
<?php
include"alertandmark.php";
?>
<div class="content-wrapper">
    <!-- Content Header (Page header) -->
    <section class="content-header">
      <div class="container-fluid">
        <div class="row mb-2">
          <div class="col-sm-6">
            <h1>Add New EFD</h1>
          </div>
          <div class="col-sm-6">
            <ol class="breadcrumb float-sm-right">
              <li class="breadcrumb-item"><a href="#">Home</a></li>
              <li class="breadcrumb-item active">EFD Form</li>
            </ol>
          </div>
        </div>
      </div><!-- /.container-fluid -->
	   <div class="card card-info">
              <div class="card-header">
                <h3 class="card-title"> EFD</h3>
              </div>
              <!-- /.card-header -->
              <!-- form start -->
              <form action='add_form_action.php' method='POST'>
                <div class="card-body">
                  <div class="form-group">
                    <label for="exampleInputEmail1">Customer Name <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter CustomerName" name='CustomerName' required>
                  </div>
				  
				
				    <div class="form-group">
                    <label for="exampleInputEmail1">Customer TIN <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter TIN" name='CustomerTin' required>
                  </div>
		
		
		  <div class="form-group">
                    <label for="exampleInputEmail1">Address <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter Address" name='Address' required>
                  </div>
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Serial Number <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter S/N" name='EfdSN' value='EFD'>
                  </div>
				  
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Street <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter Stree" name='Street' required>
                  </div>
				  
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Phone <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter Phone" name='Phone' required>
                  </div>
				  
				     <div class="form-group">
                    <label for="exampleInputEmail1">MODEL <?php  echo $mandatory_star; ?> </label>
					<SELECT class="form-control" id="exampleInputEmail1" name='model'>
					 <OPTION>133M</OPTION>
					 <OPTION>181M</OPTION>
					 <OPTION>777M</OPTION>
					 <OPTION>VFD</OPTION>
					 </SELECT>
                  </div>
				  
				     <div class="form-group">
					 <label for="exampleInputEmail1">PAYMENT MODE <?php  echo $mandatory_star; ?> </label>
					 <SELECT class="form-control" id="exampleInputEmail1" name='PaymentMode'>
					 <OPTION>FULL PAID</OPTION>
					 <OPTION>PARTIAL PAID</OPTION>
					 </SELECT>
                  
                  </div>
				     <div class="form-group">
                    <label for="exampleInputEmail1">AMOUNT <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter Phone" name='amount' required>
                  </div>
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Business  <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter Business" name='Business' required>
                  </div>
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Tax Office <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter TaxOFFICE" name='TaxOffice' required>
                  </div>
				  
				    <div class="form-group">
                    <label for="exampleInputEmail1">Invoice <?php  echo $mandatory_star; ?> </label>
                    <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter INV" name='Invoice' required>
                  </div>
				   <div class="form-group">
                    <label for="exampleInputEmail1" >VFD PRINTER <?php  echo $mandatory_star; ?> </label>
					<SELECT class="form-control" id="exampleInputEmail1" name='printer'>
					 <OPTION>HQ</OPTION>
					 <OPTION>KBH</OPTION>
			
					 </SELECT>
                  </div>
				    <div class="form-group">
                    <label for="exampleInputEmail1">Applied Onn <?php  echo $mandatory_star; ?> </label>
                    <input type="date" class="form-control" id="exampleInputEmail1" placeholder="Enter Date" name='EfdPurchaseDate' required>
                  </div>
				  
				  <div class="form-group">
                   
                    <input type="hidden" class="form-control" id="exampleInputEmail1" placeholder="Enter Date" name='status'>
                  </div>
				  
				  
				  
                  <div class="form-group"> <b>Description</b>
                    <textarea class="form-control" id="exampleInputEmail1" placeholder="Enter email" name="description">
					</textarea>
                  </div>
				  
            
					 
					  
					
					  
                  <div class="form-group">
                
                    <div class="input-group">
                    
                    
                    </div>
                  </div>
                 
                </div>
                <!-- /.card-body -->

                <div class="card-footer">
                  <button type="submit" class="btn btn-primary">Submit</button>
                </div>
				
				
				

              </form>
            </div>
	</div>
    </section>
	           