<?php include "layouts/menu.php"; ?>    
 <script>
function add3()
{
var x = document.getElementById("1").value;
var y = document.getElementById("bba").value;
document.getElementById("1").value =(x*1)+(y*1);
}
</script>

  <script>
function add()
{
var x = document.getElementById("txt1").value;
var y = document.getElementById("txt2").value;
document.getElementById("tot").value =(x*1)+(y*1);
}
</script>
<script>
function add1()
{
var x1 = document.getElementById("1").value;
var y1 = document.getElementById("2").value;
document.getElementById("txt2").value =(x1*1)*(y1/100);
}
</script>
<script>
function add2()
{
var x1 = document.getElementById("1").value;
var y1 = document.getElementById("3").value;
document.getElementById("txt1").value =parseInt((x1*1)/(y1*1));
}
</script>
  <!--  page-wrapper -->
         <div class="right_col" role="main">
            <div class="row">
                 <!-- page header -->
                <div class="col-lg-12">
                    <h1 class="page-header  alert alert-danger">Document Release</h1>
                </div>
                <!--end page header -->
            </div>
            <div class="row">
                <div class="col-lg-12">
                    <!-- Form Elements -->
                    <div class="panel panel-default">
                        <div class="panel-heading">
                            Fill the form
                        </div>
                        <div class="panel-body">
                            <div class="row">
                                <div class="col-lg-6">
                                   <?php	$qry=mysqli_query($conn, "select * from customerdetails where mfin='$mfin'");
						$n=mysqli_num_rows($qry);
						if($n==0)
						{
							$rty = 1;
						}
						else
					    {
						while($row=mysqli_fetch_array($qry))
						{
						$sss = $row['hpl'];
						}
						$rty = $sss + 1;
						} ?>
   <form role="form" name="form1" method="post" action="register1.php" enctype="multipart/form-data">
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >HPL</label>
      <input type="text" class="form-control" id="inputPassword3" name="hpl" value="<?php echo $rty;?>" placeholder="E.g 1008" required>
<span class="glyphicon glyphicon-user form-control-feedback"></span> 
 </div>
  <div class="form-group has-success has-feedback">
    <label for="inputEmail3" >Vehicle No</label>
      <input type="text" class="form-control" id="inputEmail3" name="vno" value="" placeholder="E.g TN 21 S 2676">
  <span class="glyphicon glyphicon-shopping-cart form-control-feedback"></span>
  </div>
  <div class="form-group has-success has-feedback">
    <label for="inputEmail3" >Upload Image</label>
    <input type="file" id="exampleInputFile" name="uimg" >
    <p class="help-block">Upload Passport size Photo here.</p>
	<span class="glyphicon glyphicon-cloud-upload form-control-feedback"></span>
  </div>  
  <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Model</label>
      <input type="text" class="form-control" id="inputPassword3" name="model" value="" placeholder="Vehicle Model">
   <span class="glyphicon glyphicon-time form-control-feedback"></span>
  </div>
    <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Vehicle Name</label>
      <input type="text" class="form-control" id="inputPassword3" name="vname" value="" placeholder="Vehicle Name">
    <span class="glyphicon glyphicon-plane form-control-feedback"></span>
  </div>
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Color</label>
      <input type="text" class="form-control" id="inputPassword3" name="color" value="" placeholder="Vehicle Color E.g RED">
    <span class="glyphicon glyphicon-tint form-control-feedback"></span>
  </div>
  <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >H.P Amount</label>
      <input type="text" class="form-control" id="1" name="hpamount"  value="" placeholder="H.P Amount" onChange="add1()">
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Interest in %</label>
      <input type="text" class="form-control" id="2" name="inter"  value="" placeholder="2" onChange="add1()">
    <span class="glyphicon glyphicon-info-sign form-control-feedback"></span>
  </div>
  
  <div class="form-group has-success has-feedback">
    <label for="inputPassword3" class="control-label">H.P Date</label>
      <input type="text" class="form-control" id="datepicker"  name="hpdate" value="" placeholder="H.P Date" onfocus="insertDate(this,'DD-MM-YYYY')">
 <span class="glyphicon glyphicon-calendar form-control-feedback"></span>
    </div>
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Due Month</label>
      <input type="text" class="form-control" id="3" name="duemnt" value="" placeholder="Due Month" onchange="add2()";>
  <span class="glyphicon glyphicon-time form-control-feedback"></span>
  </div>

