| Current File : /home/inlingua/public_html/sensoriumpsychologists.com/franchise_registration.php |
<?php include('include/header.php');
include_once('classes/config.php');
session_start();
?>
<div class="site-breadcrumb">
<div class="container">
<a href="index.php"><i class="fa fa-home"></i> Home</a><i class="fa fa-angle-right"></i> Registration<i class="fa fa-angle-right"></i>
<span>Franchise Registration</span>
</div>
</div>
<section class="contact-page spad pt-0">
<div class="container">
<div class="text-center">
<h3>Registration Now</h3>
<p></p>
</div>
<div class="sc_contact_form sc_contact_form_contact contact-form" style="border:1px solid #c3c3cc; padding:25px;">
<form data-formtype="contact" class="validate123 comment-form --contact" method="post" enctype="multipart/form-data" action="franchise_payment.php">
<?php
$today = date("ymd");
$rand = strtoupper(substr(uniqid(sha1(time())),0,4));
$unique1 = $today . $rand;
?>
<div class="row">
<div class="col-md-4">
<label class="required" for="name">Full Name</label>
<input id="name" type="text" name="name" placeholder="Full Name" data-rule-required="true"> <input type="hidden" name="code" value="<?php echo "FR".$unique1;?>">
</div>
<div class="col-md-4">
<label class="required" for="email">E-mail</label>
<input type="text" id="username" name="email" placeholder="E-mail Id" onblur="return check_username();">
<div id="Info"></div>
<span id="Loading"><img src="css/loader.gif" alt="" ></span>
</div>
<div class="col-md-4">
<label class="required" for="">Mobile No.</label>
<input id="" type="text" name="mobile_no" placeholder="Mobile No." data-rule-required="true" data-rule-minlength="10" data-rule-maxlength="13" data-rule-number="true">
</div>
<div class="col-md-4">
<label class="required" for="">Office No.</label>
<input id="" type="text" name="office_number" placeholder="Office No." data-rule-minlength="10" data-rule-maxlength="13" data-rule-number="true">
</div>
<div class="col-md-8">
<label class="required" for="">Address</label>
<input id="p_address" type="text" name="p_address" placeholder="Address" data-rule-required="true">
</div>
<div class="col-md-12 message">
<label class="" for="">Educational Qualification Promoter/Partner/Individual</label> <textarea id="edu_qualification" class="textAreaSize" data-rule-required="true" placeholder="Educational Qualification Promoter/Partner/Individual" name="edu_qualification"></textarea>
</div>
<div class="col-md-12 message">
<label class="" for="">Institute</label>
<textarea id="institute" class="textAreaSize" name="institute" placeholder="Institute"></textarea>
</div>
<div class="col-md-4">
<label class="" for="">PAN No.</label>
<input id="pan_no" type="text" name="pan_no" placeholder="Pan No." data-rule-required="true">
</div>
<div class="col-md-4">
<label class="" for="">Occupation</label>
<input id="occu" type="text" name="occu" placeholder="Occupation" data-rule-required="true">
</div>
<div class="col-md-4">
<label class="" for="">Nature of Work</label>
<input id="work" type="text" name="work" placeholder="Nature of Work" data-rule-required="true">
</div>
<div class="col-md-12">
<h5>For Persons In Business</h5>
</div>
<div class="col-md-4">
<label class="" for="">Company Name(s)</label>
<input id="cname" type="text" name="cname" placeholder="Company Name" >
</div>
<div class="col-md-4">
<label class="" for="">Ownership Prop./Pvt. Partner</label>
<input id="ownership" type="text" name="ownership" placeholder="Ownership Prop./Pvt. Partner">
</div>
<div class="col-md-4">
<label class="" for="">Nature of Business</label>
<input id="business" type="text" name="business" placeholder="Nature of Business">
</div>
<div class="col-md-4">
<label class="" for="">Principal Product/Brand</label>
<input id="principal" type="text" name="principal" placeholder="Principal Product/Brand" >
</div>
<div class="col-md-4">
<label class="" for="">Years in Business</label>
<input id="ybusi" type="text" name="ybusi" placeholder="Years in Business" >
</div>
<div class="col-md-4">
<label class="" for="">Annual Turnover (Current Fiscal YR)</label>
<input id="turnover" type="text" name="turnover" placeholder="Annual Turnover" >
</div>
<div class="col-md-12">
<h5>For Persons In Service</h5>
</div>
<div class="col-md-4">
<label class="required" for="">Name of Current Employer</label>
<input id="employer" type="text" name="employer" placeholder="Name of Current Employer" data-rule-required="true">
</div>
<div class="col-md-4">
<label class="required" for="">Designation</label>
<input id="designation" type="text" name="designation" placeholder="Designation" data-rule-required="true">
</div>
<div class="col-md-4">
<label class="required" for="">Job Profile</label>
<input id="job" type="text" name="job" placeholder="Job Profile" data-rule-required="true">
</div>
<div class="col-md-12">
<h5>Franchise Details</h5>
<h6>Existing Franchise Details</h6>
<h6></h6>
</div>
<div class="col-md-2">
<label class="required" for="">City for Franchise</label>
<input id="city_f" type="text" name="city_f" placeholder="City for Franchise" data-rule-required="true">
</div>
<div class="col-md-2">
<label class="required" for="">Location</label>
<input id="location" type="text" name="location" placeholder="Location" data-rule-required="true">
</div>
<div class="col-md-2">
<label class="required" for="">Area (In Square Feets)</label>
<input id="area" type="text" name="area" placeholder="Area" data-rule-required="true">
</div>
<div class="col-md-3">
<label class="required" for="">Area on Hire/Lease/Loan</label>
