| Current File : /home/inlingua/www/sensoriumpsychologists.com/backup/panel/franchise/franchise_edit_profile.php |
<!DOCTYPE html>
<html>
<head>
<title>Shristi</title>
<?php require("../common/head_links.php");?>
</head>
<body class="hold-transition skin-blue sidebar-mini">
<div class="wrapper">
<?php require("common/header.php");?>
<?php require("common/left_side_bar.php");?>
<!-- Content Wrapper. Contains page content -->
<div class="content-wrapper">
<!-- Content Header (Page header) -->
<section class="content-header">
<h1> View/Update Profile</h1>
</section>
<!-- Main content -->
<section class="content">
<form role="form" method="post" enctype="multipart/form-data" onSubmit="return validate_form()">
<div class="row">
<!-- left column -->
<div class="col-md-6">
<!-- general form elements -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Login Details</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<label for="username">User name</label>
<input type="text" class="form-control" value="" disabled>
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Details</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<label for="name">Name </label>
<input type="text" class="form-control" id="first_name" name="name" value="">
</div>
<div class="form-group">
<label for="">Contact No</label>
<input type="text" class="form-control" id="contact_no" name="contact_no" value="">
</div>
<div class="form-group">
<label for="">Office Contact No</label>
<input type="text" class="form-control" id="" onkeypress="return isNumberKey(event)" name="" value="" >
</div>
<div class="form-group">
<label for="email_id">Email ID </label>
<input type="email" class="form-control" id="email_id" style="text-transform:lowercase;" name="email_id" value="" >
</div>
<div class="form-group">
<label for="name">Educational Qualification Promoter/Partner/Individual </label>
<textarea class="form-control" rows="3" id="" name="" value=""></textarea>
</div>
<div class="form-group">
<label for="name">Institute </label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="name">PAN No. </label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="name">Occupation </label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="name">Nature of Work</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">For Persons In Service</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<label for="name">Name of Current Employer </label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Designation</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Job Profile</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
</div>
<!--/.col (left) -->
<!-- right column -->
<div class="col-md-6">
<!-- Horizontal Form -->
<!-- form start -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Permanent Address <span style="color:#F00;">*</span></h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<textarea class="form-control" name="p_local" id="p_local" rows="3" placeholder="Permanent Address" ></textarea>
</div>
<div class="form-group">
<input type="text" class="form-control" name="p_city" id="p_city" placeholder="City" style="text-transform:capitalize;" value="" />
</div>
<div class="form-group">
<select class="form-control" name="p_state" id="p_state" >
<option value="">-Select State-</option>
<option >Andaman & Nicobar</option>
<option >Andhra Pradesh</option>
<option >Arunachal Pradesh</option>
<option >Assam</option>
<option >Bihar</option>
<option >Chhattisgarh</option>
<option >Dadrar Nagar Haveli</option>
<option >Daman & Diu</option>
<option >Delhi</option>
<option >Goa</option>
<option >Gujarat</option>
<option >Haryana</option>
<option >Himachal Pradesh</option>
<option >Jammu & Kashmir</option>
<option >Jharkhand</option>
<option >Karnataka</option>
<option >Kerala</option>
<option >Lakshadweep</option>
<option >Madhya Pradesh</option>
<option >Maharashtra</option>
<option >Manipur</option>
<option >Meghalaya</option>
<option >Mizoram</option>
<option >Nagaland</option>
<option >Orissa</option>
<option >Pondicherry</option>
<option >Punjab</option>
<option >Rajasthan</option>
<option >Sikkim</option>
<option >Tamil Nadu</option>
<option >Telangana</option>
<option >Tripura</option>
<option >Uttar Pradesh</option>
<option >Uttaranchal</option>
<option >West Bengal</option>
</select>
</div>
<div class="form-group">
<input type="text" class="form-control" name="p_pincode" id="p_pincode" placeholder="Pincode" value="" maxlength="6" onkeypress="return isNumberKey(event)" />
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Correspondence Address <span style="color:#F00;">*</span> <input type="button" class="btn btn-primary" value="Copy Permanent" id="copy_addr_btn" onClick="copy_addr()" /></h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<textarea class="form-control" name="c_local" id="c_local" rows="3" placeholder="Local Address" ></textarea>
