[clinton/MarylandElectronicPetitionSignature.git] / enter_information.php

<?PHP include_once('header.php');  ?>

  
 <div class='col-sm-12'> please enter your name and zip code as it appears on your Maryland Voter Registration </div>
  
  <div class='col-sm-6'>first name </div>
  
  <div class='col-sm-6'>last name </div>
  
  
    <div class='col-sm-6'><input> </div>
  
  <div class='col-sm-6'><input> </div>
  
  <div class='col-sm-6'>house number</div>
  
  <div class='col-sm-6'>zip code </div>
  
  
    <div class='col-sm-6'><input> </div>
  
  <div class='col-sm-6'><input> </div>
  
  <div class='col-sm-12'> <input type='submit'></div>


<?PHP include_once('footer.php');
Commit	Line	Data
09a581dc PM	1	<?PHP include_once('header.php'); ?>
	2
	3
	4	<div class='col-sm-12'> please enter your name and zip code as it appears on your Maryland Voter Registration </div>
	5
	6	<div class='col-sm-6'>first name </div>
	7
	8	<div class='col-sm-6'>last name </div>
	9
	10
	11	<div class='col-sm-6'><input> </div>
	12
	13	<div class='col-sm-6'><input> </div>
	14
	15	<div class='col-sm-6'>house number</div>
	16
	17	<div class='col-sm-6'>zip code </div>
	18
	19
	20	<div class='col-sm-6'><input> </div>
	21
	22	<div class='col-sm-6'><input> </div>
	23
	24	<div class='col-sm-12'> <input type='submit'></div>
	25
	26
	27	<?PHP include_once('footer.php');