182 lines
7.6 KiB
PHP
182 lines
7.6 KiB
PHP
<script>
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function validate(){
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var firm_name = $('#firm_name').val();
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if(firm_name == ''){
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BootstrapDialog.alert('Please Enter Firm Name.!!!');
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return false;
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}
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save_firm();
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}
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</script>
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<style>
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#modal-add-firm{
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overflow-y:scroll;
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}
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</style>
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<div class="modal fade" id="modal-add-firm" name="modal-add-firm" role="dialog" aria-hidden="true">
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<form role="form" id="firm_form" name="firm_form" action="#" method="post">
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<div class="modal-dialog">
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<div class="modal-content">
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<div class="widget-header">
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<h5 class="widget-title">Checkup Result Category</h5>
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<div class="widget-toolbar">
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<div class="widget-menu">
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<a href="#" class="close" data-action="close" data-dismiss="modal">
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<i class="ace-icon fa fa-times"></i>
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</a>
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</div>
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</div>
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</div>
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<div class="modal-body">
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_code">FIRM CODE</label>
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<input type="text" class="form-control" name="firm_code"
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id="firm_code" value="" placeholder="Enter Firm code" required/>
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<input type="hidden" class="form-control" name="firm_id"
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id="firm_id" value="" placeholder="Enter Firm code" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_name">FIRM NAME</label>
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<input type="text" class="form-control" name="firm_name"
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id="firm_name" placeholder="Enter Firm Name" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_location">FIRM LOCATION</label>
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<input type="text" class="form-control" name="firm_location"
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id="firm_location" placeholder="Enter Firm Name" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_loaction1">FIRM LOCATION1</label>
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<input type="text" class="form-control" name="firm_location1"
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id="firm_location1" placeholder="Enter firm location1" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="state_id">STATE ID</label>
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<input type="text" class="form-control" name="state_id"
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id="state_id" placeholder="Enter State Id" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="Pin">PIN</label>
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<input type="text" class="form-control" name="pin"
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id="pin" placeholder="Enter Pin" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_head_office">FIRM HEAD OFFICE</label>
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<input type="text" class="form-control" name="firm_head_office"
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id="firm_head_office" placeholder="Enter Firm Head Office " required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_phone">FIRM PHONE</label>
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<input type="text" class="form-control" name="firm_phone"
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id="firm_phone" placeholder="Enter Firm Phone" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="firm_fax">FIRM FAX</label>
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<input type="text" class="form-control" name="firm_fax"
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id="firm_fax" placeholder="Enter Firm Fax" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px; width:500px;">
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<label for="firm_email">FIRM EMAIL</label>
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<input type="text" class="form-control" name="firm_email"
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id="firm_email" placeholder="Enter Firm Email" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px; width:500px;">
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<label for="firm_contact">FIRM CONTACT</label>
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<input type="text" class="form-control" name="firm_contact"
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id="firm_contact" placeholder="Enter Firm Contact" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px; width:350px;">
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<label for="firm_logo">FIRM LOGO</label>
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<input type="file" class="form-control" name="firm_logo"
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id="firm_logo" placeholder="Enter Firm Logo" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="gst_in">GST IN</label>
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<input type="text" class="form-control" name="gst_in"
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id="gst_in" placeholder="Enter Gst In" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="bank">BANK</label>
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<input type="text" class="form-control" name="bank"
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id="bank" placeholder="Enter Bank" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="branch">BRANCH</label>
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<input type="text" class="form-control" name="branch"
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id="branch" placeholder="Enter Branch " required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="account">ACOUNT</label>
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<input type="text" class="form-control" name="account"
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id="account" placeholder="Enter Account" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="ifsc">IFSC</label>
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<input type="text" class="form-control" name="ifsc"
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id="ifsc" placeholder="Enter IFSC" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="pan_no">PAN NO</label>
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<input type="text" class="form-control" name="pan_no"
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id="pan_no" placeholder="Enter PAN NO" required/>
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</div>
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<div class="form-group" style="float:left; margin:3px;">
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<label for="tin_no">TIN NO</label>
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<input type="text" class="form-control" name="tin_no"
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id="tin_no" placeholder="Enter TIN NO " required/>
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</div>
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<div class="form-group" >
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<label for="service_no">SERVICE NO</label>
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<input type="text" class="form-control" name="service_no"
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id="service_no" placeholder="Enter Service No" required/>
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</div>
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<div class="form-group">
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<label for="central_no">CENTRAL NO</label>
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<input type="text" class="form-control" name="central_no"
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id="central_no" placeholder="Enter Central No" required/>
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</div>
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<div class="form-group">
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<label for="division">DIVISION</label>
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<input type="text" class="form-control" name="division"
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id="division" placeholder="Enter Division" required/>
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</div>
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<div class="form-group">
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<label for="range1">RANGE 1</label>
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<input type="text" class="form-control" name="range1"
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id="range1" placeholder="Enter Checkup Range1" required/>
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</div>
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<div class="form-group">
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<label for="colleborate">COLLEBORATE</label>
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<input type="text" class="form-control" name="colleborate"
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id="colleborate" placeholder="Enter Colleborate" required/>
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</div>
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<div class="form-group">
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<label for="remarks">REMARKS</label>
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<input type="text" class="form-control" name="remarks"
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id="remarks" placeholder="Enter Remarks" required/>
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</div>
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<div class="form-group">
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<label for="status">STATUS</label>
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<input type="text" class="form-control" name="status"
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id="status" placeholder="Enter Status" required/>
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</div>
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</div>
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<div class="widget-toolbox padding-8 clearfix" >
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<button type="button" class="btn btn-info btn-sm save_button" onclick="validate();"><i class="ace-icon fa fa-floppy-o bigger-110"></i>Save </button>
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<button type="button" class="btn btn-danger btn-sm" data-dismiss="modal"><i class="ace-icon fa fa-times bigger-110"></i>Cancel</button>
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</div>
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</div>
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</div>
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</form>
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</div>
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