registration_form.php 8.56 KB
<html xmlns="http://www.w3.org/1999/html"><head>
<meta charset="utf-8">
<link href="http://fonts.googleapis.com/css?family=Ubuntu:400,300,500,700" rel="stylesheet" type="text/css">
<link rel="stylesheet" type="text/css" href="style.css">
<link rel="stylesheet" type="text/css" href="bootstrap/css/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="bootstrap1/css/bootstrap.css">

<script type="text/javascript" async="" src="./modal/watch.js"></script>
<script src="./modal/jquery.min.js"></script>
<script src="./perfect-scrollbar/js/perfect-scrollbar.js"></script>
<link rel="stylesheet" href="perfect-scrollbar/css/perfect-scrollbar.css">
<script src="./js/ital_auto.js"></script>
<script src="./js/script.js"></script>
<link rel="stylesheet" type="text/css" href="css/msdropdown/dd.css">
</head>


<body>

<div class="modal fade" id="basicModal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel">
  			<div class="modal-dialog" role="document">
    		<div class="modal-content">
      		<div class="modal-header">
        	<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
      		</div>
		      <div class="modal-body">
		        <div id="modal_form_registration" >
	<span id="modal_close"><img src="/images/close_form.png"></span>
		<form action="" method="post" id="registration_form">
			<h3>Заявка на регистрацию</h3>
			<div class="purple_registration active_button" style="margin-left:65px; border-radius:4px 0 0 0 " id="person"><p>Частное лицо</p></div><div id="company" class="purple_registration"><p>Оптовик</p></div>
			<div class="registration_holder">
			
			<div class="registration_for_person">
			 
                                
                                <input type="text" name="familyname" id="family_name" placeholder="Фамилия
                                " minlength="2" required="">
                               
                                <input name="name" id="name" placeholder="Имя" minlength="2" type="text" required="">
                                <input type="email" name="email" id="email_registration" placeholder="email" minlength="10" required="">
                               
                                <input type="phone" name="telephone" id="telephone_registration" placeholder="Телефон" minlength="7" required="">
                                <input type="telephone" name="telephone" id="telephone_registration_add" placeholder="Телефон">
                                <p class="add_telephone" style="font-size: 14px;
    margin-right: 12px;
    margin-top: 10px;">добавить еще 1 телефон</p>
								<p>Фактический адрес</p>
								<div class="selectize_item2">
					               
					                
			                         <select class="area">
			                            <option value="" disabled="" selected="">Выберите область</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>
                				<div class="selectize_item2">
					                
					                
			                         <select class="city">
			                            <option value="" disabled="" selected="">Выберите город</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>
                				<div class="selectize_item2">
					                
					                
			                         <select class="steel">
			                            <option value="" disabled="" selected="">Перевозчик</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>

                				<input type="text" placeholder="Введите код" id="code_input" required="">
                				<div class="code_generate">
                				<img src="/images/code_generator.png">
                				</div>
                                <button class="purple" type="submit" value="Submit">Зарегестрироваться</button>

                            
             </div> 
             <div class="registration_for_company">
			 
                                <input type="text" name="fullname" id="company_name" placeholder="Компания
                                " minlength="2" required="">
                                <input type="text" name="fullname" id="family_name" placeholder="Фамилия
                                " minlength="2" required="">
                               
                                <input type="" name="name" id="name" placeholder="Имя" minlength="2" required="">
                                <input type="email" name="email" id="email_registration" placeholder="email" minlength="10" required="">
                               
                                <input type="telephone" name="telephone" id="telephone_registration" placeholder="Телефон" minlength="7" required="">
                                <input type="telephone" name="telephone" id="telephone_registration_add1" placeholder="Телефон" style="display:none">
                                <p class="add_telephone1" style="font-size: 14px;
    margin-right: 12px;
    margin-top: 10px;">добавить еще 1 телефон</p>
								<p>Фактический адрес</p>
								<div class="selectize_item2">
					               
					                
			                         <select class="area">
			                            <option value="" disabled="" selected="">Выберите область</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>
                				<div class="selectize_item2">
					                
					                
			                         <select class="city">
			                            <option value="" disabled="" selected="">Выберите город</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>
                				<div class="selectize_item2">
					                
					                
			                         <select class="steel">
			                            <option value="" disabled="" selected="">Перевозчик</option>
			                            <option value="2">Выбери меня!</option>
			                            <option value="3">Выбери меня!</option>
			                            <option value="5">Меня!</option>
			                            <option value="4">Меня</option>
			                         </select>
                
                				</div>

                				<input type="text" placeholder="Введите код" id="code_input">
                				<div class="code_generate">
                				<img src="/images/code_generator.png">
                				</div>
                                <button class="purple" type="submit" value="Submit">Зарегестрироваться</button>

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

</div>
		      </div>
		      
		    </div>
  </div>
</div>

</body>