hafifierahman
92 lines
3.0 KiB
PHP
92 lines
3.0 KiB
PHP
<!-- Modal Wakil -->
|
|
<div class="modal fade" id="WakilModal" tabindex="-1" role="dialog" aria-labelledby="WakilModalCenterTitle" aria-hidden="true">
|
|
<div class="modal-dialog modal-dialog-centered" role="document">
|
|
<div class="modal-content">
|
|
<div class="modal-header">
|
|
<h5 class="modal-title" id="WakilModalTitle">Daftar Wakil</h5>
|
|
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
|
|
<span aria-hidden="true">×</span>
|
|
</button>
|
|
</div>
|
|
<div class="modal-body">
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>No Wakil</label>
|
|
</div>
|
|
<div class="col-4">
|
|
<input type="text" class="form-control" id="nowakil" name="nowakil" readonly/>
|
|
</div>
|
|
</div>
|
|
|
|
<input type="hidden" id="nopelanggan"/>
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>No KP</label>
|
|
</div>
|
|
<div class="col-7">
|
|
<input type="text" class="form-control" id="nokp" name="nokp" readonly/>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>Nama</label>
|
|
</div>
|
|
<div class="col-8">
|
|
<input type="text" class="form-control" id="nama" name="nama"/>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>Alamat</label>
|
|
</div>
|
|
<div class="col-8">
|
|
<input type="text" class="form-control" id="alamat" name="alamat"/>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>No Tel</label>
|
|
</div>
|
|
<div class="col-6">
|
|
<input type="text" class="form-control" id="notel" name="notel"/>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>Nota</label>
|
|
</div>
|
|
<div class="col-8">
|
|
<input type="text" class="form-control" name="nota" id="nota"/>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="form-group row">
|
|
<div class="col-4">
|
|
<label>Hubungan</label>
|
|
</div>
|
|
<div class="col-8">
|
|
<select class="form-control" name="slthubungan" id="slthubungan">
|
|
<option value="Ibu">Ibu</option>
|
|
<option value="Bapa">Bapa</option>
|
|
<option value="Suami">Suami</option>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
|
|
<div class="modal-footer">
|
|
<button type="button" class="btn btn-danger btn-lg" data-dismiss="modal">Batal</button>
|
|
<button type="button" class="btn btn-success btn-lg" onclick="daftarwakil();">Terima</button>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|