Preview: register.php
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/home/urbanman/roadkaraja.in/register.php
<!DOCTYPE html>
<html lang="en">
<meta http-equiv="content-type" content="text/html;charset=UTF-8" />
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Online Registration</title>
<link href="assets/dist/css/pages/login-register-lock.css" rel="stylesheet">
<link href="assets/dist/css/style.min.css" rel="stylesheet">
<script src="../ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<!--Validation Jquery File-->
<script src="assets/dist/js/jquery.js"></script>
<script src="assets/dist/js/jquery.validate.js"></script>
</head>
<body>
<!-- ============================================================== -->
<!-- Main wrapper - style you can find in pages.scss -->
<!-- ============================================================== -->
<section id="wrapper" class="login-register login-sidebar" style="background-image:url('img/005.jpg');">
<div class="login-box card">
<div class="card-body" style="overflow-y: scroll;">
<style>
.alert{
margin-top: 1rem!important;
}
</style>
<form class="form-horizontal form-material" id="RegisterForm" action="submit-reg.php" method="post">
<!-- <div class="text-center">
<a href="index.html" class="db">logo here</a>
</div>-->
<h3 class="box-title m-t-20 m-b-0">Register Now</h3><small>Create your account </small><br><br>
<div class="form-group ">
<div class="col-xs-12">
<input class="form-control" type="text" name="customer_name" placeholder="Customer Name" >
</div>
</div>
<div class="form-group ">
<div class="col-xs-12">
<input class="form-control" type="number" name="phone_number" placeholder="Phone Number" >
</div>
</div>
<div class="form-group ">
<div class="col-xs-12">
<input class="form-control" type="password" name="password" id="password" placeholder="Password">
</div>
</div>
<div class="form-group ">
<div class="col-xs-12">
Date of Birth:
<input class="form-control" type="date" name="dob" id="dob">
</div>
</div>
<div class="form-group text-center m-t-20">
<div class="col-xs-12">
<button class="btn btn-info btn-lg btn-block text-uppercase waves-effect waves-light" type="submit">Register</button>
</div>
</div>
<div class="form-group m-b-0">
<div class="col-sm-12 text-center">
<p>Already have an account? <a href="index.php" class="text-info m-l-5"><b>Login Here</b></a></p>
</div>
</div>
</form>
</div>
</div>
</section>
<script src="assets/popper/popper.min.js"></script>
<script src="assets/bootstrap/dist/js/bootstrap.min.js"></script>
</body>
</html>
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