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masmalupit

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masmalupit
Feb 22nd, 2020
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  1. <div class="gcform" style="width:740px;">
  2. <div class="head">
  3. <span>RESET PASSWORD</span>
  4. </div>
  5.  
  6. <div class="body">
  7. <p class="title">We have verified that you are the owner of the account.<br>Please reset your password.</p>
  8. <div class="forms">
  9. <form class="form-horizontal" novalidate="novalidate">
  10.  
  11. <div class="form-group">
  12. <div class="col-xs-2"></div>
  13. <label for="question" class="col-xs-2"><li class="form-field">Question</li></label>
  14. <div class="col-xs-6">
  15. <span>What is your father's middle name?</span>
  16. </div>
  17. </div>
  18.  
  19. <div class="form-group">
  20. <div class="col-xs-2"></div>
  21. <label for="answer" class="col-xs-2"><li class="form-field">Answer</li></label>
  22. <div class="col-xs-6">
  23. <input type="password" name="answer" id="answer" class="form-control" placeholder="" data-msg-required="Tooltip box height adjusted to text length.<br>Breaking lines depending on the length of the text." required="" aria-required="true" aria-invalid="false">
  24. <i class="fa form-control-feedback" id="answer1" aria-hidden="true"></i>
  25. </div>
  26. </div>
  27.  
  28. <div class="form-group">
  29. <div class="col-xs-2"></div>
  30. <label for="bday" class="col-xs-2"><li class="form-field">Birthday</li></label>
  31. <div class="col-xs-6">
  32. <select class="form-control" name="dob_month" id="dob_month" style="width:115px;" aria-required="true" aria-invalid="false">
  33. <option value="">Month</option>
  34. <option value="01">January</option>
  35. <option value="02">February</option>
  36. <option value="03">March</option>
  37. <option value="04">April</option>
  38. <option value="05">May</option>
  39. <option value="06">June</option>
  40. <option value="07">July</option>
  41. <option value="08">August</option>
  42. <option value="09">September</option>
  43. <option value="10">October</option>
  44. <option value="11">November</option>
  45. <option value="12">December</option>
  46. </select>
  47.  
  48. <select class="form-control" name="dob_day" id="dob_day" style="width:75px;" aria-required="true" aria-invalid="false">
  49. <option value="">Day</option>
  50. <option value="01">01</option>
  51. <option value="02">02</option>
  52. <option value="03">03</option>
  53. <option value="04">04</option>
  54. <option value="05">05</option>
  55. <option value="06">06</option>
  56. <option value="07">07</option>
  57. <option value="08">08</option>
  58. <option value="09">09</option>
  59. <option value="10">10</option>
  60. <option value="11">11</option>
  61. <option value="12">12</option>
  62. <option value="13">13</option>
  63. <option value="14">14</option>
  64. <option value="15">15</option>
  65. <option value="16">16</option>
  66. <option value="17">17</option>
  67. <option value="18">18</option>
  68. <option value="19">19</option>
  69. <option value="20">20</option>
  70. <option value="21">21</option>
  71. <option value="22">22</option>
  72. <option value="23">23</option>
  73. <option value="24">24</option>
  74. <option value="25">25</option>
  75. <option value="26">26</option>
  76. <option value="27">27</option>
  77. <option value="28">28</option>
  78. <option value="29">29</option>
  79. <option value="30">30</option>
  80. <option value="31">31</option>
  81. </select>
  82.  
  83. <select class="form-control" name="dob_year" id="dob_year" style="width:97px;" aria-required="true" aria-invalid="false">
  84. <option value="">Year</option>
  85. <option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option><option value="1919">1919</option><option value="1918">1918</option><option value="1917">1917</option><option value="1916">1916</option><option value="1915">1915</option><option value="1914">1914</option><option value="1913">1913</option><option value="1912">1912</option><option value="1911">1911</option><option value="1910">1910</option><option value="1909">1909</option><option value="1908">1908</option><option value="1907">1907</option><option value="1906">1906</option><option value="1905">1905</option><option value="1904">1904</option><option value="1903">1903</option><option value="1902">1902</option><option value="1901">1901</option><option value="1900">1900</option></select>
  86. </div>
  87. </div>
  88.  
  89. </form>
  90. </div>
  91. </div>
  92.  
  93. <!-- button area -->
  94. <div class="button-area">
  95. <button type="button" id="btn-submit" class="btn-special">Confirm</button>
  96. </div>
  97. </div>
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