Viewing file:  provider_form.php (4.03 KB) -rw-r--r--
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<?
$this->load->view('cpanel/header');
?>
<script src="<?=base_url()?>js/jquery.validationEngine-en.js" type="text/javascript"></script>
<script src="<?=base_url()?>js/jquery.validationEngine.js" type="text/javascript"></script>
<script>
$(document).ready(function() {
$("#formID").validationEngine()
//$.validationEngine.loadValidation("#date")
//alert($("#formID").validationEngine({returnIsValid:true}))
//$.validationEngine.buildPrompt("#date","This is an example","error") // Exterior prompt build example
//$.validationEngine.closePrompt(".formError",true) // CLOSE ALL OPEN PROMPTS
});
</script>
<form id="formID" method="post" action="<?=site_url('gateway/addEditProvider')?>">
<input type='hidden' name='id' id='id' value='<?= $id; ?>' >
<input type='hidden' name='action' id='action' value='<?= $action; ?>' >
<table width="80%" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td colspan="2" valign="top" style="padding-top:20px;">
<img src="<?=base_url()?>images/s.gif" width="600" height="1" border="0" alt="" />
<div id="module_info">
<span>»</span> <?=$titleMessage?> <?=$titleErrorMessage?> </div>
</td>
</tr>
<tr>
<td colspan="2" valign="top" style="padding-top:10px;padding-right:5px;">
<!-- Account Information -->
<table width="100%" class="tableBorder" border="0" cellpadding="2" cellspacing="2">
<tr>
<td colspan="2" class="mainTableTitle"><?=TITLE029?></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%' style='padding-top:10px;'> Provider Name : </td>
<td class='formLabelLeft' width='70%' style='padding-top:10px;'><input type='text' class='validate[required,length[6,30]] formInput' name='provider_name' id='provider_name' style='width:200px;' value='<?= $provider_name; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Description : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='description' id='description' style='width:200px;' value='<?= $description; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Contact Name : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='contact_name' id='contact_name' style='width:200px;' value='<?= $contact_name; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Contact Email : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='contact_email' id='contact_email' style='width:200px;' value='<?= $contact_email; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Contact Phone : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='contact_phone' id='contact_phone' style='width:200px;' value='<?= $contact_phone; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Office Phone : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='office_phone' id='office_phone' style='width:200px;' value='<?= $office_phone; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Office Email : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='office_email' id='office_email' style='width:200px;' value='<?= $office_email; ?>' /></td>
</tr>
<tr>
<td class='formLabelRigit' width='30%'> Address : </td>
<td class='formLabelLeft' width='70%'><input type='text' class='formInput' name='office_address' id='office_address' style='width:200px;' value='<?= $office_address; ?>' /></td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="2" align="center" style="padding:15px;"><input type="submit" class="submit_but" name="submit" value="<?= $action == 'Add' ? " Submit Now " : "Edit Now" ?>" class="input-submit" /></td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td> </td>
</tr>
</table>
</form>
<?
$this->load->view('cpanel/left_nemu');
$this->load->view('cpanel/footer');
?>
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