cemeterymapping/signup.php

146 lines
4.7 KiB
PHP

<?php
$customer = New customer;
$res = $customer->single_customer($_SESSION['CUSID']);
?>
<h3>Your Account</h3>
<form class="form-horizontal span6" action="customer/controller.php?action=edit" onsubmit="return personalInfo();" name="personal" method="POST" enctype="multipart/form-data">
<div class="col-lg-12" style="margin-top:5%;">
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"FULLNAME">Full Name:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="FULLNAME" name="FULLNAME" placeholder=
"Full Name" type="text" value="<?php echo $res->FULLNAME; ?>">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"ADDRESS">Address:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="ADDRESS" name="ADDRESS" placeholder=
"Address" type="text" value="<?php echo $res->ADDRESS; ?>">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"CUSUNAME">Username:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="CUSUNAME" name="CUSUNAME" placeholder=
"Username" type="text" value="<?php echo $res->CUSUSERNAME; ?>">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"CUSPASS">Password:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="CUSPASS" name="CUSPASS" placeholder=
"Password" type="password" value="" required="true"><span></span>
<!-- <p>Note</p>
Password must be atleast 8 to 15 characters. Only letter, numeric digits, underscore and first character must be a letter.
-->
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"CONTACTNO">Contact#:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="CONTACTNO" name="CONTACTNO" placeholder=
"Contact Number" type="text" value="<?php echo $res->CONTACTNO; ?>">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4 control-label" for=
"EMAILADDRESS">Email Address:</label>
<div class="col-md-8">
<input class="form-control input-sm" id="EMAILADDRESS" name="EMAILADDRESS" placeholder=
"Email Address" type="email" value="<?php echo $res->EMAILADDRESS; ?>">
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="col-md-12">
<label class="col-md-4" align = "right"for=
"btn"></label>
<div class="col-md-8">
<input type="submit" name="save" value="Save" class="submit btn btn-primary btn-lg" />
</div>
</div>
</div>
</div>
</form>
</form>