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  1. <?php require_once 'include/initialize.php'; ?>
  2.  
  3.  
  4.  
  5. <div class="modal-dialog" style="width:50%">
  6. <div class="modal-content">
  7. <div class="modal-header">
  8. <button class="close" data-dismiss="modal" type=
  9. "button">×</button>
  10.  
  11.  
  12. <legend><h2 class="text-left">Sign Up</h2></legend>
  13.  
  14. <?php // require_once 'cart/signmodal.php'; ?>
  15. <?php //require_once 'include/initialize.php'; ?>
  16.  
  17. <form class="form-horizontal span6" action="" name="personal" method="POST" enctype="multipart/form-data">
  18. <?php
  19. // echo isset($_POST['FIRSTNAME'])? 'yes' : '';
  20. $autonum = New Autonumber();
  21. $res = $autonum->single_autonumber(1);
  22.  
  23. ?>
  24.  
  25. <div class="form-group">
  26. <div class="col-md-10">
  27. <label class="col-md-4 control-label" for=
  28. "FIRSTNAME">First Name:</label>
  29. <input id="CUSTOMERID" name="CUSTOMERID" type="HIDDEN" value="<?php echo $res->AUTO; ?>">
  30. <div class="col-md-8">
  31. <input class="form-control input-sm" id="FIRSTNAME" name="FIRSTNAME" placeholder=
  32. "First Name" type="text" value="">
  33. </div>
  34. </div>
  35. </div>
  36.  
  37. <div class="form-group">
  38. <div class="col-md-10">
  39. <label class="col-md-4 control-label" for=
  40. "LASTNAME">Last Name:</label>
  41.  
  42. <div class="col-md-8">
  43. <input class="form-control input-sm" id="LASTNAME" name="LASTNAME" placeholder=
  44. "Last Name" type="text" value="">
  45. </div>
  46. </div>
  47. </div>
  48.  
  49.  
  50. <div class="panel panel-default">
  51. <div class="panel-head" style="margin-left:3%"><h3>address</h3></div>
  52. <div class="panel-body">
  53. <div class="form-group">
  54. <div class="col-md-10">
  55. <label class="col-md-4 control-label" for=
  56. "HOMENUMBER">Home Number:</label>
  57.  
  58. <div class="col-md-8">
  59. <input class="form-control input-sm" id="HOMENUMBER" name="HOMENUMBER" placeholder=
  60. "Home Number" type="text" value="">
  61. </div>
  62. </div>
  63. </div>
  64.  
  65. <div class="form-group">
  66. <div class="col-md-10">
  67. <label class="col-md-4 control-label" for=
  68. "STREET">Street / Village:</label>
  69.  
  70. <div class="col-md-8">
  71. <input class="form-control input-sm" id="STREET" name="STREET" placeholder=
  72. "Street" type="text" value="">
  73. </div>
  74. </div>
  75. </div>
  76.  
  77. <div class="form-group">
  78. <div class="col-md-10">
  79.  
  80.  
  81. <label class="col-md-4 control-label" for=
  82. "BARANGGY">Barangay:</label>
  83.  
  84. <div class="col-md-8">
  85. <input class="form-control input-sm" id="BARANGGY" name="BARANGGY" placeholder=
  86. "Barangay" type="text" value="">
  87. </div>
  88. </div>
  89. </div>
  90. <div class="form-group">
  91. <div class="col-md-10">
  92. <label class="col-md-4 control-label" for=
  93. "CITYADDRESS">City:</label>
  94.  
  95. <div class="col-md-8">
  96. <input class="form-control input-sm" id="CITYADDRESS" name="CITYADDRESS" placeholder=
  97. "City Address" type="text" value="">
  98. </div>
  99. </div>
  100. </div>
  101.  
  102. </div>
  103. </div>
  104.  
  105.  
  106. <div class="form-group">
  107. <div class="col-md-10">
  108. <label class="col-md-4 control-label" for=
  109. "USERNAME">Username:</label>
  110.  
  111. <div class="col-md-8">
  112. <input class="form-control input-sm" id="USERNAME" name="USERNAME" placeholder=
  113. "username" type="text" value="">
  114. </div>
  115. </div>
  116. </div>
  117.  
  118. <div class="form-group">
  119. <div class="col-md-10">
  120. <label class="col-md-4 control-label" for=
  121. "PASS">Password:</label>
  122.  
  123. <div class="col-md-8">
  124. <input class="form-control input-sm" id="PASS" name="PASS" placeholder=
  125. "Password" type="password" value=""><span></span>
  126. </div>
  127. </div>
  128. </div>
  129.  
  130. <div class="form-group">
  131. <div class="col-md-10">
  132. <label class="col-md-4 control-label" for=
  133. "PASS"></label>
  134.  
  135. <div class="col-md-8">
  136. <p>Note</p>
  137. Password must be atleast 8 to 15 characters. Only letter, numeric digits, underscore and first character must be a letter.
  138. </div>
  139. </div>
  140. </div>
  141.  
  142. <div class="form-group">
  143. <div class="col-md-10">
  144. <label class="col-md-4 control-label" for=
  145. "CONTACTNUMBER">Contact Number:</label>
  146.  
  147. <div class="col-md-8">
  148. <input class="form-control input-sm" id="CONTACTNUMBER" name="CONTACTNUMBER" placeholder=
  149. "Contact Number" type="text" value="">
  150. </div>
  151. </div>
  152. </div>
  153.  
  154. <div class="form-group">
  155. <div class="col-md-10">
  156. <label class="col-md-4 control-label" for=
  157. "ZIPCODE">Zip Code:</label>
  158.  
  159. <div class="col-md-8">
  160. <input class="form-control input-sm" id="ZIPCODE" name="ZIPCODE" placeholder=
  161. "Zip Code" type="number" value="">
  162. </div>
  163. </div>
  164. </div>
  165.  
  166. <div class="form-group">
  167. <div class="col-md-10">
  168. <label class="col-md-4" align = "right"for=
  169. "image">Upload Image:</label>
  170.  
  171. <div class="col-md-8">
  172. <input type="file" name="image" value="" id="image"/>
  173. </div>
  174. </div>
  175. </div>
  176.  
  177. <div class="form-group">
  178. <div class="col-md-10">
  179. <label class="col-md-4" align = "right"for=
  180. "image"></label>
  181. <div class="col-md-8">
  182. <p>
  183.  
  184.  
  185. </div>
  186. </div>
  187. </div>
  188.  
  189.  
  190.  
  191. <div class="modal-footer"><p align="left">&copy; Katerina Ordering System</p>
  192. <button class="btn btn-default" data-dismiss="modal" type=
  193. "button">Close</button>
  194. <input type="button" data-target="#smyModal" data-toggle="modal" value="Sign Up" class="submit btn btn_katerina" onclick="return personalInfo();"/>
  195.  
  196. </div>
  197.  
  198. </form>
  199.  
  200. </div>
  201. </div>
  202. </div>
  203.  
  204. <script language="javascript" type="text/javascript">
  205. function OpenPopupCenter(pageURL, title, w, h) {
  206. var left = (screen.width - w) / 2;
  207. var top = (screen.height - h) / 4;
  208. var targetWin = window.open(pageURL, title, 'toolbar=no, location=no, directories=no, status=no, menubar=no, scrollbars=no, resizable=no, copyhistory=no, width=' + w + ', height=' + h + ', top=' + top + ', left=' + left);
  209. }
  210. function closeWin() {
  211. myWindow.close();
  212. }
  213. </script>
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