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  1. <div class="row">
  2.     <div class="col-md-12">
  3.       <div class="page-header">
  4.         <h4>
  5.           <i class="glyphicon glyphicon-edit"></i>
  6.           Input data
  7.         </h4>
  8.       </div> <!-- /.page-header -->
  9.  
  10.       <div class="panel panel-default">
  11.         <div class="panel-body">
  12.           <form class="form-horizontal" method="POST" action="proses-simpan.php">
  13.  
  14.             <div class="form-group">
  15.               <label class="col-sm-2 control-label">Nama</label>
  16.               <div class="col-sm-3">
  17.                 <input type="text" class="form-control" name="nama" autocomplete="off" required>
  18.               </div>
  19.             </div>
  20.  
  21.             <div class="form-group">
  22.               <label class="col-sm-2 control-label">Username</label>
  23.               <div class="col-sm-3">
  24.                 <input type="text" class="form-control" name="username" autocomplete="off" required>
  25.               </div>
  26.             </div>
  27.  
  28.             <div class="form-group">
  29.               <label class="col-sm-2 control-label">Password</label>
  30.               <div class="col-sm-3">
  31.                   <input type="text" class="form-control" name="password" autocomplete="off" required>
  32.                 </div>
  33.               </div>
  34.             </div>
  35.  
  36.             <div class="form-group">
  37.                <label class="col-sm-2 control-label">Email address</label>
  38.                <div class="col-sm-3">
  39.                 <input type="email" class="form-control" name="email" placeholder="name@example.com">
  40.             </div>
  41.  
  42.             <hr/>
  43.             <div class="form-group">
  44.               <div class="col-sm-offset-2 col-sm-10">
  45.                 <input type="submit" class="btn btn-info btn-submit" name="simpan" value="Simpan">
  46.                 <a href="index.php" class="btn btn-default btn-reset">Batal</a>
  47.               </div>
  48.             </div>
  49.           </form>
  50.         </div> <!-- /.panel-body -->
  51.       </div> <!-- /.panel -->
  52.     </div> <!-- /.col -->
  53.   </div> <!-- /.row -->
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