93 lines
4.7 KiB
PHP
93 lines
4.7 KiB
PHP
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<!-- Dashboard content -->
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<div class="row">
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<div class="col-lg-8">
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<!-- Form horizontal -->
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<div class="panel panel-flat">
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<!-- div class="panel-heading">
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<h5 class="panel-title">Add New Transporter</h5>
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</div -->
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<div class="panel-body">
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<form class="form-horizontal" action="/transp/addnew" method='POST'>
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<fieldset class="content-group">
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<legend class="text-bold">Add New Transporter</legend>
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<div class="form-group">
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<label class="control-label col-lg-2">Created by</label>
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<div class="col-lg-10">
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<input type="text" class="form-control" readonly="readonly" value='Web Admin'>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-lg-2">Transporter</label>
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<div class="col-lg-10">
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<input type="text" class="form-control" name='transporter' value='<?= $transporter ?>'>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-lg-2">Contact Name</label>
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<div class="col-lg-5">
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<input type="text" class="form-control" name='firstname' placeholder='Firstname' value='<?= $firstname ?>'>
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</div>
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<div class="col-lg-5">
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<input type="text" class="form-control" name='lastname' placeholder='Lastname'value='<?= $lastname ?>'>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-lg-2">Email/Username</label>
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<div class="col-lg-6">
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<input type="text" class="form-control" name='username' placeholder='Email as Username' value='<?= $username ?>'>
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</div>
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<div class="col-lg-4">
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<input type="password" class="form-control" name='password' placeholder='Password'>
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</div>
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</div>
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<legend class="text-bold">Address</legend>
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<div class="form-group">
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<label class="control-label col-lg-2">Address</label>
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<div class="col-lg-10">
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<input type="text" class="form-control" name="street" placeholder='Street Address' value='<?= $street ?>'>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-lg-2">Zip Code/Phone</label>
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<div class="col-lg-5">
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<input type="text" class="form-control" name="zipcode" placeholder='Zip code' value='<?= $zipcode ?>'>
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</div>
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<div class="col-lg-5">
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<input type="text" class="form-control" name="phone" placeholder='Phone' value='<?= $phone ?>'>
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-lg-2">City/State</label>
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<div class="col-lg-6">
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<input type="text" class="form-control" name="city" value='<?= $city ?>' placeholder='City'>
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</div>
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<div class="col-lg-4">
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<select name="state" class="form-control">
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<option value="GA">Georgia</option>
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</select>
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</div>
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</div>
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</fieldset>
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<div class="text-right">
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<button type="submit" class="btn btn-primary">Next <i class="icon-arrow-right14 position-right"></i></button>
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</div>
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</form>
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</div>
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</div>
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<!-- /form horizontal -->
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</div>
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<div class="col-lg-4">
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<? include 'recent_transporter_side_list.php'; ?>
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</div>
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</div>
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<!-- /dashboard content -->
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