Viewing File: /home/webrbaew/candycleansestore.co/pre-order-form.php
<!DOCTYPE html><html lang="en">
<head>
<?php
include "includes/operations.php";
include "includes/headerlinks.php";
?>
<?php
$res = mysqli_query($con, "SELECT * FROM system_configuration");
$lang = mysqli_fetch_array($res);
?>
</head>
<body>
<main class="main__content_wrapper">
<!-- Start slider section -->
<section class="breadcrumb__section breadcrumb__bg">
<div class="container">
<div class="row row-cols-1">
<div class="col">
<div class="breadcrumb__content">
<h1 class="breadcrumb__content--title text-white mb-10">Candy Cleanse Website (Form Setup)</h1>
</div>
</div>
</div>
</div>
</section>
<section class="contact__section section--padding">
<div class="container">
<div class="section__heading mb-40">
<h2 class="section__heading--maintitle contact__section--hrading mb-10">Complete the form</h2>
<p class="contact__section--hrading__desc">In order to proceed your website!</p>
<?php if(isset($_GET['success'])){?>
<div class="" id="mydiv" style="font-size:20px">
<i class="fa fa-check" style="color:#6fb327 !important"></i> <strong>Thanks for submitted the form. We will back you asap!</strong>
</div>
<?php }?>
</div>
<div class="main__contact--area">
<div class="row align-items-center row-md-reverse">
<div class="col-lg-12">
<div class="contact__form">
<form class="contact__form--inner" method="POST">
<div class="row">
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input1">First Name <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="f_name" id="input1" placeholder="Your First Name" type="text" required>
<div data-lastpass-icon-root="" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div></div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input2">Last Name <input class="contact__form--input" name="l_name" id="input2" placeholder="Your Last Name" type="text">
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input3">Phone Number <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="phone" id="input3" placeholder="Phone number" type="text" required>
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">Email <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="email" id="input4" placeholder="Email" type="text" required>
</div>
</div>
<div class="col-lg-12 col-md-12">
<label class="contact__form--label" for="input4">Is your stripe account set up? <span class="contact__form--label__star">*</span></label>
<div class="form-check">
<input class="form-check-input" type="radio" id="check1" name="stripe" value="Yes">
<label class="form-check-label">Yes</label>
<input class="form-check-input" type="radio" id="check1" name="stripe" value="No">
<label class="form-check-label">No</label>
</div><br>
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">If No, we cannot set-up your Candy Cleanse Website until you set-up your stripe account. Please go to stripe.com and set-up your stripe account so we can set up your Website. <span class="contact__form--label__star">*</span></label>
</div>
</div>
<div class="col-lg-12 col-md-12">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">If Yes, please give us the username and password below:<span class="contact__form--label__star">*</span></label>
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input3">Username <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="stripe_username" id="input3" placeholder="Username" type="text">
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">Password <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="stripe_password" id="input4" placeholder="Password" type="text">
</div>
</div>
<div class="col-lg-12 col-md-12">
<label class="contact__form--label" for="input4">Did you purchase your domain name? <span class="contact__form--label__star">*</span></label>
<div class="form-check">
<input class="form-check-input" type="radio" id="check1" name="domain" value="Yes">
<label class="form-check-label">Yes</label>
<input class="form-check-input" type="radio" id="check1" name="domain" value="No">
<label class="form-check-label">No</label>
</div><br>
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">If No, we cannot set-up your Candy Cleanse Website until you have purchased a domain name from goddady.com <span class="contact__form--label__star">*</span></label>
</div>
</div>
<div class="col-lg-12 col-md-12">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">If Yes, please give us the username and password below:<span class="contact__form--label__star">*</span></label>
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input3">Username <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="domain_username" id="input3" placeholder="Username" type="text">
</div>
</div>
<div class="col-lg-6 col-md-6">
<div class="contact__form--list mb-20">
<label class="contact__form--label" for="input4">Password <span class="contact__form--label__star">*</span></label>
<input class="contact__form--input" name="domain_password" id="input4" placeholder="Password" type="text">
</div>
</div>
<div class="col-12">
<div class="contact__form--list mb-10">
<label class="contact__form--label" for="input5">Put any additional notes <span class="contact__form--label__star"></span></label>
<textarea class="contact__form--textarea" name="message" id="input5" placeholder="Write Your Message"></textarea>
</div>
</div>
</div>
<button class="contact__form--btn primary__btn" name="user_form" type="submit">Submit Now</button>
<p class="form-messege"></p>
</form>
</div>
</div>
</div>
</div>
</div>
</section>
</main>
</body></html>
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