forked from mirrors/easyappointments
119 lines
5.3 KiB
PHP
119 lines
5.3 KiB
PHP
<div id="wizard-frame-3" class="wizard-frame" style="display:none;">
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<div class="frame-container">
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<h2 class="frame-title"><?= lang('customer_information') ?></h2>
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<div class="row frame-content">
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<div class="col-12 col-md-6">
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<div class="form-group">
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<label for="first-name" class="control-label">
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<?= lang('first_name') ?>
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<span class="text-danger">*</span>
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</label>
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<input type="text" id="first-name" class="required form-control" maxlength="100"/>
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</div>
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<div class="form-group">
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<label for="last-name" class="control-label">
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<?= lang('last_name') ?>
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<span class="text-danger">*</span>
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</label>
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<input type="text" id="last-name" class="required form-control" maxlength="120"/>
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</div>
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<div class="form-group">
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<label for="email" class="control-label">
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<?= lang('email') ?>
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<span class="text-danger">*</span>
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</label>
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<input type="text" id="email" class="required form-control" maxlength="120"/>
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</div>
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<?php if ($show_field['phone-number']) : ?>
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<div class="form-group">
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<label for="phone-number" class="control-label">
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<?= lang('phone_number') ?>
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<?= $require_phone_number === '1' ? '<span class="text-danger">*</span>' : '' ?>
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</label>
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<input type="text" id="phone-number" maxlength="60"
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class="<?= $require_phone_number === '1' ? 'required' : '' ?> form-control"/>
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</div>
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<?php endif; ?>
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</div>
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<div class="col-12 col-md-6">
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<?php if ($show_field['address']) : ?>
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<div class="form-group">
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<label for="address" class="control-label">
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<?= lang('address') ?>
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</label>
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<input type="text" id="address" class="form-control" maxlength="120"/>
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</div>
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<?php endif; ?>
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<?php if ($show_field['city']): ?>
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<div class="form-group">
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<label for="city" class="control-label">
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<?= lang('city') ?>
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</label>
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<input type="text" id="city" class="form-control" maxlength="120"/>
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</div>
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<?php endif; ?>
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<?php if ($show_field['zip-code']) : ?>
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<div class="form-group">
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<label for="zip-code" class="control-label">
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<?= lang('zip_code') ?>
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</label>
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<input type="text" id="zip-code" class="form-control" maxlength="120"/>
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</div>
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<?php endif; ?>
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<?php if ($show_field['notes']) : ?>
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<div class="form-group">
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<label for="notes" class="control-label">
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<?= lang('notes') ?>
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</label>
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<textarea id="notes" maxlength="500" class="form-control" rows="1"></textarea>
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</div>
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<?php endif; ?>
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</div>
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</div>
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</div>
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<?php if ($display_terms_and_conditions): ?>
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<div class="form-check mb-3">
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<input type="checkbox" class="required form-check-input" id="accept-to-terms-and-conditions">
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<label class="form-check-label" for="accept-to-terms-and-conditions">
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<?= strtr(lang('read_and_agree_to_terms_and_conditions'),
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[
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'{$link}' => '<a href="#" data-toggle="modal" data-target="#terms-and-conditions-modal">',
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'{/$link}' => '</a>'
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])
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?>
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</label>
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</div>
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<?php endif ?>
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<?php if ($display_privacy_policy): ?>
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<div class="form-check mb-3">
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<input type="checkbox" class="required form-check-input" id="accept-to-privacy-policy">
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<label class="form-check-label" for="accept-to-privacy-policy">
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<?= strtr(lang('read_and_agree_to_privacy_policy'),
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[
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'{$link}' => '<a href="#" data-toggle="modal" data-target="#privacy-policy-modal">',
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'{/$link}' => '</a>'
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])
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?>
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</label>
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</div>
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<?php endif ?>
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<div class="command-buttons">
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<button type="button" id="button-back-3" class="btn button-back btn-outline-secondary"
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data-step_index="3">
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<i class="fas fa-chevron-left mr-2"></i>
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<?= lang('back') ?>
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</button>
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<button type="button" id="button-next-3" class="btn button-next btn-dark"
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data-step_index="3">
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<?= lang('next') ?>
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<i class="fas fa-chevron-right ml-2"></i>
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</button>
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</div>
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</div>
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