-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathcustomer_registration.html
121 lines (121 loc) · 3.17 KB
/
customer_registration.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
<!-- UI: Prithviraj Narahari, php code: Alexander Martens -->
<!DOCTYPE HTML>
<head>
<title> CUSTOMER REGISTRATION </title>
</head>
<body>
<table align="center" style="border:2px solid blue;">
<tr>
<form id="register" action="customer_registration.php" method="post">
<td align="right">
Username<span style="color:red">*</span>:
</td>
<td align="left" colspan="3">
<input type="text" id="username" name="username" placeholder="Enter your username">
</td>
</tr>
<tr>
<td align="right">
PIN<span style="color:red">*</span>:
</td>
<td align="left">
<input type="password" id="pin" name="pin">
</td>
<td align="right">
Re-type PIN<span style="color:red">*</span>:
</td>
<td align="left">
<input type="password" id="retype_pin" name="retype_pin">
</td>
</tr>
<tr>
<td align="right">
Firstname<span style="color:red">*</span>:
</td>
<td colspan="3" align="left">
<input type="text" id="firstname" name="firstname" placeholder="Enter your firstname">
</td>
</tr>
<tr>
<td align="right">
Lastname<span style="color:red">*</span>:
</td>
<td colspan="3" align="left">
<input type="text" id="lastname" name="lastname" placeholder="Enter your lastname">
</td>
</tr>
<tr>
<td align="right">
Address<span style="color:red">*</span>:
</td>
<td colspan="3" align="left">
<input type="text" id="address" name="address">
</td>
</tr>
<tr>
<td align="right">
City<span style="color:red">*</span>:
</td>
<td colspan="3" align="left">
<input type="text" id="city" name="city">
</td>
</tr>
<tr>
<td align="right">
State<span style="color:red">*</span>:
</td>
<td align="left">
<select id="state" name="state">
<option selected disabled>select a state</option>
<option>MI</option>
<option>CA</option>
<option>TN</option>
</select>
</td>
<td align="right">
Zip<span style="color:red">*</span>:
</td>
<td align="left">
<input type="text" id="zip" name="zip">
</td>
</tr>
<tr>
<td align="right">
Credit Card<span style="color:red">*</span>
</td>
<td align="left">
<select id="credit_card" name="credit_card">
<option selected disabled>select a card type</option>
<option>VISA</option>
<option>MASTER</option>
<option>DISCOVER</option>
</select>
</td>
<td colspan="2" align="left">
<input type="text" id="card_number" name="card_number" placeholder="Credit card number">
</td>
</tr>
<tr>
<td colspan="2" align="right">
Expiration Date<span style="color:red">*</span>:
</td>
<td colspan="2" align="left">
<input type="text" id="expiration" name="expiration" placeholder="MM/YY">
</td>
</tr>
<tr>
<td colspan="2" align="center">
<form id="register" action="customer_registration.php" method="post">
<input type="submit" id="register_submit" name="register_submit" value="Register">
</form>
</td>
</form>
<form id="no_registration" action="index.php" method="post">
<td colspan="2" align="center">
<input type="submit" id="donotregister" name="donotregister" value="Don't Register">
</td>
</form>
</tr>
</table>
</body>
</HTML>