82 lines
4.4 KiB
PHP
82 lines
4.4 KiB
PHP
@extends('user-layouts.user_template')
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@section('content')
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<div class="content-wrapper" style="min-height: 916px;">
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<!-- Content Header (Page header) -->
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<section class="content-header">
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<h1>
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Address Book
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<!-- <small>Control panel</small> -->
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</h1>
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<ol class="breadcrumb">
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<li><a href="{{ url ('user') }}"><i class="fa fa-home"></i> Home</a></li>
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<li><a href="{{ url ('user/address-book') }}""><i class="fa fa-address-book-o"></i> Address Book</a></li>
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<li class="active">Add New Address</li>
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</ol>
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</section>
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<!-- Main content -->
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<section class="content">
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<div class="row">
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<div class="col-md-12">
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<div class="box box-primary">
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<div class="box-header with-border">
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<h3 class="box-title">
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Add New Address
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</h3>
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</div>
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<form role="form" id="frm-create-address-book">
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<div class="box-body">
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<div class="row">
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<div class="col-md-6">
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<div class="form-group">
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<label>Fullname</label>
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<input type="text" class="form-control" name="fullname" placeholder="Fullaname">
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</div>
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<div class="form-group">
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<label>Mobile Number</label>
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<input type="text" class="form-control" name="mobilenumber" placeholder="Please enter your mobile number">
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</div>
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<div class="form-group">
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<label>Other Notes</label>
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<input type="text" class="form-control" name="othernotes" placeholder="Please enter your notes">
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</div>
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<!-- /.box-body -->
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label>House Number, Building and Street Name</label>
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<input type="text" class="form-control" name="address" placeholder="Please enter your House Number, Building and Street Name">
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</div>
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<div class="form-group">
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<label>State</label>
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<select class="form-control" name="state" id="lst-states" >
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<option value="">Select State</option>
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</select>
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</div>
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<div class="form-group">
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<label>City</label>
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<select class="form-control" name="city" id="lst-cities">
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<option value="">Select City</option>
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</select>
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</div>
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<div class="form-group">
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<label>Zip Code</label>
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<input type="text" class="form-control" name="zipcode" placeholder="Please enter your zip code">
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</div>
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</div>
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</div>
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</div>
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<div class="box-footer">
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<button type="submit" class="btn btn-primary btn-custom-save">Save</button>
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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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</section>
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<!-- /.content -->
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</div>
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@endsection
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