Viewing file:  account_create.php (8.45 KB) -rw-r--r--
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<?php
include('lock.php');
?>
<?php
include('account.php');
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title></title>
<link rel="stylesheet" href="//code.jquery.com/ui/1.11.1/themes/smoothness/jquery-ui.css">
<script src="//code.jquery.com/jquery-1.10.2.js"></script>
<script src="//code.jquery.com/ui/1.11.1/jquery-ui.js"></script>
<link rel="stylesheet" href="/resources/demos/style.css">
<script>
$(function() {
$( "#datepicker" ).datepicker({ dateFormat: 'dd-mm-yy' });
});
</script>
<style type="text/css">
body,td,th {
font-family: Arial, Helvetica, sans-serif;
font-size: 14px;
color: #000;
}
</style>
</head>
<center>
<body>
<table width="852" bgcolor="#FFFFFF" height="465" border="0">
<tr>
<td width="846" align="left" valign="top"><form id="form1" name="form1" method="post" action="reg_print.php">
<table width="844" border="0">
<tr>
<td colspan="3" bgcolor="#CCCCCC">Welcome: <?php echo $login_session; ?> </td>
<td bgcolor="#CCCCCC"> </td>
<td bgcolor="#CCCCCC"><a href="logout.php">Logout</a></td>
<td bgcolor="#CCCCCC"> </td>
<td bgcolor="#CCCCCC"> </td>
<td colspan="3" bgcolor="#CCCCCC"><?php echo "Today is " . date("d/m/y") . "<br>";?></td>
</tr>
<tr>
<td width="108">Account No</td>
<td width="6">:</td>
<td width="161"><input name="account" type="text" required="required" id="account" tabindex="1" value="<?php echo $accountnew; ?>" size="20" maxlength="20" readonly="readonly"/></td>
<td width="7"> </td>
<td width="91">Name</td>
<td width="6">:</td>
<td width="162"><label for="textfield8"></label>
<input type="text" name="name" id="name" tabindex="8" /></td>
<td width="105">Father Name</td>
<td width="10"> </td>
<td width="146"><label for="textfield"></label>
<label for="textfield14"></label>
<input type="text" name="f_name" id="f_name" tabindex="15"/></td>
</tr>
<tr>
<td>Pan No</td>
<td>:</td>
<td><label for="textfield4"></label>
<input type="text" name="panno" id="panno" tabindex="2"/></td>
<td> </td>
<td>Address</td>
<td>:</td>
<td><input type="text" name="address" id="address" tabindex="9" /></td>
<td>Phone</td>
<td> </td>
<td><label for="textfield2"></label>
<input type="text" name="phone" id="phone" tabindex="16"/></td>
</tr>
<tr>
<td>Email</td>
<td> </td>
<td>
<input type="text" name="email" id="email" tabindex="3"></td>
<td> </td>
<td>Date of Birth</td>
<td> </td>
<td><label for="textfield9"></label>
<input type="text" name="dob" id="datepicker" required="required" tabindex="10" /></td>
<td>Occupation</td>
<td> </td>
<td><label for="textfield3"></label>
<input type="text" name="occupation" id="occupation" tabindex="18"/></td>
</tr>
<tr>
<td>Qualification</td>
<td> </td>
<td><label for="textfield5"></label>
<input type="text" name="qualification" id="qualification" tabindex="4"/></td>
<td> </td>
<td>Date</td>
<td> </td>
<td><label for="textfield10"></label>
<input type="text" name="dated" id="datepicker" required="required" tabindex="11" /></td>
<td>Pass Book No</td>
<td> </td>
<td><label for="textfield15"></label>
<input type="text" name="passbookno" id="passbookno" tabindex="18" /></td>
</tr>
<tr>
<td>Nominee Name</td>
<td> </td>
<td><label for="textfield6"></label>
<input type="text" name="nominee_name" id="nominee_name" tabindex="5"/></td>
<td> </td>
<td>Nominee Age</td>
<td> </td>
<td><label for="textfield11"></label>
<input type="text" name="nominee_age" id="nominee_age" tabindex="12" /></td>
<td>Nominee Relation</td>
<td> </td>
<td><label for="textfield16"></label>
<input type="text" name="nomineerelation" id="nomineerelation" tabindex="20"/></td>
</tr>
<tr>
<td>Agent Name</td>
<td> </td>
<td><label for="textfield7"></label>
<input type="text" name="agent_name" id="agent_name" tabindex="6"/></td>
<td> </td>
<td>Agent Code</td>
<td> </td>
<td><label for="textfield12"></label>
<input type="text" name="agentcode" id="agentcode" tabindex="13"/></td>
<td>Cheque No</td>
<td> </td>
<td><label for="textfield25"></label>
<input type="text" name="chequeno" id="chequeno" /> <label for="textfield17"></label></td>
</tr>
<tr>
<td>Plan Name</td>
<td> </td>
<td><label for="select"></label>
<select name="select" size="1" id="select" tabindex="7">
<option>One Time Installment</option>
<option>Monthly Installment</option>
<option>Daily Installment</option>
<option>MIS Plan</option>
</select></td>
<td> </td>
<td>Plan Time (Yrs)</td>
<td> </td>
<td><label for="textfield13"></label>
<input type="text" name="plantime" id="plantime" tabindex="14" /></td>
<td>Amount</td>
<td> </td>
<td><label for="textfield18"></label>
<input type="text" name="amount" id="amount" tabindex="21"/></td>
</tr>
<tr>
<td>Receipt No</td>
<td> </td>
<td><label for="textfield20"></label>
<input name="receipt" type="text" id="receipt" value="<?php echo $receiptnew; ?>" readonly/></td>
<td> </td>
<td>Payment Mode</td>
<td> </td>
<td><label for="textfield22"></label>
<input name="paymentmode" type="text" id="paymentmode" value="" /></td>
<td>Next Inst Date</td>
<td> </td>
<td><label for="textfield24"></label>
<input type="date" name="nextinstdate" id="datepicker" required="required" /></td>
</tr>
<tr>
<td>Bank Name</td>
<td> </td>
<td><label for="textfield21"></label>
<input type="text" name="bankname" id="bankname" /></td>
<td> </td>
<td>No of Install</td>
<td> </td>
<td><label for="textfield23"></label>
<input type="text" name="noofinstall" id="noofinstall" /></td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td><label for="textfield19"></label></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="submit" name="ADD" id="ADD" value="ADD" tabindex="22" /></td>
<td> </td>
<td> </td>
</tr>
</table>
</form></td>
</tr>
</table>
</body></center>
</html>
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