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156 lines
6.0 KiB
156 lines
6.0 KiB
<!--A Design by W3layouts
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Author: W3layout
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Author URL: http://w3layouts.com
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License: Creative Commons Attribution 3.0 Unported
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License URL: http://creativecommons.org/licenses/by/3.0/
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-->
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<!DOCTYPE HTML>
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<html>
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<head>
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<title>Fare Order Form a Responsive Widget Template :: w3layouts</title>
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<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
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<meta name="keywords" content="Fare Order Form Responsive Widget,Login form widgets, Sign up Web forms , Login signup Responsive web form,Flat Pricing table,Flat Drop downs,Registration Forms,News letter Forms,Elements" />
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<script type="application/x-javascript"> addEventListener("load", function() { setTimeout(hideURLbar, 0); }, false); function hideURLbar(){ window.scrollTo(0,1); } </script>
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<!-- jQuery (necessary for Bootstrap's JavaScript plugins) -->
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<!-- Custom Theme files -->
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<!-- font-awesome-icons -->
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<link href="css/font-awesome.css" rel="stylesheet">
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<!-- //font-awesome-icons -->
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<link href="css/style.css" rel='stylesheet' type='text/css' />
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<!--fonts-->
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<link href="//fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
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<link href="//fonts.googleapis.com/css?family=Niconne" rel="stylesheet">
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<!--//fonts-->
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</head>
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<body>
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<!--background-->
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<h1> Fare Order Form </h1>
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<div class="bg-agile">
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<img src="images/side.png" alt="">
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<div class="book-appointment">
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<h2>Make Your Order Here</h2>
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<div class="book-form agileits-login">
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<form action="#" method="post">
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<div class="phone_email">
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<label>Full name : </label>
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<div class="form-text">
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<i class="fa fa-user" aria-hidden="true"></i>
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<input type="text" name="Name" placeholder="" required="">
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</div>
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</div>
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<div class="phone_email phone_email1">
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<label>Email : </label>
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<div class="form-text">
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<i class="fa fa-envelope-o" aria-hidden="true"></i>
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<input type="email" name="email" placeholder="" required="">
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</div>
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</div>
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<div class="phone_email">
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<label>Phone number : </label>
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<div class="form-text">
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<i class="fa fa-phone" aria-hidden="true"></i>
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<input type="text" name="Phone no" placeholder="" required="">
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</div>
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</div>
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<div class="phone_email phone_email1">
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<label>Address : </label>
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<div class="form-text">
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<i class="fa fa-map-marker" aria-hidden="true"></i>
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<input type="text" name="address" placeholder="" required="">
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</div>
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</div>
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<div class="clear"></div>
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<div class="agileits_reservation_grid">
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<div class="span1_of_1">
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<label>Date : </label>
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<div class="book_date">
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<i class="fa fa-calendar" aria-hidden="true"></i>
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<input id="datepicker" name="Text" type="text" value="" onfocus="this.value = '';" onblur="if (this.value == '') {this.value = 'mm/dd/yyyy';}" required="">
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</div>
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</div>
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<div class="span1_of_1">
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<!-- start_section_room -->
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<label>Time : </label>
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<div class="section_room">
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<i class="fa fa-clock-o" aria-hidden="true"></i>
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<select id="country" onchange="change_country(this.value)" class="frm-field required">
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<option value="AX"></option>
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<option value="null">Lunch</option>
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<option value="null">Dinner</option>
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<option value="AX">Break Fast</option>
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</select>
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</div>
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</div>
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<div class="span1_of_1">
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<label>No.of people : </label>
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<!-- start_section_room -->
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<div class="section_room">
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<i class="fa fa-users" aria-hidden="true"></i>
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<select id="country1" onchange="change_country(this.value)" class="frm-field required sect">
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<option value="AX"></option>
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<option value="null">1 People</option>
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<option value="null">2 People</option>
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<option value="null">3 People</option>
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<option value="AX">4 People</option>
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<option value="AX">More</option>
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</select>
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</div>
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</div>
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<div class="clear"></div>
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</div>
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<div class="wthree-text">
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<h6>Items</h6>
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<ul>
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<li>
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<label class="anim">
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<input type="checkbox" class="checkbox">
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<span>Soups</span>
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</label>
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</li>
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<li>
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<label class="anim">
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<input type="checkbox" class="checkbox">
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<span>Burger</span>
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</label>
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</li>
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<li>
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<label class="anim">
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<input type="checkbox" class="checkbox">
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<span>Drinks</span>
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</label>
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</li>
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<li>
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<label class="anim">
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<input type="checkbox" class="checkbox">
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<span>Desserts</span>
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</label>
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</li>
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</ul>
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<div class="clearfix"> </div>
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</div>
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<input type="submit" value="Order Now">
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</form>
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</div>
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</div>
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</div>
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<!--copyright-->
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<div class="copy w3ls">
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<p>© 2017. Fare Order Form . All Rights Reserved | Design by <a href="http://w3layouts.com/" target="_blank">W3layouts</a> </p>
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</div>
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<!--//copyright-->
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<script type="text/javascript" src="js/jquery-2.1.4.min.js"></script>
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<!-- Calendar -->
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<link rel="stylesheet" href="css/jquery-ui.css" />
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<script src="js/jquery-ui.js"></script>
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<script>
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$(function() {
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$( "#datepicker,#datepicker1,#datepicker2,#datepicker3" ).datepicker();
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});
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</script>
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<!-- //Calendar -->
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</body>
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</html> |