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- <form method="post" action="register-provider.php" enctype="multipart/form-data">
- <input name="name" type="text" placeholder="Name"/>
- <select name="cat">
- <option value="electrician">Electrician</option>
- <option value="plumber">Plumber</option>
- <option value="carpenter">Carpenter</option>
- <option value="dance">Teacher-Dance </option>
- <option value="sing">Teacher-Singing </option>
- <option value="maths">Teacher-Maths </option>
- <option value="decoration">Decorations </option>
- <option value="catering">Catering Services </option>
- <option value="wedding">Wedding Planner </option>
- <option value="int_designer">Interior Designer </option>
- </select>
- <input name="email" type="email" placeholder="Email Address"/>
- <input name="phone" type="text" placeholder="Phone Number"/>
- <input name="address1" type="text" placeholder="Address Line 1"/>
- <input name="address2" type="text" placeholder="Address Line 2"/>
- <input name="address3" type="text" placeholder="Address Line 3"/>
- <a href="pincodes.html">Pincode Helper</a><br>
- <br><input name="city" type="text" placeholder="City"/>
- <select name="location">
- <option value="Afzalgunj">Afzalgunj</option>
- <option value="Amberpet">Amberpet</option>
- <option value="Andhra Mahila sabha">Andhra Mahila sabha</option>
- <option value="Moulali">Moulali </option>
- </option>
- <input name="pincode" type="text" placeholder="Pin Code"/>
- <input name="password" type="password" placeholder="Password"/>
- <button type="submit" name="submit" class="btn btn-default">Signup</button></form>
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