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Bootstrap 4.1.1 Snippet by sai91

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<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container register"> <div class="row"> <div class="col-md-3 register-left"> <img src="https://www.accenture.com/t20181205T092600Z__w__/us-en/_acnmedia/Accenture/Conversion-Assets/MainPages/Images/Global_26/Accenture-Electric-Purple-Logo-marquee.png"alt=""/> <h3>C-Focus</h3> <p>Cap-1 Production Tracker!</p> <input type="submit" name="" value="ABC123"/><br/> </div> <div class="col-md-9 register-right"> <ul class="nav nav-tabs nav-justified" id="myTab" role="tablist"> <li class="nav-item"> <a class="nav-link active" id="home-tab" data-toggle="tab" href="#home" role="tab" aria-controls="home" aria-selected="true">BOT & REBILL</a> </li> <li class="nav-item"> <a class="nav-link" id="profile-tab" data-toggle="tab" href="#profile" role="tab" aria-controls="profile" aria-selected="false">CNP & MD</a> </li> <li class="nav-item"> <a class="nav-link" id="Status-tab" data-toggle="tab" href="#Status" role="tab" aria-controls="Status" aria-selected="false">ATM</a> </li> </ul> <div class="tab-content" id="myTabContent"> <div class="tab-pane fade show active" id="home" role="tabpanel" aria-labelledby="home-tab"> <h3 class="register-heading">BOT & REBILL</h3> <div class="row register-form"> <div class="col-md-6"> <div class="form-group"> <form action="connect.php method="post"> <input type="text" class="form-control" placeholder="Claim Number *" value="" /> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Account type</option> <option value="360 Account">360 Account</option> <option value="Retail">Retail</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Work type</option> <option value="360 Rebill workbasket">360 Rebill workbasket</option> <option value="BOT Exceptions Workbasket">BOT Exceptions Workbasket</option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Count of Transaction *" value="" /> </div> <div class="form-group"> <div class="maxl"> <label class="radio inline"> <input type="radio" name="Status" value="completed" checked> <span> Completed </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="Pend"> <span>Pend </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="transfered"> <span>Transfered</span> </label> </div> </div> </div> <div class="col-md-6"> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Action</option> <option value="Immediate PC">Immediate PC</option> <option value="Write off">Write off</option> <option value="Remove Credit">Remove Credit</option> <option value="Break">Break</option> <option value="Team Huddle">Team Huddle</option> <option value="Back Office claim">Back Office claim</option> <option value="Process Training">Process Training</option> <option value="Reports-For client">Reports-For client</option> <option value="Work allocation">Work allocation</option> <option value="Mail checking-internal/client">Mail checking-internal/client</option> <option value="Clarification provided/Raised">Clarification provided/Raised</option> <option value="Client call">Client call</option> <option value="Cross Training">Cross Training</Option> <Option value="Meeting with Supervisor">Meeting with Supervisor</Option> <option value="Town Hall">Town Hall</option> <Option value="Online Assessment- Accenture">Online Assessment- Accenture</Option> <option value="Online Assessment- Client">Online Assessment- Client</option> <option value="On Job Training">On Job Training</option> <option value="Internal Reports">Internal Reports</option> <option value="Operational Excellence">Operational Excellence</option> <option value="System Downtime">System Downtime</option> <option value="System Shortage">System Shortage</option> <option value="Idle- No work">Idle- No work</option> <option value="Fun at Work">Fun at Work</option> <option value="Refile the claim">Refile the claim</option> <option value="Immediate Action Required">Immediate Action Required</option> <option value="Quality Check">Quality Check</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Activity type</option> <option value="Production">Production</option> <option value="Non Production">Non Production</option> <option value="Other Production">Other Production</option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Dispute amount *" value="" /> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Comments *" value="" /> </div> <input type="submit" class="btnRegister" value="submit"/> </div> </div> </div> <div class="tab-pane fade show" id="profile" role="tabpanel" aria-labelledby="profile-tab"> <h3 