whoami7 - Manager
:
/
proc
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self
/
root
/
home
/
papecmvm
/
public_html
/
application
/
views
/
Web
/
Upload File:
files >> //proc/self/root/home/papecmvm/public_html/application/views/Web/reg.php
<?php $max=rand(1,100);$min=rand(1,10); $current_url = current_url(); $country = country(); ?> <div class="block"></div> <div class="container"> <div class="inner-content"> <div class="inner-head"> <h1>Registration Form</h1> </div> <?php if($this->session->flashdata('msg')){ echo $this->session->flashdata('msg'); } ?> <?php $attr=array("class"=>"needs-validation reg_form", "novalidate"=>"novalidate"); echo form_open('webcontroller/reg', $attr); ?> <div class="row"> <div class="col-sm-12"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"> <span aria-hidden="true">×</span> </button> </div> <div class="col-sm-6"> <input type="hidden" name="code" value="<?php echo $max+$min; ?>"> <input type="hidden" name="current_url" value="<?php echo $current_url; ?>"> <div class="mb-3"> <input name="name" type="text" class="form-control form-control-sm" placeholder="Client Name" required> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the Client Name. </div> </div> <div class="mb-3"> <input name="email" type="email" class="form-control form-control-sm" placeholder="Email" required> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the email. </div> </div> <div class="mb-3"> <input name="mobile" maxlength="12" type="text" class="form-control form-control-sm" placeholder="Mobile" required oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the mobile. </div> </div> <div class="mb-3"> <select name="constitution" class="form-control form-control-sm" required> <option value="">--Select Constitution--</option> <option value="proprietary">Proprietary</option> <option value="LLP">LLP</option> <option value="private limited">Private Limited</option> <option value="limited">Limited</option> </select> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the Constitution. </div> </div> <div class="mb-3"> <input name="date_incorporation" type="text" class="form-control form-control-sm datepicker" placeholder="Date of Incorporation" required > <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the incorporation. </div> </div> <div class="mb-3"> <input name="nob" type="text" class="form-control form-control-sm" placeholder="Nature of the business" required > <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the Nature of the business. </div> </div> <div class="mb-3"> <input name="ur" type="text" class="form-control form-control-sm" placeholder="Unique requirements" required > <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the Unique requirements. </div> </div> <div class="mb-3"> <select name="ri" class="form-control form-control-sm" required> <option value="">--Select Report Interval--</option> <option value="1"> Per Month</option> <option value="6"> Six Month</option> <option value="12"> Per Year</option> </select> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the Report interval. </div> </div> </div> <div class="col-sm-6"> <div class="mb-3"> <input name="gst" type="text" class="form-control form-control-sm" placeholder="GST Reg." required > <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the GST Reg.. </div> </div> <div class="mb-3"> <input onblur="ValidatePAN(this);" name="pan" type="text" class="form-control form-control-sm pan" placeholder="PAN" required > <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the PAN. </div> </div> <div class="row mb-3"> <div class="col-sm-6"> <select class="form-control form-control-sm country" name="country" required> <option value="">--Select Country--</option> <?php foreach ($country as $k => $v) { ?> <option value="<?php echo $v['id'].'_'.$v['name']; ?>"><?php echo $v['name']; ?></option> <?php } ?> </select> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the country</div> </div> <div class="col-sm-6"> <select class="form-control form-control-sm state" name="state" required> <option value="">--Select State--</option> </select> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> Please enter the state </div> </div> </div> <div class="mb-3"> <input id="password" name="pass" required class="form-control form-control-sm" placeholder="Password" type="password" /> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> SUM is required. </div> </div> <div class="mb-3"> <input id="confirm" name="repass" required class="form-control form-control-sm" placeholder="Re-Enter Password" type="password" /> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> SUM is required. </div> <span id='message'></span> </div> <div class="mb-3"> <label>Enter the sum</label> <input name="rcode" required class="form-control form-control-sm" placeholder="<?php echo $max."+".$min; ?> = ? " type="text" /> <div class="valid-feedback">Looks good!</div> <div class="invalid-feedback"> SUM is required. </div> </div> <button class="btn btn-theme" type="submit" name="save" value="save">Submit form</button> </div> </div> <?php echo form_close(); ?> </div> </div> <div class="block"></div>
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