88 lines
3.4 KiB
PHP
88 lines
3.4 KiB
PHP
<fieldset class="content-group">
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<legend id="translator_name" class="text-bold">Add New Translator</legend>
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<input type="hidden" id="interpreter_id" name="interpreter_id" value="0">
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<!-- Basic text input -->
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<div class="form-group">
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<label class="control-label col-lg-3">Email <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="email" id="email" name="email" class="form-control" required="required" placeholder="Email">
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</div>
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</div>
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<!-- /basic text input -->
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<!-- Basic text input -->
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<div class="form-group">
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<label class="control-label col-lg-3">Firstname <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="text" id="firstname" name="firstname" class="form-control" required="required" placeholder="Firstname">
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</div>
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</div>
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<!-- /basic text input -->
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<!-- Basic text input -->
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<div class="form-group">
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<label class="control-label col-lg-3">Lastname <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="text" id="lastname" name="lastname" class="form-control" required="required" placeholder="Lastname">
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</div>
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</div>
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<!-- /basic text input -->
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<!-- Basic text input -->
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<div class="form-group">
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<label class="control-label col-lg-3">Phone <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="text" id="phone" name="phone" class="form-control" required="required" placeholder="phone">
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</div>
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</div>
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<!-- /basic text input -->
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<!-- Input with icons -->
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<div class="form-group has-feedback">
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<label class="control-label col-lg-3">Address <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="text" id="street" name="street" class="form-control" required="required" placeholder="Address">
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</div>
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</div>
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<!-- /input with icons -->
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<!-- Input with icons -->
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<div class="form-group has-feedback">
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<label class="control-label col-lg-3">City <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<input type="text" id="city" name="city" class="form-control" required="required" placeholder="City">
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</div>
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</div>
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<!-- /input with icons -->
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<!-- Multiple select -->
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<div class="form-group">
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<label class="control-label col-lg-3">State <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<select id="stat" name="state" class="form-control" required="required">
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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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<!-- /multiple select -->
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<!-- Input group -->
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<div class="form-group">
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<label class="control-label col-lg-3">Zipcode <span class="text-danger">*</span></label>
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<div class="col-lg-9">
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<div class="input-group">
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<input type="text" id="zipcode" name="zipcode" class="form-control" required="required" placeholder="Zipcode">
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</div>
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</div>
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</div>
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<!-- /input group -->
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<div class="text-right">
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<button type="submit" class="btn btn-primary btn-xs">Submit <i class="icon-arrow-right14 position-right"></i></button>
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</div>
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</fieldset>
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