class="register-heading">CNP & MD</h3> <div class="row register-form"> <div class="col-md-6"> <div class="form-group"> <input type="text" class="form-control" placeholder="Claim Number *" value="" /> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Account type</option> <option value="360 Account">360 Account</option> <option value="Retail">Retail</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Work type</option> <option value="Cancel Recurring">Cancel Recurring</option> <option value="Low Risk Fraud">Low Risk Fraud</option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Count of Transaction *" value="" /> </div> <div class="form-group"> <div class="maxl"> <label class="radio inline"> <input type="radio" name="Status" value="completed" checked> <span> Completed </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="Pend"> <span>Pend </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="transfered"> <span>Transfered</span> </label> </div> </div> </div> <div class="col-md-6"> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Action</option> <option value="Immediate PC">Immediate PC</option> <option value="Write off">Write off</option> <option value="Remove Credit">Remove Credit</option> <option value="Break">Break</option> <option value="Ethoca Response Received">Ethoca Response Received</option> <option value="Verifi Response Received">Verifi Response Received</option> <option value="Retail Money Movement">Retail Money Movement</option> <option value="Reconciliation">Reconciliation</option> <option value="Team Huddle">Team Huddle</option> <option value="Back Office claim">Back Office claim</option> <option value="Process Training">Process Training</option> <option value="Reports-For client">Reports-For client</option> <option value="Work allocation">Work allocation</option> <option value="Mail checking-internal/client">Mail checking-internal/client</option> <option value="Clarification provided/Raised">Clarification provided/Raised</option> <option value="Client call">Client call</option> <option value="Cross Training">Cross Training</Option> <Option value="Meeting with Supervisor">Meeting with Supervisor</Option> <option value="Town Hall">Town Hall</option> <Option value="Online Assessment- Accenture">Online Assessment- Accenture</Option> <option value="Online Assessment- Client">Online Assessment- Client</option> <option value="On Job Training">On Job Training</option> <option value="Internal Reports">Internal Reports</option> <option value="Operational Excellence">Operational Excellence</option> <option value="System Downtime">System Downtime</option> <option value="System Shortage">System Shortage</option> <option value="Idle- No work">Idle- No work</option> <option value="Fun at Work">Fun at Work</option> <option value="Refile the claim">Refile the claim</option> <option value="Immediate Action Required">Immediate Action Required</option> <option value="Quality Check">Quality Check</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Activity Type</option> <option value="Production">Production</option> <option value="Non Production">Non Production</option> <option value="Other Production">Other Production</option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Dispute amount *" value="" /> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Comments *" value="" /> </div> <input type="submit" class="btnRegister" value="submit"/> </div> </div> </div> <div class="tab-pane fade show" id="Status" role="tabpanel" aria-labelledby="Status-tab"> <h3 class="register-heading">ATM</h3> <div class="row register-form"> <div class="col-md-6"> <div class="form-group"> <input type="text" class="form-control" placeholder="Claim Number *" value="" /> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Account type</option> <option value="360 Account">360 Account</option> <option value="Retail">Retail</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Work type</option> <option value="ATM Escalated Credit">ATM Escalated Credit </option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Count of Transaction *" value="" /> </div> <div class="form-group"> <div class="maxl"> <label class="radio inline"> <input type="radio" name="Status" value="completed" checked> <span> Completed </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="Pend"> <span>Pend </span> </label> <label class="radio inline"> <input type="radio" name="Status" value="transfered"> <span>Transfered</span> </label> </div> </div> </div> <div class="col-md-6"> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Action</option> <option value="Immediate PC">Immediate PC</option> <option value="Write