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MarylandElectronicPetitionSignature.git
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Update enter_information.php
author
Patrick McGuire
<insidenothing@gmail.com>
Thu, 21 May 2020 13:15:16 +0000
(09:15 -0400)
committer
GitHub
<noreply@github.com>
Thu, 21 May 2020 13:15:16 +0000
(09:15 -0400)
enter_information.php
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diff --git
a/enter_information.php
b/enter_information.php
index
ef682c3
..
4aa6bd1
100644
(file)
--- a/
enter_information.php
+++ b/
enter_information.php
@@
-59,33
+59,46
@@
slack_general('Entering Information','md-petition');
<script>document.title = "MEPS - Enter Information";</script>
<form method='POST'>
<script>document.title = "MEPS - Enter Information";</script>
<form method='POST'>
-
<div class='row'>
- <div class='col-sm-12' style='text-align:center;'><h
3><?PHP echo $dX['text_title'];?></h3><p style="margin:25px; padding25px; background-color:lightyellow;"><?PHP echo $dX['text_block'];?></p
></div>
+ <div class='row'>
+ <div class='col-sm-12' style='text-align:center;'><h
1><?PHP echo $dX['text_title'];?></h1><h2 style="margin:25px; padding25px; background-color:lightyellow;"><?PHP echo $dX['text_block'];?></h2
></div>
</div>
<div class='row'>
</div>
<div class='row'>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>First Name</h3></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Last Name</h3></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Date of Birth</h3></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>First Name</h2></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>Last Name</h2></div>
</div>
</div>
+
+ <div class='row'>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_first_name'></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_last_name'></div>
+ </div>
+
<div class='row'>
<div class='row'>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_first_name'></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_last_name'></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='DOB' type="date"></div>
- </div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>Date of Birth</h2></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>Phone Number</h2></div>
+ </div>
+
+ <div class='row'>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='DOB' type="date"></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='contact_phone' type='tel'> </div>
+ </div>
+
<div class='row'>
<div class='row'>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>House Number</h3></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>ZIP Code</h3></div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><h3>Phone Number</h3></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>House Number</h2></div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><h2>ZIP Code</h2></div>
</div>
</div>
+
<div class='row'>
<div class='row'>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_house_number' type='number'> </div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='web_zip_code' type='number'> </div>
- <div class='col-sm-4' style='height:50px; text-align:center;'><input name='contact_phone' type='tel'> </div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_house_number' type='number'> </div>
+ <div class='col-sm-6' style='height:50px; text-align:center;'><input name='web_zip_code' type='number'> </div>
</div>
</div>
+
+
<div class='row'>
<div class='col-sm-6' style='height:50px; text-align:center;'><button type="reset" class="btn btn-warning btn-lg btn-block">Clear</button></div>
<div class='col-sm-6' style='height:50px; text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">Next</button></div>
</div>
<div class='row'>
<div class='col-sm-6' style='height:50px; text-align:center;'><button type="reset" class="btn btn-warning btn-lg btn-block">Clear</button></div>
<div class='col-sm-6' style='height:50px; text-align:center;'><button type="submit" class="btn btn-success btn-lg btn-block">Next</button></div>
</div>
+
</form>
</form>
+
<?PHP include_once('footer.php');
<?PHP include_once('footer.php');