</div>
<div class="form-group">
<input type="text" class="form-control" name="c_city" id="c_city" placeholder="City" style="text-transform:capitalize;" value="" />
</div>
<div class="form-group">
<select class="form-control" name="c_state" id="c_state">
<option value="">-Select State-</option>
<option >Andaman & Nicobar</option>
<option >Andhra Pradesh</option>
<option >Arunachal Pradesh</option>
<option >Assam</option>
<option >Bihar</option>
<option >Chhattisgarh</option>
<option >Dadrar Nagar Haveli</option>
<option >Daman & Diu</option>
<option >Delhi</option>
<option >Goa</option>
<option >Gujarat</option>
<option >Haryana</option>
<option >Himachal Pradesh</option>
<option >Jammu & Kashmir</option>
<option >Jharkhand</option>
<option >Karnataka</option>
<option >Kerala</option>
<option >Lakshadweep</option>
<option >Madhya Pradesh</option>
<option >Maharashtra</option>
<option >Manipur</option>
<option >Meghalaya</option>
<option >Mizoram</option>
<option >Nagaland</option>
<option >Orissa</option>
<option >Pondicherry</option>
<option >Punjab</option>
<option >Rajasthan</option>
<option >Sikkim</option>
<option >Tamil Nadu</option>
<option >Telangana</option>
<option >Tripura</option>
<option >Uttar Pradesh</option>
<option >Uttaranchal</option>
<option >West Bengal</option>
</select>
</div>
<div class="form-group">
<input type="text" class="form-control" name="c_pincode" id="c_pincode" placeholder="Pincode" value="" maxlength="6" onkeypress="return isNumberKey(event)" />
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">For Persons In Business</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<label for="name">Company Name(s) </label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Ownership Prop./Pvt. Partner</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Nature of Business</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Principal Product/Brand</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Years in Business</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
<div class="form-group">
<label for="">Annual Turnover (Current Fiscal YR)</label>
<input type="text" class="form-control" id="" name="" value="">
</div>
</div>
<!-- /.box-body -->
</div>
<!-- /.box -->
</div>
<!--/.col (right) -->
</div>
<div class="row">
<div class="col-md-12">
<h3 class="box-title">Franchise Details</h3>
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Existing Franchise Details</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<div class="col-md-2">
<label class="required" for="">City for Franchise</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-2">
<label class="required" for="">Location</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-2">
<label class="required" for="">Area (Square Feets)</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-3">
<label class="required" for="">Area on Hire/Lease/Loan</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-3">
<label class="required" for="">Prop. / Partnership / Pvt. Ltd.</label>
<input id="" type="text" class="form-control" name="">
</div>
</div>
</div>
<!-- /.box-body -->
</div>
<div class="box box-primary">
<div class="box-header with-border">
<h3 class="box-title">Proposed Franchise Details</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<div class="box-body">
<div class="form-group">
<div class="col-md-2">
<label class="required" for="">Intersted City for Franchise</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-2">
<label class="required" for="">Proposed Location</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-2">
<label class="required" for="">Area (Square Feets)</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-3">
<label class="required" for="">Area on Hire/Lease/Loan</label>
<input id="" type="text" class="form-control" name="">
</div>
<div class="col-md-3">
<label class="required" for="">Prop. / Partnership / Pvt. Ltd.</label>
<input id="" type="text" class="form-control" name="">
</div>
</div>
</div>
<!-- /.box-body -->
</div>
</div>
</div>
<!-- /.row -->
<div class="row">
<div class="col-md-12">
<button type="button" onClick="window.location.href='index.php'" class="btn btn-danger" style="margin-right:10px;margin-top:10px;">Back</button>
<button type="submit" class="btn btn-success" style="margin-top:10px;">Submit</button>
</div>
</div>
</form>
</section>
<!-- /.content -->
</div><!-- /.content-wrapper -->
<?php require("../common/footer.php");?>
</div><!-- ./wrapper -->
<?php require("../common/footer_links.php");?>
</body>
</html>