"Registration from"
Bootstrap 3.3.0 Snippet by KIRANMULI

<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <nav class="navbar navbar-default navbar-fixed-top"> <div class="container-fluid"> <div class="navbar-header"> <button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#myNavbar"> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span> </button> <a class="navbar-brand" href="/crm/"><img src="{% static 'css/images/logo.png' %}" height="35px" style="margin-top:-10px;"></a> </div> <div> <div class="collapse navbar-collapse" id="myNavbar"> <ul class="nav navbar-nav"> <li><a href=/crm/farmer/search/> <strong><span class="glyphicon glyphicon-user blue"></span>Farmer </strong></a></li> <li><a href="/crm/catalog/view"><strong><span class="glyphicon glyphicon-grain blue"></span>Products</strong></a></li> <li><a href="/crm/salesorder/search/"><strong><span class="glyphicon glyphicon-shopping-cart blue"></span> Orders</strong> </a></li> <li><a href="/crm/salesorder/calls/"> <strong><span class="glyphicon glyphicon-earphone"></span>Manage Calls</strong> </a></li> </ul> <ul class="nav navbar-nav navbar-right"> <li><a style="color:0099FF" href="/logout"><span class="glyphicon glyphicon-log-out"></span>Logout</a></li> </ul> </div> </div> </div> </nav> <div class="container" style="margin-top:50px;"> <form class="form-horizontal" method="post" action=""> <fieldset> <div id="edit_farmer" style="display:none"></div> <div class="row"> <div class="col-md-2 panel panel-heading">Contact Information</div> <div class="col-md-4 panel panel-heading" style="display:none; color:red" id="contact_error"></div> </div> <div class="row form-group"> <label class="col-md-2 control-label" for="mobile">Contact No.</label> <div class="col-md-3"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-phone"></i> </span> <input id="mobile" maxlength="10" name="mobile" placeholder="xxxxxxxxxxxx" class="form-control input-md ac_mobile" type="number" value={{mobile}} > </div> </div> <label class="col-md-1 control-label" for="sms">Language</label> <div class="col-md-3"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-list"></i> </span> <select id="sms" name="sms" class="form-control input-md"> <option value="en">English</option> <option value="gu">Gujarati</option> <option value="mr">Marathi</option> <option value="hi">Hindi</option> </select> </div> </div> <div class="col-md-1"> <a id="add_mobile" onclick=add_mobile()><i class="glyphicon glyphicon-plus"></i></a> </div> </div> <div class="row form-group"> <div class="col-md-8" id="mobile_numbers"></div> </div> <div class="row form-group"> <label class="col-md-1 control-label" for="first_name">First Name</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-user"></i> </span> <input id="first_name" name="first_name" placeholder="" class="form-control input-md" type="text"> </div></div> <label class="col-md-1 control-label" for="middle_name">Mid Name</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-user"></i> </span> <input id="middle_name" name="middle_name" placeholder="" class="form-control input-md" type="text"> </div> </div> <label class="col-md-1 control-label" for="last_name">Last Name</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-user"></i> </span> <input id="last_name" name="last_name" placeholder="" class="form-control input-md" type="text"> </div> </div> </div> <div class="row form-group"> <label class="col-md-2 control-label" for="farmer_type">Farmer Type</label> <div class="col-md-4"> <label class="radio-inline"><input type="radio" name="farmer_type" value="Farmer" checked>Farmer</label> <label class="radio-inline"><input type="radio" name="farmer_type" value="Politician">Politician</label> <label class="radio-inline"><input type="radio" name="farmer_type" value="Retailer">Retailer</label> <label class="radio-inline"><input type="radio" name="farmer_type" value="Supplier">Supplier</label> </div> <label class="col-md-1 control-label" for="description">Description</label> <div class="col-md-4"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-pencil"></i> </span> <textarea class="form-control" id="description" name="description" placeholder="Description"></textarea> </div></div> </div> <div class="form-group"> <label class="col-md-3 control-label" for="smartphone">Has Touchscreen Phone ?</label> <div class="col-md-3"> <label class="radio-inline"><input type="radio" name="smartphone" value=true>Yes</label> <label class="radio-inline"><input type="radio" name="smartphone" value=false>No</label> <label class="radio-inline"><input type="radio" name="smartphone" value=null checked>Don't Know</label> </select> </div> </div> <div class="row"> <div class="col-md-2 panel panel-heading">Address Information</div> <div class="col-md-4 panel panel-heading" style="display:none; color:red" id="address_error"></div> </div> <div class="row form-group"> <label class="col-md-2 control-label" for="village">Village</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-home"></i> </span> <input id="village" name="village" placeholder="" class="form-control input-md ac_village" required="" type="text"> </div> </div> <label class="col-md-1 control-label" for="state">State</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-list"></i> </span> <input id="state" name="state" placeholder="" class="form-control input-md ac_state" required="" type="text"> </div></div> <label class="col-md-1 control-label" for="district">District</label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-list"></i> </span> <input id="district" name="district" placeholder="" class="form-control input-md ac_district" required="" type="text"> </div> </div> </div> <div class="row form-group"> <label class="col-md-2 control-label" for="taluka">Taluka</label> <div class="col-md-2"> <input id="taluka" name="taluka" placeholder="" class="form-control input-md ac_taluka" required="" type="text"> </div> <label class="col-md-1 control-label" for="other_taluka">Other Taluka</label> <div class="col-md-2"> <input id="other_taluka" name="other_taluka" disabled="true" class="form-control input-md ac_taluka" type="text"> </div> <label class="col-md-1 control-label" for="post_office">Post Office</label> <div class="col-md-2"> <input id="post_office" name="post_office" placeholder="" class="form-control input-md ac_post_office" required="" type="text"> </div> </div> <div class="row form-group"> <label class="col-md-2 control-label" for="pin_code">Pin Code</label> <div class="col-md-2"> <input id="pin_code" name="pin_code" placeholder="" disabled="true" class="form-control input-md" required="" type="text"> </div> <label class="col-md-3 control-label" for="street_address">Address Line 1</label> <div class="col-md-5"> <div class="input-group"> <span class="input-group-addon"> <i class="glyphicon glyphicon-pencil"></i> </span> <textarea class="form-control" id="street_address" name="street_address" placeholder="Addess Details..."></textarea> </div> </div> </div> <div class="form-group row"> <div class="col-md-8 text-center"> <button id="save" name="save" class="btn btn-large btn-success"> Save Farmer Information</button> <button class="btn btn-large btn-danger" type="button" onclick=history.go(-1)> Cancel </button> </div> </div> </fieldset> </form> </div> <div class="b"> <div class="navbar navbar-default navbar-fixed-bottom"> <div class="container"> <p class="navbar-text pull-left">© 2016 - Site Built By <a href="http://www.nimbrisk.com">NimbriskTechnology.com</a> </p> <a href="" class="navbar-btn btn-danger btn-xs btn pull-right"> <span class="glyphicon glyphicon-star"></span>  Subscribe on YouTube</a> </div> </div> </div>
li:hover { background-color: #C8C8C8 ; } .blue { color: green; } form { padding-left: 20px; padding-right: 10px; } .b { margin-bottom:90px; }

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