50 lines
2.6 KiB
PHP
50 lines
2.6 KiB
PHP
<div class="modal fade" id="createMerchantModal" tabindex="-1" role="dialog" aria-hidden="true">
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<div class="modal-dialog" role="document">
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<div class="modal-content">
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<div class="color-line"></div>
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<div class="modal-header">
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<h4 class="modal-title titleHead" ></h4>
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<small class="font-bold">Merchant Registration</small>
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</div>
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<div class="modal-body">
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<div class="alert alert-danger hidden" id="topupError"></div>
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<div class="alert alert-success hidden" id="topupSuccess"></div>
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<!-- {{ url('organisation/merchant') }} -->
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<form action="" id="newMerchantForm" method="POST" class="form-horizontal">
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{{ csrf_field() }}
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<div class="form-group">
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<label class="col-sm-2 control-label">Fullname</label>
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<div class="col-sm-10">
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<input type="text" class="form-control" name="fullname" placeholder="Full Name of Merchant " required>
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</div>
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</div>
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<div class="hr-line-dashed"></div>
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<div class="form-group"><label class="col-sm-2 control-label">Phone</label>
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<div class="col-sm-10">
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<input type="text" name="phone_number" class="form-control" id="merchantPhone" placeholder="Phone number " required >
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</div>
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</div>
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<div class="hr-line-dashed"></div>
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<div class="form-group"><label class="col-sm-2 control-label">Language</label>
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<div class="col-sm-10">
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<select class="form-control" name="language" id="merchantLanguage">
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<option value="">-- Select Language --</option>
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<option value="english">English</option>
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<option value="chichewa">Chichewa</option>
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</select>
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</div>
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</div>
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<div class="hr-line-dashed"></div>
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<div class="form-group">
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<div class="col-sm-12 ">
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<button class="btn btn-primary btn-block" type="submit">Submit</button>
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<button class="btn btn-default btn-block" type="button">Cancel</button> <br>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div> |