hafifierahman
111 lines
4.2 KiB
PHP
111 lines
4.2 KiB
PHP
<!-- Modal Wakil -->
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<div class="modal fade" id="WakilModal" tabindex="-1" role="dialog" aria-labelledby="WakilModalCenterTitle" aria-hidden="true">
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<div class="modal-dialog modal-dialog-centered" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title" id="WakilModalTitle">Daftar Wakil</h5>
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<button type="button" class="close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<div class="modal-body">
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<div class="form-group row">
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<div class="col-4">
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<label>No Wakil</label>
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</div>
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<div class="col-4">
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<input type="text" class="form-control" id="nowakil" name="nowakil" readonly/>
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<span name="errornowakil" style="color:red;"></span>
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</div>
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</div>
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<input type="hidden" id="nopelangganwakil"/>
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<input type="hidden" id="norujukanwakil"/>
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<div class="form-group row">
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<div class="col-4">
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<label>No KP</label>
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</div>
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<div class="col-7">
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<input type="text" class="form-control" id="nokpwakil" name="nokpwakil" readonly/>
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<span name="errornokpwakil" style="color:red;"></span>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-4">
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<label>Nama</label>
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</div>
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<div class="col-8">
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<input type="text" class="form-control" id="namawakil" name="namawakil"/>
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<span name="errornamawakil" style="color:red;"></span>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-4">
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<label>Alamat</label>
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</div>
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<div class="col-8">
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<input type="text" class="form-control" id="alamatwakil" name="alamatwakil"/>
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<span name="erroralamatwakil" style="color:red;"></span>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-4">
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<label>No Tel</label>
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</div>
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<div class="col-6">
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<input type="text" class="form-control" id="notelwakil" name="notelwakil"/>
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<span name="errornotelwakil" style="color:red;"></span>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-4">
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<label>Nota</label>
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</div>
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<div class="col-8">
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<input type="text" class="form-control" name="notawakil" id="notawakil"/>
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<span name="errornotawakil" style="color:red;"></span>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-4">
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<label>Hubungan</label>
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</div>
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<div class="col-8">
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<select class="form-control" name="slthubungan" id="slthubungan">
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<option value="Ibu">Ibu</option>
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<option value="Bapa">Bapa</option>
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<option value="Suami">Suami</option>
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<option value="Isteri">Isteri</option>
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<option value="Adik-Beradik">Adik-Beradik</option>
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<option value="Emak-Saudara">Emak-Saudara</option>
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<option value="Bapa-Saudara">Bapa-Saudara</option>
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<option value="Sepupu">Sepupu</option>
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<option value="Kawan">Kawan</option>
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<option value="Datuk">Datuk</option>
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<option value="Nenek">Nenek</option>
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<option value="Cucu">Cucu</option>
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<option value="Abang">Abang</option>
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<option value="Kakak">Kakak</option>
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<option value="Anak">Anak</option>
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</select>
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</div>
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</div>
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</div>
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<div class="modal-footer">
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<button type="button" class="btn btn-danger btn-lg" data-dismiss="modal">Batal</button>
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<button type="button" class="btn btn-success btn-lg" onclick="daftarwakil();">Terima</button>
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</div>
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</div>
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</div>
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</div>
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