<input id="area_on" type="text" name="area_on" placeholder="Area on Hire/Lease/Loan" data-rule-required="true">
</div>
<div class="col-md-3">
<label class="required" for="">Prop. / Partnership / Pvt. Ltd.</label>
<input id="f_ownership" type="text" name="f_ownership" placeholder="Prop. / Partnership / Pvt. Ltd." data-rule-required="true">
</div>
<div class="col-md-12">
<h5>Proposed Franchise Details</h5>
</div>
<div class="col-md-2">
<label class="" for="">Intersted City for Franchise</label>
<input id="i_city" type="text" name="i_city" placeholder="Intersted City for Franchise" >
</div>
<div class="col-md-2">
<label class="" for="">Proposed Location</label>
<input id="p_location" type="text" name="p_location" placeholder="Proposed Location" >
</div>
<div class="col-md-2">
<label class="" for="">Area (In Square Feets)</label>
<input id="p_area" type="text" name="p_area" placeholder="Area" >
</div>
<div class="col-md-3">
<label class="" for="">Area on Hire/Lease/Loan</label>
<input id="p_areaon" type="text" name="p_areaon" placeholder="Area on Hire/Lease/Loan" >
</div>
<div class="col-md-3">
<label class="" for="">Prop. / Partnership / Pvt. Ltd.</label>
<input id="f2_ownership" type="text" name="f2_ownership" placeholder="Prop. / Partnership / Pvt. Ltd." >
</div>
<div class="col-md-12">
<h5>In Which state would you like to start the project</h5>
</div>
<div class="col-md-3">
<label class="required" for="p_time" style="text-align:left; padding-top:10px">State</label>
</div>
<div class="col-md-2">
<select name="center" data-rule-required="true" >
<?php $center=$query->select('shristi_center');
while($center_row=$center->fetch_assoc()){
?>
<option value="<?php echo $center_row['center_id'];?>"><?php echo $center_row['name'];?></option><?php }?>
</select>
</div>
<div class="col-md-12">
<h5>How soon you can start the project</h5>
</div>
<div class="col-md-3">
<label for="p_time" style="text-align:left; padding-top:10px">One Month/Two Months/Three Months</label>
</div>
<div class="col-md-2">
<select name="p_time" data-rule-required="true" >
<option value="One">One Month</option>
<option value="Two">Two Months</option>
<option value="Three">Three Months</option>
</select>
</div>
<div class="col-md-1">
<label for="amount" style="text-align:right; padding-top:10px">Amount</label>
</div>
<div class="col-md-2">
<?php
$results=$query->select_where('shristi_account_renew','id','3');
$row1=$results->fetch_assoc();
?>
<input id="" type="text" name="amount" placeholder="Amount" placeholder="Amount" data-rule-required="true" value="<?php echo $row1['amount'];?>">
</div>
<div class="col-md-2">
<label for="payment_mode" style="text-align:right; padding-top:10px">Payment Mode</label>
</div>
<div class="col-md-2 controls">
<select name="payment_mode" data-rule-required="true">
<option value="Cash">Cash</option>
<option value="Draft">Demand Draft</option>
<option value="Card">Card</option>
</select>
</div>
<div class="sc_contact_form_button">
<div class="squareButton ico">
<input type="submit" name="submit" value="Register" class="site-btn sc_contact_form_submit icon-comment">
</div>
</div>
</div>
</form>
</div>
</div>
</section>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.7.1/jquery.min.js" type="text/javascript"></script>
<script type="text/javascript" src="js/jquery.validate.min.js"></script>
<script type="text/javascript">
$(document).ready(function() {
$('#Loading').hide();
});
function check_username(){
var username = $("#username").val();
//alert(#username);
if(username.length > 2){
$('#Loading').show();
$.post("lib/ajaxclass1.php", {
username: $('#username').val(),
}, function(response){
$('#Info').fadeOut();
$('#Loading').hide();
setTimeout("finishAjax('Info', '"+escape(response)+"')", 450);
});
return false;
}
}
function finishAjax(id, response){
$('#'+id).html(unescape(response));
$('#'+id).fadeIn(1000);
}
</script>
<script type="text/javascript">
$(function() {
$(".validate123").validate( {
rules: {
name: {
required: true
},
email: {
required: true
},
mobile_no: {
required: true,
minlength:9,
maxlength:10,
number: true,
},
p_address: {
required: true
},
employer: {
required: true
},
designation: {
required: true
},
job: {
required: true
},
city_f: {
required: true
},
location: {
required: true
},
area: {
required: true
},
area_on: {
required: true
},
f_ownership: {
required: true
},
center: {
required: true
},
p_time: {
required: true
},
amount: {
required: true
},
payment_mode: {
required: true
}
},messages: {
f_name: {
required: 'Please enter First Name'
},
l_name: {
required: 'Please enter Last Name'
}
},
errorPlacement:function(error, element) {
error.insertAfter(element.parent());
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}
);
}
);
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.invalid{border-color:#F00 !important;}
.state-success{border-color:#090 !important;}
em {
display: none !important;
margin-top: 6px;
padding: 0 1px;
font-style: normal;
font-size: 11px;
line-height: 15px;
color: #ff1d13;
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background-image:url(css/no.jpg);
background-repeat:no-repeat;
background-position:left;
color:#FF0000;
padding-left: 33px;
padding-top: 6px;
padding-right: 11px;
float: right;
margin-right: -31%;
}#Successs{
background-image:url(css/yes.jpg);
background-repeat:no-repeat;
background-position:left;
color:#669933;
padding-left: 33px;
padding-top: 6px;
padding-right: 11px;
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<?php include('include/footer.php'); ?>
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