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- <div class="container-fluid">
- <ol class="breadcrumb">
- <li class="breadcrumb-item">
- <a href="#">Pelanggan</a>
- </li>
- <li class="breadcrumb-item active">Tambah Data Pelanggan</li>
- </ol>
- <div class="row">
- <div class="col-md-12">
- <div class="card">
- <div class="card-header text-white bg-primary">
- Tambah Data Pelanggan
- </div>
- <?php echo form_open('Pelanggan/tambah') ?>
- <div class="card-body">
- <div class="form-group">
- <label for="nama_bencana">Nama Pelanggan</label>
- <input type="text" class="form-control" name="nama_pelanggan" required="">
- </div>
- <div class="form-group">
- <label for="foto">Jenis Kelamin</label>
- <select name="kelamin" class="form-control">
- <option value="LAKI-LAKI">LAKI-LAKI</option>
- <option value="PEREMPUAN">PEREMPUAN</option>
- </select>
- </div>
- <div class="form-group">
- <label for="foto">Alamat</label>
- <textarea name="alamat" cols="30" rows="10" class="form-control"></textarea>
- </div>
- <div class="form-group">
- <label for="korban jiwa">No Telpon</label>
- <input type="number" class="form-control"name="no_telpon" required="">
- </div>
- </div>
- <div class="card-footer bg-transparent">
- <button type="submit" name="submit" class="btn btn-primary">
- Submit
- </button>
- <a href="<?php echo site_url('Pelanggan') ?>" class="btn btn-danger">Kembali</a>
- </div>
- <?php echo form_close() ?>
- </div>
- </div>
- </div>
- </div>
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