242 lines
13 KiB
PHP
242 lines
13 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="utf-8">
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<meta http-equiv="X-UA-Compatible" content="IE=edge">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<title><?php echo SITE_NAME; ?> Agent</title>
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<!-- Global stylesheets -->
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<link href="https://fonts.googleapis.com/css?family=Roboto:400,300,100,500,700,900" rel="stylesheet" type="text/css">
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<link href="/assets/css/icons/icomoon/styles.css" rel="stylesheet" type="text/css">
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<link href="/assets/css/bootstrap.css" rel="stylesheet" type="text/css">
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<link href="/assets/css/core.css" rel="stylesheet" type="text/css">
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<link href="/assets/css/components.css" rel="stylesheet" type="text/css">
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<link href="/assets/css/colors.css" rel="stylesheet" type="text/css">
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<!-- /global stylesheets -->
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<!-- Core JS files -->
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<script type="text/javascript" src="/assets/js/plugins/loaders/pace.min.js"></script>
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<script type="text/javascript" src="/assets/js/core/libraries/jquery.min.js"></script>
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<script type="text/javascript" src="/assets/js/core/libraries/bootstrap.min.js"></script>
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<script type="text/javascript" src="/assets/js/plugins/loaders/blockui.min.js"></script>
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<!-- /core JS files -->
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<!-- Theme JS files -->
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<script type="text/javascript" src="/assets/js/core/app.js"></script>
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<!-- /theme JS files -->
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</head>
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<body class="login-container" style="background-color: #ffffff;">
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<!-- Page container -->
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<div class="page-container">
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<!-- Page content -->
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<div class="page-content">
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<!-- Main content -->
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<div class="content-wrapper">
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<div class="panel panel-body login-form" >
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<div class="thumb">
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<a href="/"><img src="/assets/images/logo.png" alt="<?php echo SITE_NAME; ?>"></a>
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</div>
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</div>
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<!-- Registration form -->
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<?php echo form_open('signup'); ?>
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<div class="row">
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<div class="col-lg-6 col-lg-offset-3">
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<div class="panel registration-form">
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<div class="panel-body">
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<div class="text-center">
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<h5 class="content-group-lg">Create account <small class="display-block">All fields are required</small></h5>
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</div>
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<?php echo $action_message; ?>
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<div class="form-group has-feedback">
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<?= form_error('agent_name') ?>
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<input type="text" class="form-control" placeholder="Location or business name" name="agent_name" value="<?=set_value('agent_name')?>">
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<div class="form-control-feedback">
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<i class="icon-user-plus text-muted"></i>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('firstname') ?>
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<input type="text" class="form-control" placeholder="Contact firstname" name="firstname" value="<?=set_value('firstname')?>">
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<div class="form-control-feedback">
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<i class="icon-user-check text-muted"></i>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('lastname') ?>
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<input type="text" class="form-control" placeholder="Contact lastname" name="lastname" value="<?=set_value('lastname')?>">
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<div class="form-control-feedback">
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<i class="icon-user-check text-muted"></i>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('username') ?>
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<input type="email" class="form-control" placeholder="Your Username - Email" name="username" value="<?=set_value('username')?>">
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<div class="form-control-feedback">
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<i class="icon-user-lock text-muted"></i>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('password') ?>
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<input type="password" class="form-control" placeholder="Create password" name="password">
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<div class="form-control-feedback">
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<i class="icon-user-lock text-muted"></i>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('street') ?>
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<input type="text" class="form-control" placeholder="Business Address" name="street" value="<?=set_value('street')?>">
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<div class="form-control-feedback">
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<i class="icon-user-plus text-muted"></i>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('zipcode') ?>
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<input type="text" class="form-control" placeholder="Zip Code" name="zipcode" value="<?=set_value('zipcode')?>">
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<div class="form-control-feedback">
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<i class="icon-user-plus text-muted"></i>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('city') ?>
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<input type="text" class="form-control" placeholder="City" value="<?= set_value('city') ?>" name="city">
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<div class="form-control-feedback">
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<i class="icon-mention text-muted"></i>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('state') ?>
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<select name="state" class="form-control" >
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<option value="">Select State</option>
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<option value="GA"<?=$state=='GA'?' selected':''?>>Georgia</option>
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</select>
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<div class="form-control-feedback">
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<i class="icon-mention text-muted"></i>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group has-feedback">
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<?= form_error('phone') ?>
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<input type="text" class="form-control" placeholder="Phone" value="<?= set_value('phone') ?>" name="phone">
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<div class="form-control-feedback">
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<i class="icon-mention text-muted"></i>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group has-feedback">
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="checkbox">
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<label>
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<?= form_error('tos') ?>
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<input type="checkbox" name="tos" value="1" class="styled"<?=(isset($tos) && $tos==1)?' checked':''?>>
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Accept <a href="#">terms of service</a>
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</label>
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</div>
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</div>
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<div class="text-right">
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<button type="submit" class="btn btn-link"><i class="icon-arrow-left13 position-left"></i> Back to login form</button>
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<button type="submit" class="btn bg-teal-400 btn-labeled btn-labeled-right ml-10"><b><i class="icon-plus3"></i></b> Create account</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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</form>
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<!-- /registration form -->
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</div>
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<!-- /main content -->
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</div>
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<!-- /page content -->
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</div>
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<!-- /page container -->
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<!-- Footer -->
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<div class="navbar navbar-default navbar-fixed-bottom footer">
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<ul class="nav navbar-nav visible-xs-block">
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<li><a class="text-center collapsed" data-toggle="collapse" data-target="#footer"><i class="icon-circle-up2"></i></a></li>
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</ul>
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<div class="navbar-collapse collapse" id="footer">
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<div class="navbar-text just-white" >
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© 2018. <a href="#"><?php echo SITE_NAME; ?></a>
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</div>
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<div class="navbar-right">
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<ul class="nav navbar-nav just-white">
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<li><a href="/">Home</a></li>
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<li><a href="#">Terms</a></li>
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<li><a href="#">Contact</a></li>
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</ul>
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</div>
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</div>
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</div>
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<!-- /footer -->
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</body>
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</html>
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