SHOW:
|
|
- or go back to the newest paste.
| 1 | <div id="userModalRegister" class="reveal-modal" data-reveal aria-labelledby="modalTitle" aria-hidden="true" role="dialog"> | |
| 2 | <h2 id="modalTitle">Register</h2> | |
| 3 | <p>Register an account now to be able to place orders and enjoy countless discounts.</p> | |
| 4 | <form data-abide id="registerform" novalidate="novalidate"> | |
| 5 | <fieldset> | |
| 6 | <legend>Basic information</legend> | |
| 7 | <div class="row"> | |
| 8 | <div class="large-4 columns"> | |
| 9 | <label>Initials <small>required</small> | |
| 10 | <input type="text" id="initials" placeholder="initials" required /> | |
| 11 | </label> | |
| 12 | <small class="error">Initials are required.</small> | |
| 13 | </div> | |
| 14 | ||
| 15 | <div class="large-4 columns"> | |
| 16 | <label>Insertions | |
| 17 | <input type="text" id="inserations" placeholder="inserations" /> | |
| 18 | </label> | |
| 19 | </div> | |
| 20 | ||
| 21 | <div class="large-4 columns"> | |
| 22 | <label>Surname <small>required</small> | |
| 23 | <input type="text" id="surname" placeholder="surname" required /> | |
| 24 | </label> | |
| 25 | <small class="error">Surname is required.</small> | |
| 26 | </div> | |
| 27 | </div> | |
| 28 | ||
| 29 | <div class="row"> | |
| 30 | <div class="large-12 columns"> | |
| 31 | <label>Password <small>required</small> | |
| 32 | <input type="password" id="password" placeholder="password" required /> | |
| 33 | </label> | |
| 34 | <small class="error">Passwords must be at least 8 characters with 1 capital letter, 1 number, and one special character.</small> | |
| 35 | </div> | |
| 36 | ||
| 37 | <div class="large-12 columns"> | |
| 38 | <label>Confirm password <small>required</small> | |
| 39 | <input type="password" id="confirmPassword" placeholder="password" required data-equalto="password" /> | |
| 40 | </label> | |
| 41 | <small class="error">Passwords must match.</small> | |
| 42 | </div> | |
| 43 | </div> | |
| 44 | ||
| 45 | <div class="row"> | |
| 46 | <div class="large-6 columns"> | |
| 47 | <label>Email <small>required</small> | |
| 48 | <input type="email" id="email" placeholder="mymail@gmail.com" required /> | |
| 49 | </label> | |
| 50 | <small class="error">Valid email required.</small> | |
| 51 | </div> | |
| 52 | ||
| 53 | <div class="large-6 columns"> | |
| 54 | <label>Phone <small>required</small> | |
| 55 | <input type="tel" id="phone" placeholder="06 12345678" required /> | |
| 56 | </label> | |
| 57 | <small class="error">Please provide a valid phone number</small> | |
| 58 | </div> | |
| 59 | </div> | |
| 60 | ||
| 61 | <div class="row"> | |
| 62 | <div class="large-6 columns"> | |
| 63 | <label>Address <small>required</small> | |
| 64 | <input type="text" id="address" placeholder="Somestreet 51" required /> | |
| 65 | </label> | |
| 66 | <small class="error">Address is required.</small> | |
| 67 | </div> | |
| 68 | ||
| 69 | <div class="large-6 columns"> | |
| 70 | <label>ZIP Code <small>required</small> | |
| 71 | <input type="text" id="zipcode" placeholder="1234AB" required /> | |
| 72 | </label> | |
| 73 | <small class="error">ZIP Code is required.</small> | |
| 74 | </div> | |
| 75 | </div> | |
| 76 | ||
| 77 | <div class="row"> | |
| 78 | <div class="large-12 columns"> | |
| 79 | <label>Date of Birth <small>required</small> | |
| 80 | <input type="date" id="dob" required /> | |
| 81 | </label> | |
| 82 | <small class="error">Date of Birth is required.</small> | |
| 83 | </div> | |
| 84 | </div> | |
| 85 | </fieldset> | |
| 86 | ||
| 87 | <fieldset> | |
| 88 | <legend>Addition information</legend> | |
| 89 | </fieldset> | |
| 90 | ||
| 91 | <fieldset> | |
| 92 | <legend>Ready!</legend> | |
| 93 | <div class="row"> | |
| 94 | <div class="large-12 columns"> | |
| 95 | <button type="submit" class="medium button green">Register</button> | |
| 96 | </div> | |
| 97 | </div> | |
| 98 | </fieldset> | |
| 99 | </form> | |
| 100 | </div> |
