<?php include "layouts/menu.php"; ?> 
        <!--  page-wrapper -->
         <div class="right_col" role="main">
            <div class="row">
                 <!-- page header -->
                <div class="col-lg-12">
                    <h1 class="page-header alert alert-info">New Registration For Book Binding/Monthly Interest</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">
							<a href="m.register.php">New Customer</a>
											<?php $hpl=$_REQUEST['hpl'];?>		<?php			$qry=mysqli_query($conn, "select * from customerdetails where mfin='$mfin' &&  hpl='$hpl'");
									$n=mysqli_num_rows($qry);
									if($n==0)
									{
										echo "No existing Customer";
									}
									else
									{
									$row=mysqli_fetch_array($qry);?>
                                <div class="col-lg-6">
   <form role="form" name="form1" method="post" action="m.register.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 $row['hpl'];?>" 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="<?php echo $row['vno'];?>" 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="<?php echo $row['model'];?>" 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="<?php echo $row['vname'];?>" 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="<?php echo $row['color'];?>" 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">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>
                                <div class="col-lg-6">
 <div class="form-group has-error has-feedback">
    <label for="txt2">Interest</label>
      <input type="text" class="form-control" id="txt2"  name="interest" value="" placeholder="Interest" onChange="add()">
	     <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="<?php echo $row['name'];?>" 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="<?php echo $row['pno'];?>" 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>
     <input type="text" class="form-control" rows="3" name="address" value="<?php echo $row['address'];?>" placeholder="Address">
	  <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>
      <input type="text" class="form-control" rows="3" name="co" value="<?php echo $row['co'];?>" placeholder="">
    <span class="glyphicon glyphicon-user 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="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="<?php echo $row['bname'];?>" placeholder="Broker Name">
 <span class="glyphicon glyphicon-cloud-download form-control-feedback"></span>
  </div>
   <div class="form-group has-success has-feedback">
    <label for="inputPassword3">Insurance Date</label>
      <input type="text" class="form-control" id="datepicker2" name="idate" value="<?php echo $row['idate'];?>" placeholder="Insurance 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">FC Date</label>
      <input type="text" class="form-control" id="datepicker8" name="uname" value="<?php echo $row['uname'];?>" placeholder="Fc 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">Tax Date</label>
      <input type="text" class="form-control " id="datepicker9" name="pwd" value="<?php echo $row['pwd'];?>" placeholder="Tax Dtae" onfocus="insertDate(this,'DD-MM-YYYY')">
   <span class="glyphicon glyphicon-calendar form-control-feedback"></span>
  </div>
 <div class="form-group">
    <div class="col-sm-offset-2 col-sm-10">
      <button type="submit" class="btn btn-primary btn-lg btn-block" name="s5">Register</button>

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