-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathform.html
120 lines (116 loc) · 2.52 KB
/
form.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
<!DOCTYPE html>
<html>
<head>
<title>SUBMIT FORM</title>
<script type="text/javascript">
function submit()
{
return true
}
</script>
<style>
body{
background-color:white;
}
.fake{
text-align:center;
background-color:#7bb0b0;
}
#button{
text-align:center;
color: blue;
}
input #button{
background-color: #e6ffff;
font-weight:bold;
border:1px solid black;
text-align: center;
}
#button:hover{
background-color:#e6ffff;
}
:empty{
height:40px;
background:white;
-moz-border-radius:5%;
border-radius:5%;
}
:root{
border-radius: 50px;
margin-left: auto;
margin-right: auto;
margin-top: 100px;
margin-bottom: auto;
border:10px solid black;
margin:100px auto;
padding:30px;
background-image:url(bbb.jpg);
width:550px;
text-align: center;
-moz-border-radius:50%;
}
</style>
<title>COMPLAINT REGISTRATION FORM.</title>
</head>
<body>
<form onsubmit="return submit()" action="website1.html">
<h2><b>FILL THIS FORM TO REGISTER YOUR COMPLAINT.</b></h2>
<table>
<tr>
<td><b>NAME :</b></td>
<td><input type="text" name="Username" required ></td>
</tr>
<tr>
<td><b>PASSWORD :</b></td>
<td><input type="password" name="Password" required></td>
</tr>
<tr>
<td><b>GENDER :</b></td>
<td>
<input type="radio" name="Gender" value="m" required>Male
<input type="radio" name="Gender" value="f" required>Female
</td>
</tr>
<tr>
<td><b>E-MAIL :</b></td>
<td><input type="email" name="Email" required></td>
</tr>
<tr>
<td><b>PHONE NO :</b></td>
<td>
<select name="PhoneCode" required>
<option selected hidden value="select code">Select Code</option>
<option value="+91">+91</option>
<option value="+92">+92</option>
<option value="+97">+97</option>
</select>
<input type="tel" name="Phone" required>
</td>
</tr>
<tr>
<td><b>ADDRESS:</b></td>
<td><input type="text" name="Address" required></td>
</tr>
<tr>
<td><b>COMPLAINT FOR WHAT:</b></td>
<td><input type="text" name="Your complaint" required></td>
</tr>
<tr>
<td><b>PLACE:</b></td>
<td><input type="text" name="Place" required></td>
</tr>
<tr>
<td><b>DATE :</b></td>
<td><input type="date" name="Date " required></td>
</tr>
<tr>
<td><b>TIME :</b></td>
<td><input type="time" name="Time " required></td>
</tr>
<tr>
<td><input type="submit" name="feedback[action]" value="SUBMIT" onclick="submit()" id="button"/>
</tr>
</table>
</form>
</body>
</html>