Advertisement
medtrans

Untitled

Feb 6th, 2018
178
0
Never
Not a member of Pastebin yet? Sign Up, it unlocks many cool features!
text 4.51 KB | None | 0 0
  1. <!doctype html>
  2. <html>
  3. <meta name="viewport" content="width=device-width, initial-scale=1.0">
  4. <title>Untitled Document</title>
  5. <link rel="stylesheet" type="text/css" href="../bootstrap/3/css/bootstrap.min.css" />
  6. <script type="text/javascript" src="../ScriptLibrary/jquery-latest.pack.js"></script>
  7. <script type="text/javascript" src="../dmxAppConnect/dmxAppConnect.js"></script>
  8. <link rel="stylesheet" type="text/css" href="../bootstrap/3/css/dmxBootstrap3Forms.css" />
  9. <script type="text/javascript" src="../bootstrap/3/js/dmxBootstrap3Forms.js"></script>
  10. <script type="text/javascript" src="../bootstrap/3/js/bootstrap.min.js"></script>
  11. </head>
  12. c
  13. <body id="newform" is="dmx-app">
  14. <form action="../dmxConnect/api/CM_gift_insert.php" method="post" class="form-horizontal" id="form" role="form" is="dmx-serverconnect-form" dmx-generator="bootstrap3" dmx-form-type="form-horizontal" dmx-on:submit="form.reset()">
  15.  
  16. <div class="form-group">
  17. <label for="inp_CM_company_name" class="col-md-2 control-label">Cm company name</label>
  18. <div class="col-md-10">
  19. <input type="text" class="form-control" name="CM_company_name" id="inp_CM_company_name" dmx-bind:value="">
  20. </div>
  21. </div>
  22. <div class="form-group">
  23. <label for="inp_CM_gift_first" class="col-md-2 control-label">Cm gift first</label>
  24. <div class="col-md-10">
  25. <input type="text" class="form-control" name="CM_gift_first" id="inp_CM_gift_first" dmx-bind:value="">
  26. </div>
  27. </div>
  28. <div class="form-group">
  29. <label for="inp_CM_gift_last" class="col-md-2 control-label">Cm gift last</label>
  30. <div class="col-md-10">
  31. <input type="text" class="form-control" name="CM_gift_last" id="inp_CM_gift_last" dmx-bind:value="">
  32. </div>
  33. </div>
  34. <div class="form-group">
  35. <label for="inp_CM_gift_email" class="col-md-2 control-label">Cm gift email</label>
  36. <div class="col-md-10">
  37. <input type="text" class="form-control" name="CM_gift_email" id="inp_CM_gift_email" dmx-bind:value="">
  38. </div>
  39. </div>
  40. <div class="form-group">
  41. <label for="inp_CM_gift_address" class="col-md-2 control-label">Cm gift address</label>
  42. <div class="col-md-10">
  43. <input type="text" class="form-control" name="CM_gift_address" id="inp_CM_gift_address" dmx-bind:value="">
  44. </div>
  45. </div>
  46. <div class="form-group">
  47. <label for="inp_CM_gift_city" class="col-md-2 control-label">Cm gift city</label>
  48. <div class="col-md-10">
  49. <input type="text" class="form-control" name="CM_gift_city" id="inp_CM_gift_city" dmx-bind:value="">
  50. </div>
  51. </div>
  52. <div class="form-group">
  53. <label for="inp_CM_gift_state" class="col-md-2 control-label">Cm gift state</label>
  54. <div class="col-md-10">
  55. <input type="text" class="form-control" name="CM_gift_state" id="inp_CM_gift_state" dmx-bind:value="">
  56. </div>
  57. </div>
  58. <div class="form-group">
  59. <label for="inp_CM_gift_zip" class="col-md-2 control-label">Cm gift zip</label>
  60. <div class="col-md-10">
  61. <input type="text" class="form-control" name="CM_gift_zip" id="inp_CM_gift_zip" dmx-bind:value="">
  62. </div>
  63. </div>
  64. <div class="form-group">
  65. <label for="inp_CM_gift_first_choice" class="col-md-2 control-label">Cm gift first choice</label>
  66. <div class="col-md-10">
  67. <input type="text" class="form-control" name="CM_gift_first_choice" id="inp_CM_gift_first_choice" dmx-bind:value="">
  68. </div>
  69. </div>
  70. <div class="form-group">
  71. <label for="inp_CM_gift_second_choice" class="col-md-2 control-label">Cm gift second choice</label>
  72. <div class="col-md-10">
  73. <input type="text" class="form-control" name="CM_gift_second_choice" id="inp_CM_gift_second_choice" dmx-bind:value="">
  74. </div>
  75. </div>
  76. <div class="form-group">
  77. <label for="inp_CM_gift_third_choice" class="col-md-2 control-label">Cm gift third choice</label>
  78. <div class="col-md-10">
  79. <input type="text" class="form-control" name="CM_gift_third_choice" id="inp_CM_gift_third_choice" dmx-bind:value="">
  80. </div>
  81. </div>
  82. <div class="form-group">
  83. <label for="inp_quote_doc_orders" class="col-md-2 control-label"></label>
  84. <div class="col-md-10">
  85. <input name="quote_doc_orders" type="hidden" class="form-control" id="inp_quote_doc_orders" Placeholer "" value="<?php echo $_SESSION['user']; ?> ">
  86. </div>
  87. </div>
  88. <div class="form-group">
  89. <label class="col-md-2 control-label"></label>
  90. <div class="col-md-10">
  91. <button type="submit" class="btn btn-default">Save</button>
  92. </div>
  93. </div>
  94. </form>
  95. </body>
  96. </html>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement