Update enter_information.php

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'>
   
-   <div class='row'>
-    <div class='col-sm-12' style='text-align:center;'><h3><?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;'><h1><?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 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 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='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='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 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 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>
+
 <?PHP include_once('footer.php');