off">Write off</option> <option value="Remove Credit">Remove Credit</option> <option value="Break">Break</option> <option value="Ethoca Response Received">Ethoca Response Received</option> <option value="Verifi Response Received">Verifi Response Received</option> <option value="Retail Money Movement">Retail Money Movement</option> <option value="Reconciliation">Reconciliation</option> <option value="Team Huddle">Team Huddle</option> <option value="Back Office claim">Back Office claim</option> <option value="Process Training">Process Training</option> <option value="Reports-For client">Reports-For client</option> <option value="Work allocation">Work allocation</option> <option value="Mail checking-internal/client">Mail checking-internal/client</option> <option value="Clarification provided/Raised">Clarification provided/Raised</option> <option value="Client call">Client call</option> <option value="Cross Training">Cross Training</Option> <Option value="Meeting with Supervisor">Meeting with Supervisor</Option> <option value="Town Hall">Town Hall</option> <Option value="Online Assessment- Accenture">Online Assessment- Accenture</Option> <option value="Online Assessment- Client">Online Assessment- Client</option> <option value="On Job Training">On Job Training</option> <option value="Internal Reports">Internal Reports</option> <option value="Operational Excellence">Operational Excellence</option> <option value="System Downtime">System Downtime</option> <option value="System Shortage">System Shortage</option> <option value="Idle- No work">Idle- No work</option> <option value="Fun at Work">Fun at Work</option> <option value="Refile the claim">Refile the claim</option> <option value="Immediate Action Required">Immediate Action Required</option> <option value="Quality Check">Quality Check</option> </select> </div> <div class="form-group"> <select class="form-control"> <option class="hidden" selected disabled>Activity Type</option> <option value="Production">Production</option> <option value="Non Production">Non Production</option> <option value="Other Production">Other Production</option> </select> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Dispute amount *" value="" /> </div> <div class="form-group"> <input type="text" class="form-control" placeholder="Comments *" value="" /> </div> <input type="submit" class="btnRegister" value="submit"/> </div> </div> </div> </div> </div> </div> </form> </div>
.register{ background: -webkit-linear-gradient(left, #3931af, #00c6ff); margin-top: 3%; padding: 3%; } .register-left{ text-align: center; color: #fff; margin-top: 4%; } .register-left input{ border: none; border-radius: 1.5rem; padding: 2%; width: 60%; background: #f8f9fa; font-weight: bold; color: #383d41; margin-top: 30%; margin-bottom: 3%; cursor: pointer; } .register-right{ background: #f8f9fa; border-top-left-radius: 10% 50%; border-bottom-left-radius: 10% 50%; } .register-left img{ margin-top: 15%; margin-bottom: 5%; width: 25%; -webkit-animation: mover 2s infinite alternate; animation: mover 1s infinite alternate; } @-webkit-keyframes mover { 0% { transform: translateY(0); } 100% { transform: translateY(-20px); } } @keyframes mover { 0% { transform: translateY(0); } 100% { transform: translateY(-20px); } } .register-left p{ font-weight: lighter; padding: 12%; margin-top: -9%; } .register .register-form{ padding: 10%; margin-top: 10%; } .btnRegister{ float: right; margin-top: 10%; border: none; border-radius: 1.5rem; padding: 2%; background: #0062cc; color: #fff; font-weight: 600; width: 50%; cursor: pointer; } .register .nav-tabs{ margin-top: 3%; border: none; background: #0062cc; border-radius: 1.5rem; width: 48%; float: right; } .register .nav-tabs .nav-link{ padding: 2%; height: 34px; font-weight: 600; color: #fff; border-top-right-radius: 1.5rem; border-bottom-right-radius: 1.5rem; } .register .nav-tabs .nav-link:hover{ border: none; } .register .nav-tabs .nav-link.active{ width: 150px; color: #0062cc; border: 2px solid #0062cc; border-top-left-radius: 1.5rem; border-bottom-left-radius: 1.5rem; } .register-heading{ text-align: center; margin-top: 8%; margin-bottom: -15%; color: #495057; }
<?php $Claim Number = $_POST['Claim Number']; $360 Account = $_POST['360 Account']; $Retail = $_POST['Retail']; $360 Rebill workbasket = $_POST['360 Rebill workbasket']; $BOT Exceptions Workbasketr = $_POST['BOT Exceptions Workbasket']; $ATM Escalated Credit = $_POST['ATM Escalated Credit']; $Count of Transaction = $_POST['Count of Transaction']; $Claim Number = $_POST['Claim Number']; $Claim Number = $_POST['Claim Number']; ?>

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