| Current Path : /home1/savoy/www/savoyglobal.net/sibs_draft/system/application/views/Customer/ |
Linux gator3171.hostgator.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 |
| Current File : /home1/savoy/www/savoyglobal.net/sibs_draft/system/application/views/Customer/trackcustomerform.php |
<?php if ( ! defined('BASEPATH')) exit('No direct script access allowed');?>
<form id="customForm" name="customForm">
<fieldset>
<div class="leftalign">
<ul>
<li><label>Customer Name</label> <label><input name="txt_cusName" type="text" id="txt_cusName" title="Provide a valid Customer Name"></label></li>
<li><label>Customer Id</label> <label><input name="txt_cuscode" type="text" id="txt_cuscode" title="Provide a valid Customer Id."></label></li>
<li><label>Quotation Ref No </label> <label><input name="txt_Quot_refNo" type="text" id="txt_Quot_refNo" title="Provide a valid Customer Id."></label></li>
<li><label>Insurance Company</label><label><input name="txt_companyname" type="text" id="txt_companyname" title="Provide a valid Insurance Company name"></label></li>
</ul>
</div>
<div class="rightalign">
<ul>
<li><label>Employee Name</label> <label><input name="txt_staffname" type="text" id="txt_staffname" title="Provide a valid staff Name"></label></li>
<li><label>Employee No</label> <label><input name="txt_staffcode" type="text" id="txt_staffcode" title="Provide a valid staff Code"></label></li>
<li><label>Policy No</label> <label><input name="txt_plicyCode" type="text" id="txt_plicyCode" title="Provide a valid Policy No"></label></li>
<li><label>Issue Date</label> <label><input name="txt_issuedate" type="text" id="txt_issuedate" title="Provide a valid Issue date"></label></li>
</ul>
</div>
<div class="leftalign1">
<ul>
<li><label>Insurance Classification</label>
<label>
<?php
$SegInsur=$this->mastermodel->getdatas('segment_insurances');
echo "<select style='width: 150px;' size='1' name='Sel_Insur_cls' id='Sel_Insur_cls' onchange =\"findcover(this.value)\">";
echo "<option value='0'>--Select--</option>";
if (count($SegInsur)>0)
{
foreach ($SegInsur as $key => $list)
{
echo "<option value='". $list['id'] . "' >" . $list['segment'] . "</option>";
}
echo "</select>";
}
?>
</label>
</li>
<li id="coverlist"><label>Type of Cover</label> <select name="selcovertype" size="1" id="selcovertype" style="width: 150px;">
<option value="0">
--Select --
</option>
</select></li></ul></div>
<div class="centeralign"><ul>
<li><label><input type="button" class="clickimage" value="Search" onclick="trackcustomers();"></label></li>
</ul>
</div>
</fieldset>
</form>