Created
October 26, 2019 15:42
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<!DOCTYPE html> | |
<html lang="en"> | |
<head> | |
<title>Bootstrap Example</title> | |
<meta charset="utf-8"> | |
<meta name="viewport" content="width=device-width, initial-scale=1"> | |
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.4.0/css/bootstrap.min.css"> | |
</head> | |
<body> | |
<div class="container"> | |
<h2>Purchase Order Item form</h2> | |
<div class="row"> | |
<div class="col-md-6"> | |
<div class="form-group"> | |
<label for="Title">Title:</label> | |
<input type="text" class="form-control" placeholder="Enter Title" name="Title"> | |
</div> | |
</div> | |
<div class="col-md-6"> | |
<div class="form-group"> | |
<label for="fullName">Full Name:</label> | |
<input type="text" class="form-control" placeholder="Enter Full Name" name="fullName"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<label for="street">Street Address:</label> | |
<input type="text" class="form-control" placeholder="123 Main Street" name="street"> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label for="Appartment">Appartment/Room #:</label> | |
<input type="text" class="form-control" placeholder="Appartment #" name="Appartment"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-4"> | |
<div class="form-group"> | |
<label for="city">City:</label> | |
<input type="text" class="form-control" placeholder="Enter City" name="city"> | |
</div> | |
</div> | |
<div class="col-md-4"> | |
<div class="form-group"> | |
<label for="state">State:</label> | |
<select class="form-control" name="state"> | |
<option value="">Select State --</option> | |
</select> | |
</div> | |
</div> | |
<div class="col-md-4"> | |
<div class="form-group"> | |
<label for="zip">Zip Code:</label> | |
<input type="text" class="form-control" placeholder="Zip Code" name="zip"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-12"> | |
<div class="checkbox"> | |
<label><input type="checkbox" name="remember" checked> Is Billing Address Same</label> | |
</div> | |
</div> | |
<div class="col-md-12 hidden"> | |
<div class="form-group"> | |
<label for="billing">Billing Address:</label> | |
<textarea class="form-control" rows="3" name="billing" placeholder="Billing Address"></textarea> | |
</div> | |
</div> | |
<div class="col-sm-12"> | |
<button type="submit" class="btn btn-primary float-right">Submit</button> | |
<button type="submit" class="btn btn-secondary float-right">Cancel</button> | |
</div> | |
</div> | |
</div> | |
</body> | |
</html> |
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