ]+" required="required" maxlength="100" />
                </li>

                <li>
                    <label for="dob">Date of Birth </label>
                    <input name="dob" id="dob" type="text" readonly="readonly" value="" class="datepicker" />&nbsp;&nbsp;eg. 1985-07-24
                </li>

                <li>
                    <label for="sex">Gender </label>
                    <input type="radio" id="sex_m" value="Male" checked="checked" name="sex" style="width: 20px; float: none;"/>
                    Male&nbsp;
                    <input type="radio" value="Female" id="sex_f" name="sex"  style="width: 20px; float: none;" />
                    Female
                </li>

                <li>
                    <label for="address">Address</label>
                    <input name="address" id="address" type="text" maxlength="150" />
                </li>

                <li>
                    <label for="city">City <span>*</span></label>
                    <input name="city" id="city" type="text" maxlength="100" required="required" />
                </li>

                <li>
                    <label for="country">Country <span>*</span></label>
                    <select name="country" id="country">
                        <!--<option selected="selected">--Select country--</option>-->
                        <?php 
                        $result = mysqli_query($connection, "SELECT country_id, short_name FROM country");
                        while ($row = mysqli_fetch_object($result)){
                        ?>
                        <option value="<?php echo $row->country_id;?>" <?php if($row->country_id=='IN'){echo "selected='selected'";}?>><?php echo $row->short_name;?></option>
                        <?php }?>
                    </select>
                </li>

                <li>
                    <label for="mobile">Mobile <span>*</span></label>
                    <input name="mobile" id="mobile" type="text" maxlength="10" pattern="[0-9]{10,10}" required="required" />&nbsp;&nbsp;<span id="mobile_error" name="mobile_error"></span>
                </li>

                <li>
                    <label for="email">Email</label>
                    <input name="email" id="email" type="email" maxlength="50" />&nbsp;&nbsp;<span id="email_error" name="email_error"></span>
                </li>
                
<!--                <li>
                    <label for="pan_no">P.A.N. no. </label>
                    <input type="text" name="pan_no" id="pan_no"  maxlength="20" >
                </li>
                <li>
                    <label for="receipt">P.A.N. image </label>
                    <input type="file" name="receipt" id="receipt" >
                </li>
                <li>
                    <label for="aadhar_no">Aadhar No. </label>
                    <input type="text" name="aadhar_no" id="aadhar_no"  maxlength="50">
                </li>-->

                

                <li id="send">
                    <button type="submit" id="submit">Register</button>
                </li>

            </ul>
            
        </form>
    </section>
<?php include 'footer.php';?>