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141 lines
6.2 KiB

3 years ago
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  1. <!DOCTYPE html>
  2. <html xmlns:th="http://www.thymeleaf.org">
  3. <head>
  4. <title>Document Form</title>
  5. <!-- Include Bootstrap CSS for styling (optional) -->
  6. <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous">
  7. </head>
  8. <body>
  9. <!-- <div class="container mt-5">
  10. <div class="text-center">
  11. <h2>Circular - New</h2>
  12. </div> -->
  13. <div class="main-content">
  14. <div class="container-fluid">
  15. <div class="page-header">
  16. <div class="row align-items-end">
  17. <div class="col-lg-8">
  18. <div class="page-header-title">
  19. <i class="far fa-calendar-plus bg-blue"></i>
  20. <div class="d-inline">
  21. <h5>Circular - New</h5>
  22. <!-- <span>1913 Tax Collection Module</span> -->
  23. </div>
  24. </div>
  25. </div>
  26. <!-- <div class="col-lg-4">
  27. <nav class="breadcrumb-container" aria-label="breadcrumb">
  28. <ol class="breadcrumb">
  29. <li class="breadcrumb-item">
  30. <a href="index"><i class="ik ik-home"></i></a>
  31. </li>
  32. <li class="breadcrumb-item" aria-current="page">1913 Tax Collection</li>
  33. <li class="breadcrumb-item active" aria-current="page">Create Request</li>
  34. </ol>
  35. </nav>
  36. </div> -->
  37. </div>
  38. </div>
  39. <hr>
  40. <div class="row" >
  41. <div class="col-md-6">
  42. <div class="card">
  43. <form action="/submit" method="post" enctype="multipart/form-data">
  44. <div class="form-group">
  45. <label for="documentCategory">Document Category:</label>
  46. <div class="form-check form-check-inline">
  47. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1">
  48. <label class="form-check-label" for="inlineRadio1">Common</label>
  49. </div>
  50. <div class="form-check form-check-inline">
  51. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2">
  52. <label class="form-check-label" for="inlineRadio2">Flood</label>
  53. </div>
  54. </div>
  55. <div class="form-group">
  56. <label for="documentCategory">Type:</label>
  57. <div class="form-check form-check-inline">
  58. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1">
  59. <label class="form-check-label" for="inlineRadio1">Circular</label>
  60. </div>
  61. <div class="form-check form-check-inline">
  62. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2">
  63. <label class="form-check-label" for="inlineRadio2">Minutes</label>
  64. </div>
  65. <div class="form-check form-check-inline">
  66. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1">
  67. <label class="form-check-label" for="inlineRadio1">Regular Report</label>
  68. </div>
  69. <div class="form-check form-check-inline">
  70. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2">
  71. <label class="form-check-label" for="inlineRadio2">Rainfall Report</label>
  72. </div>
  73. </div>
  74. <div class="form-group">
  75. <label for="department" class="col-sm-3 col-form-label">From Department:</label>
  76. <div class="col-sm-9">
  77. <select class="form-control" id="department" name="department">
  78. <option th:each="dep : ${departments}" th:value="${dep}" th:text="${dep}"></option>
  79. </select>
  80. </div>
  81. </div>
  82. <div class="form-group">
  83. <label for="date">Date:</label>
  84. <input type="date" class="form-control" id="date" name="date" required>
  85. </div>
  86. <div class="form-group">
  87. <label for="documentCategory">SMS:</label>
  88. <div class="form-check form-check-inline">
  89. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1">
  90. <label class="form-check-label" for="inlineRadio1">Send</label>
  91. </div>
  92. <div class="form-check form-check-inline">
  93. <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2">
  94. <label class="form-check-label" for="inlineRadio2">Not Send</label>
  95. </div>
  96. </div>
  97. <div class="form-group">
  98. <label for="smsSubject" class="col-sm-3 col-form-label">SMS Subject:</label>
  99. <div class="col-sm-9">
  100. <input type="text" class="form-control" id="smsSubject" name="smsSubject" required>
  101. </div>
  102. </div>
  103. <div class="form-group">
  104. <label for="subject" class="col-sm-3 col-form-label">Subject:</label>
  105. <div class="col-sm-9">
  106. <input type="text" class="form-control" id="subject" name="subject" required>
  107. </div>
  108. </div>
  109. <div class="form-group">
  110. <label for="file">Select File:</label>
  111. <input type="file" class="form-control-file" id="file" name="file" required>
  112. </div>
  113. <button type="submit" class="btn btn-primary">Submit</button>
  114. </form>
  115. </div>
  116. </div>
  117. </div>
  118. </div>
  119. </div>
  120. <!-- Include Bootstrap JS for button group styling (optional) -->
  121. <script src="https://code.jquery.com/jquery-3.2.1.slim.min.js"></script>
  122. <script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.12.9/umd/popper.min.js"></script>
  123. <script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/js/bootstrap.min.js"></script>
  124. </body>
  125. </html>