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<!DOCTYPE HTML>
<html>
<head>
<title>Channel4Net | Admin Panel</title>
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="keywords" content="Glance Design Dashboard Responsive web template, Bootstrap Web Templates, Flat Web Templates, Android Compatible web template,
SmartPhone Compatible web template, free WebDesigns for Nokia, Samsung, LG, SonyEricsson, Motorola web design" />
<script type="application/x-javascript"> addEventListener("load", function() { setTimeout(hideURLbar, 0); }, false); function hideURLbar(){ window.scrollTo(0,1); } </script>
<!-- Bootstrap Core CSS -->
<link href="css/bootstrap.css" rel='stylesheet' type='text/css' />
<!-- Custom CSS -->
<link href="css/style.css" rel='stylesheet' type='text/css' />
<!-- font-awesome icons CSS -->
<link href="css/font-awesome.css" rel="stylesheet">
<!-- //font-awesome icons CSS -->
<!-- side nav css file -->
<link href='css/SidebarNav.min.css' media='all' rel='stylesheet' type='text/css'/>
<!-- side nav css file -->
<!-- js-->
<script src="js/jquery-1.11.1.min.js"></script>
<script src="js/modernizr.custom.js"></script>
<!--//js-->
<!--webfonts-->
<link href="//fonts.googleapis.com/css?family=PT+Sans:400,400i,700,700i&subset=cyrillic,cyrillic-ext,latin-ext" rel="stylesheet">
<!--//webfonts-->
<!-- Metis Menu -->
<script src="js/metisMenu.min.js"></script>
<script src="js/custom.js"></script>
<link href="css/custom.css" rel="stylesheet">
<!--//Metis Menu -->
</head>
<body class="cbp-spmenu-push">
<div class="main-content">
<?php include('sidemenu.php');?>
<?php include('connection.php');
$id=$_REQUEST['id'];?>
<!-- main content start-->
<div id="page-wrapper">
<div class="main-page">
<div class="forms validation">
<h2 class="title1">Add As Customer :</h2>
<div class="row">
<div class="col-md-6 validation-grids widget-shadow" data-example-id="basic-forms">
<div class="form-title">
<h4>New Customer Details :</h4>
</div>
<?php
$sql331="select * from leads where lid='$id'";
$result331=mysql_query($sql331);
$row331=mysql_fetch_array($result331);?>
<div class="form-body">
<form data-toggle="validator" action="customer_add_code.php?id=<?php echo $id;?>" method="post">
<!--<div class="form-group">
<select class="form-control" name="firm_id" onchange="window.location='customer_add_own.php?id=' + this.value;">
<?php
if($_GET['id']!=""){?>
<option value="<?php echo $row331['lid'];?>"><?php echo $row331['name_firm'];?></option>
<?php }?>
<option value="0">SELECT FIRM NAME</option>
<?php
$sql="select * from payment_followup";
$result=mysql_query($sql)or die(mysql_error());
while($row=mysql_fetch_array($result))
{$lid=$row['name'];
$sql1="select * from leads where lid='$lid'";echo $sql1;
$result1=mysql_query($sql1);
$row1=mysql_fetch_array($result1);
if($row['payment_closed']!='closed'){?>
<option value="<?php echo $row1['lid'];?>"><?php echo $row1['name_firm'];?></option>
<?php }}?>
</select>
</div>-->
<div class="form-group">
<input type="text" class="form-control" id="customerid" placeholder="Customer Name" name="customer" data-error="Bruh, that name is invalid" style="float:left; width:49%; " required>
<input type="text" class="form-control" id="inputLand" placeholder="Contact Number" name="contact" style="float:right; width:49%;" required><div class="clearfix">
</div>
</div>
<div class="form-group">
<input type="text" class="form-control" id="inputLand" placeholder="Order Number" name="order_no" style="float:left; width:49%; " data-error="Bruh, that name is invalid" required>
<input type="text" class="form-control" id="inputLand" placeholder="Address" name="address" style="float:right; width:49%;" value="<?php echo $row331['address'];?>" required><div class="clearfix">
</div>
</div>
<div class="form-group">
<input type="text" class="form-control" id="inputLand" placeholder="City" name="city" style="float:left; width:49%;" >
<input type="text" class="form-control" id="inputLand" placeholder="State" name="state" style="float:right; width:49%;" ><div class="clearfix">
</div>
</div>
<div class="form-group">
<input type="text" class="form-control" id="inputEmail" placeholder="Pin Code" name="pin" style="float:left; width:49%;" >
<input type="text" class="form-control" id="inputEmail" placeholder="GST Number" name="gst" style="float:right; width:49%; ">
<div class="clearfix"></div>
</div>
<div class="form-group">
<p style="float:left; width:49%;"> </p> <p style="float:right; width:49%;">PAYMENT DATE</p>
</div>
<div class="form-group">
<input type="text" class="form-control" id="inputEmail" placeholder="Business For Month" name="program" style="float:left; width:49%; " required>
<input type="date" class="form-control" id="inputEmail" placeholder="Program Date" name="program_date" style="float:right; width:49%; " required>
<div class="clearfix"></div>
</div>
<div class="form-group">
<input type="text" class="form-control" id="inputEmail" placeholder="Taxable Amount" name="famount" style="float:left; width:49%; " required>
<input type="text" class="form-control" id="inputEmail" placeholder="Total Amount" name="totalamount" style="float:right; width:49%; " required>
<div class="clearfix"></div>
</div>
<div class="form-group">
<textarea id="txtarea1" cols="40" rows="5" class="form-control1" name="remarks" placeholder="Put your remarks here." style="float:left; width:49%; "></textarea>
<select class="form-control" name="product" style="float:right; width:49%;">
<option value="0">Select Product</option>
<?php
$sqlsp="select * from product_list order by name asc";
$resultsp=mysql_query($sqlsp)or die(mysql_error());
while($rowsp=mysql_fetch_array($resultsp)){
?>
<option value="<?php echo $rowsp['name'];?>"><?php echo $rowsp['name'];?></option>
<?php }?>
</select>
<div class="clearfix"></div>
</div>
<div class="form-group">
<button type="submit" class="btn btn-primary disabled" name="submit">Submit</button>
</div>
</form>
</div>
</div>
<div class="clearfix"> </div>
</div>
</div>
</div>
</div>
<?php include('footer.php');?>
</div>
<!-- side nav js -->
<script src='js/SidebarNav.min.js' type='text/javascript'></script>
<script>
$('.sidebar-menu').SidebarNav()
</script>
<!-- //side nav js -->
<!-- Classie --><!-- for toggle left push menu script -->
<script src="js/classie.js"></script>
<script>
var menuLeft = document.getElementById( 'cbp-spmenu-s1' ),
showLeftPush = document.getElementById( 'showLeftPush' ),
body = document.body;
showLeftPush.onclick = function() {
classie.toggle( this, 'active' );
classie.toggle( body, 'cbp-spmenu-push-toright' );
classie.toggle( menuLeft, 'cbp-spmenu-open' );
disableOther( 'showLeftPush' );
};
function disableOther( button ) {
if( button !== 'showLeftPush' ) {
classie.toggle( showLeftPush, 'disabled' );
}
}
</script>
<!-- //Classie --><!-- //for toggle left push menu script -->
<!--scrolling js-->
<script src="js/jquery.nicescroll.js"></script>
<script src="js/scripts.js"></script>
<!--//scrolling js-->
<!-- Bootstrap Core JavaScript -->
<script src="js/bootstrap.js"> </script>
<!--validator js-->
<script src="js/validator.min.js"></script>
<!--//validator js-->
</body>
</html>