File size: 6.4Kb
<form id="updateprofile" enctype="multipart/form-data" class="form-horizontal form-label-left" novalidate="">
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">First Name
<span style="color:red;">*</span></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="fname" class="form-control col-md-7 col-xs-12" type="text" name="fname"
data-parsley-id="9"
value="<?php echo $fname;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Last Name
<span style="color:red;">*</span></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="lname" class="form-control col-md-7 col-xs-12" type="text" name="lname"
data-parsley-id="9"
value="<?php echo $lname;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Address Line 1</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="addressone" class="form-control col-md-7 col-xs-12" type="text" name="addressone"
data-parsley-id="9"
value="<?php echo $address_one;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Address Line 2</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="addresstwo" class="form-control col-md-7 col-xs-12" type="text" name="addresstwo"
data-parsley-id="9"
value="<?php echo $address_two;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Mobile</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="mobile" class="form-control col-md-7 col-xs-12" type="text" name="mobile"
data-parsley-id="9"
value="<?php echo $phone;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Email
<span style="color:red;">*</span></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="email" class="form-control col-md-7 col-xs-12" type="text" name="email"
data-parsley-id="9"
value="<?php echo $email;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Country
<span style="color:red;">*</span></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<select id="country" class="form-control col-md-7 col-xs-12" type="text" name="country">
<option value="">Select country</option>
<?php
$fetch = $DB->country();
foreach($fetch as $row){?>
<option value="<?php echo $row['id'].",".$row['name'];?>" <?php if($row['name'] == $country){echo "selected";}?>>
<?php echo $row['name'];?></option>
<?php } ?>
</select>
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">State
<span style="color:red;">*</span></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<select id="state" class="form-control col-md-7 col-xs-12" type="text" name="state">
<option value="">Select state</option>
<?php
$fetch = $DB->state($cid);
foreach($fetch as $row){?>
<option value="<?php echo $row['name'];?>" <?php if($row['name'] == $state){echo "selected";}?>>
<?php echo $row['name'];?></option>
<?php } ?>
</select>
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">City</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="city" class="form-control col-md-7 col-xs-12" type="text" name="city"
data-parsley-id="9"
value="<?php echo $city;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Postal Code</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="postal" class="form-control col-md-7 col-xs-12" type="number" name="postal"
data-parsley-id="9"
value="<?php echo $postal_code;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Date of Birth</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input class="form-control col-md-7 col-xs-12" type="date" name="dob"
data-parsley-id="9" value="<?php echo $dob;?>">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Marital Status</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<select class="form-control col-md-7 col-xs-12" type="text" name="marital_stat">
<option value="">Select marital status</option>
<option value="single" <?php if($marital_stat == 'single'){echo "selected";}?>>Single</option>
<option value="married" <?php if($marital_stat == 'married'){echo "selected";}?>>Married</option>
<option value="divorced" <?php if($marital_stat == 'single'){echo "divorced";}?>>Divorced</option>
</select>
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12">Profile Picture:</label>
<div class="col-md-9 col-sm-6 col-xs-12">
<input id="file" class="form-control col-md-7 col-xs-12" type="file" name="file">
</div>
</div>
<br>
<div class="form-group">
<label for="middle-name" class="control-label col-md-2 col-sm-3 col-xs-12"></label>
<div class="col-md-9 col-sm-6 col-xs-12">
<div class="x_panel">
<img src="<?php if($profile_pic == ''){echo "images/no_image.jpg";}else{echo "../uploads/profile/".$profile_pic;}?>" id="img" height="200px">
</div>
</div>
</div>
<input id="action" type="hidden" name="action" value="updateprofile">
<input id="id" type="hidden" name="id" value="<?php echo $_SESSION['aid'];?>">
<input id="profile_pic" type="hidden" name="profile_pic" value="<?php echo $profile_pic;?>">
<div class="ln_solid"></div>
<div class="form-group">
<div class="col-md-6 col-sm-6 col-xs-12 col-md-offset-3">
<button type="submit" id="submit" class="btn btn-success">Update Profile</button>
</div>
</div>
</form>