  <div class="form-group has-success has-feedback">
    <label for="txt1" >Due Amount</label>
      <input type="text" class="form-control" id="txt1"  name="dueamt" value="" placeholder="Due Amount" onChange="add()">
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>
  <div class="form-group has-success has-feedback">
    <label for="txt2" >Interest</label>
      <input type="text" class="form-control" id="txt2"  name="interest" value="" placeholder="Interest" >
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>
 
   <div class="form-group has-error has-feedback">
    <label for="inputPassword3" >Total Amount</label>
      <input type="text" class="form-control" id="tot" name="total" value="" placeholder="Total Amount" onClick="add()">
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>
	  
  </div>
                                <div class="col-lg-6">  
								 <div class="form-group has-error has-feedback">
    <label for="inputPassword3" >Month</label>
      <input type="text" class="form-control" id="totf" name="nmm" value=""  onfocus="insertDate(this,'MM')">
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>
								 <div class="form-group has-error has-feedback">
    <label for="inputPassword3" >Year</label>
      <input type="text" class="form-control" id="totff" name="nmm" value=""  onfocus="insertDate(this,'YYYY')">
   <span class="glyphicon glyphicon-usd form-control-feedback"></span>
  </div>	
  <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Name</label>
      <input type="text" class="form-control" id="inputPassword3" name="name" value="" placeholder="name">
 <span class="glyphicon glyphicon-user form-control-feedback"></span>
  </div>
    <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Phone Number</label>
      <input type="text" class="form-control" id="inputPassword3" name="pno" value="" placeholder="name">
 <span class="glyphicon glyphicon-phone-alt form-control-feedback"></span>
  </div>
  <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Address</label>
      <textarea class="form-control" rows="3" name="address" value="" placeholder="Address"></textarea>
  <span class="glyphicon glyphicon-home form-control-feedback"></span>
  </div>
   
    <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Co-Applicant Details</label>
      <textarea class="form-control" rows="3" name="co" value="" placeholder=""></textarea>
    <span class="glyphicon glyphicon-user form-control-feedback"></span>
  </div>
  <div class="form-group has-warning has-feedback">
    <label for="inputEmail3" >Upload Image</label>
    <input type="file" id="exampleInputFile" name="img" >
    <p class="help-block">Upload Co-Applicant Passport size Photo here.</p>
	<span class="glyphicon glyphicon-cloud-upload form-control-feedback"></span>
  </div>  
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3" >Broker Name</label>
      <input type="text" class="form-control" id="inputPassword3" name="bname" value="" placeholder="Broker Name">
    <span class="glyphicon glyphicon-cloud-download form-control-feedback"></span>
  </div>
    <div class="form-group has-warning has-feedback">
    <label for="inputPassword3" >Insurance Date</label>
      <input type="text" class="form-control" id="datepicker2" name="idate" value="" placeholder="Insurance Date" onfocus="insertDate(this,'DD-MM-YYYY')">
  <span class="glyphicon glyphicon-calendar form-control-feedback"></span>
  </div>
  <div class="form-group has-warning has-feedback">
    <label for="inputPassword3" >FC Date</label>
      <input type="text" class="form-control" id="datepicker8" name="uname" value="" placeholder="Fc Date" onfocus="insertDate(this,'DD-MM-YYYY')">
   <span class="glyphicon glyphicon-calendar form-control-feedback"></span> 
  </div>
  <div class="form-group has-warning has-feedback">
    <label for="inputPassword3" >Tax Date</label>
      <input type="text" class="form-control" id="datepicker9" name="pwd" value="" placeholder="Tax Dtae" onfocus="insertDate(this,'DD-MM-YYYY')">
  <span class="glyphicon glyphicon-calendar form-control-feedback"></span>
  </div>
  <div class="form-group">
   
      <button type="submit" class="btn btn-success btn-lg btn-block" name="s2">Register</button>

</div>
      <div class="alert alert-success">
	  <?php include "programs/register1.php"; ?>
	  </div>
</form>
  </div>
 
 
</div>
</div></div>
</div></div></div> <?php include "layouts/footer.php"; ?></body></html>
