<div data-role="page" id="view_record">
  <div data-role="header">
    <a href="#" data-rel="back" class="ui-btn-right ui-btn  ui-btn-icon-notext ui-corner-all ui-icon-back">Back</a>
    <img class="img-responsive" src="images/logo2.png" alt="OccuTrace" height="50">
  <div data-role="main" class="ui-content">
    <form method="post" action="saveRecord.php">
      <label for="bus_name">Business Name:</label>
      <input type="text" name="bus_name" id="bus_name" placeholder="Enter Business Name">

      <label for="bus_type">Business Type:</label>
      <input type="text" name="bus_type" id="bus_type" placeholder="Enter Business Type">

      <label for="bus_tel">Business Tel:</label>
      <input type="text" name="bus_tel" id="bus_tel" placeholder="Enter Business Tel No">

      <label for="bus_img">Business Photo:</label>
      <input type="file" name="bus_img" id="bus_img" accept="image/*;capture=camera">

      <label for="comments">Comments:</label>
      <textarea name="comments" id="comments" placeholder="Enter Comments"></textarea>

      <input type="submit" value="Submit">
    </form>
  </div>
  </div>
</div>

<?php
$bus_img = $test_name = "";

$servername = "";
$username = "";
$password = "";
$dbname = "";

$bus_img = $_POST["bus_img"];
$bus_name = $_POST["bus_name"];

if ($_SERVER["REQUEST_METHOD"] == "POST") {
    $conn = mysqli_connect($servername, $username, $password, $dbname);

    if (!$conn)
    {
        die("Connection failed: " . mysqli_connect_error());}

        $sql = "INSERT INTO tblLead(leadImage, occupantName)
    VALUES ('$bus_img','$test_name')";

    if (mysqli_query($conn, $sql))
    {
    } else
    {
        echo "Error: " . $sql . mysqli_error($conn);
    }
    mysqli_close($conn);
    exit();
}
?>