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user_rep_insert_form.php
43 lines (41 loc) · 1.15 KB
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user_rep_insert_form.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Add Records Form</title>
</head>
<body>
<form action="user_rep_insertAPI.php" method="post">
<p>
<label for="lastName">REP_NAME</label>
<input type="text" name="rep_name" id="rep_name">
</p>
<p>
<label for="rep_mob_no">REP_MOB_NO</label>
<input type="text" name="rep_mob_no" id="rep_mob_no">
</p>
<p>
<label for="lastName">REP_WARD_NAME</label>
<input type="text" name="rep_ward_name" id="rep_ward_name">
</p>
<p>
<label for="lastName">REP_WARD_NO</label>
<input type="text" name="rep_ward_no" id="rep_ward_no">
</p>
<p>
<select name="lb_type">
<option value="dist_panch">District Panchayath</option>
<option value="grama_panch">Gramapanchayath</option>
<option value="block_panch">Block Panchayath</option>
<option value="muncp">Municipality</option>
<option value="corp">Corporation</option>
</select>
</p>
<p>
<label for="lastName">REP_LB_NAME</label>
<input type="text" name="rep_lb_name" id="rep_lb_name">
</p>
<input type="submit" value="Add Records">
</form>
</body>
</html>