add_contact_info.blade.php 2.4 KB

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  1. <div class="modal fade add-modal" tabindex="-1" role="dialog" aria-labelledby="gridSystemModalLabel">
  2. <div class="modal-dialog" role="document">
  3. <div class="modal-content">
  4. <div class="modal-header">
  5. <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
  6. <h4 class="modal-title" id="gridSystemModalLabel">Add Address Book Info</h4>
  7. </div>
  8. <div class="modal-body">
  9. <form action="{{url('admin/address_book')}}" method="POST">
  10. {{ csrf_field() }}
  11. <div class="form-group in-group">
  12. <label for="">Name<span class="field_mendatory">*</span></label>
  13. <input type="text" name="name" required="" class="form-control" id="" placeholder="Contact Person Name" >
  14. </div>
  15. <input type="hidden" value="{{$all->id}}" name="company_id_form_company_indi">
  16. <div class="form-group in-group">
  17. <label for="">Designation</label>
  18. <input type="text" name="designation" class="form-control" id="" placeholder="Designation" >
  19. </div>
  20. <div class="form-group in-group">
  21. <label for="">Mobile no #01<span class="field_mendatory">*</span></label>
  22. <input type="text" name="mob1" required="" class="form-control" id="" placeholder="Mobile number" >
  23. </div>
  24. <div class="form-group in-group">
  25. <label for="">Mobile no #02</label>
  26. <input type="text" name="mob2" class="form-control" id="" placeholder="Optional mobile number" >
  27. </div>
  28. <div class="form-group in-group">
  29. <label for="">Email #01</label>
  30. <input type="email" name="email1" required="" class="form-control" id="" placeholder="Email address" >
  31. </div>
  32. <div class="form-group in-group">
  33. <label for="">Email #02</label>
  34. <input type="email" name="email2" class="form-control" id="" placeholder="Optional email address" >
  35. </div>
  36. </div>
  37. <div class="modal-footer">
  38. <button type="button" class="btn btn-default" data-dismiss="modal">Close</button>
  39. <button type="submit" class="btn btn-primary">Submit</button>
  40. </div>
  41. </form>
  42. </div><!-- /.modal-content -->
  43. </div><!-- /.modal-dialog -->
  44. </div>