This commit is contained in:
2022-06-13 21:06:14 -04:00
parent d776643f7e
commit 3b21cee578
4 changed files with 66 additions and 43 deletions
+34 -18
View File
@@ -28,27 +28,42 @@
<div class="table-responsive">
<!--begin::Table-->
<form class="form-horizontal" action="/refer/refpage" method='POST' name="refer_individual">
<div class="form-group">
<label class="control-label col-lg-2">Firstname :</label>
<div class="col-lg-10">
<input type="text" class="form-control" id="ref_firstname" name="ref_firstname" value="<?php echo $ref_firstname; ?>">
</div>
</div>
<div class="form-group">
<label class="control-label col-lg-2">Lastname :</label>
<div class="col-lg-10">
<input type="text" class="form-control" id="ref_lastname" name="ref_lastname" value="<?php echo $ref_lastname; ?>">
</div>
</div>
<div class="form-group">
<label class="control-label col-lg-2">Email :</label>
<div class="col-lg-10">
<input type="text" class="form-control" id="ref_email" name="ref_email" value="<?php echo $ref_email; ?>" >
<div class="row mb-6">
<label class="col-lg-4 col-form-label required fw-bold fs-6">Firstname</label>
<div class="col-lg-8">
<div class="row">
<div class="col-lg-12 fv-row">
<input type="text" id="ref_firstname" name="ref_firstname" value="<?php echo $ref_firstname; ?>" class="form-control form-control-lg form-control-solid mb-3 mb-lg-0" placeholder="First name" />
</div>
</div>
</div>
</div>
<div class="text-right">
<button type="submit" class="btn btn-primary btn-xs" onclick="return referIndividual();">Send Message <i class="icon-arrow-right14 position-right"></i></button>
<div class="row mb-6">
<label class="col-lg-4 col-form-label required fw-bold fs-6">Lastname</label>
<div class="col-lg-8">
<div class="row">
<div class="col-lg-12 fv-row">
<input type="text" id="ref_lastname" name="ref_lastname" value="<?php echo $ref_lastname; ?>" class="form-control form-control-lg form-control-solid mb-3 mb-lg-0" placeholder="Lastname" />
</div>
</div>
</div>
</div>
<div class="row mb-6">
<label class="col-lg-4 col-form-label required fw-bold fs-6">Email</label>
<div class="col-lg-8">
<div class="row">
<div class="col-lg-12 fv-row">
<input type="text" id="ref_email" name="ref_email" value="<?php echo $ref_email; ?>" class="form-control form-control-lg form-control-solid mb-3 mb-lg-0" placeholder="Email" />
</div>
</div>
</div>
</div>
<div class="card-footer d-flex justify-content-end py-6 px-9">
<button type="submit" class="btn btn-primary" id="kt_account_profile_details_submit" onclick="return referIndividual();">Send Message</button>
</div>
<?php echo $status; ?>
@@ -94,6 +109,7 @@
<?php echo $links; ?>
<!--end::Tap pane-->
</div>
</div>
<!--end::Body-->