<%-include('header')-%>
<script>
        function passwordconfirm(){
        var x=document.forms["registration"]["Customer_password"].value;
        var y=document.forms["registration"]["Customer_confirm_password"].value;
        var z=document.forms["registration"]["Customer_contact_no"].value;
        
            if(x==y){
                var phoneno = /[7-9]{1}[0-9]{9}/ ;
                    if((z.match(phoneno)))
                    {
                        alert("Registred Successfully");
                        return true;
                    }
                    else
                    {
                    alert("Contact Number should be 10 letters");
                    return false;
                    }
                
             }
            else{
                alert("password don't match");
               return false;
            }
        }
 </script>
 <div class="main-panel">
     <div class="content-wrapper">
     <div class="row">
         <div class="col-lg-12">
             <div class="card">
             <div class="card-body">
                 <h4 class="card-title">Customer Form</h4>
                 <form name="registration"  method="POST"   onsubmit="return(passwordconfirm());">
                        <label for="Customer_id" class=" form-control-label">Customer_id</label>
                        <input type="text" placeholder="Enter Customer_Id" name="Customer_id" class="form-control" required />
                        <label for="Customer_name" class=" form-control-label">Customer Name</label>
                        <input type="text" placeholder="Enter Customer Name" name="Customer_name"class="form-control" required />
                        
                        <label for="Customer_contact_no" class=" form-control-label">Contact Number</label>
                        <input type="text" placeholder="Enter Contact Number" name="Customer_contact_no" class="form-control" required />
                        
                        <label for="Customer_email" class=" form-control-label">Email</label>
                        <input type="email" placeholder="Enter Email" name="Customer_email" class="form-control" required />
                        
                        <label for="Customer_address" class=" form-control-label">Customer_address</label>
                        <textarea type="text" placeholder="Enter your Address" name="Customer_address" class="form-control" required></textarea>
                        
                        <label for="Customer_password" class=" form-control-label">Password</label>
                        <input type="text" name="Customer_password"  placeholder="Enter Password" class="form-control" required />
                        
                        <label for="Customer_confirm_password" class=" form-control-label">Confirm Password</label>
                        <input type="text" name="Customer_confirm_password"placeholder="Confirm Password" class="form-control"  required />
                        
                        
                        <label for="Customer_dob" class=" form-control-label">Date Of Birth</label>
                        <input type="date"  name="Customer_dob"class="form-control"  required />
                        <div class="col-md-6">
                            <div class="form-group row">
                              <label class="col-sm-3 col-form-label">Gender</label>
                              <div class="col-sm-4">
                                <div class="form-check">
                                  <label class="form-check-label">
                                    <input type="radio" class="form-check-input" name="Customer_gender" value="Male" checked>
                                    Male
                                  </label>
                                </div>
                              </div>
                              <div class="col-sm-4">
                                <div class="form-check">
                                  <label class="form-check-label">
                                    <input type="radio" class="form-check-input"  name="Customer_gender" id="membershipRadios2" value="Female">
                                    Female
                                  </label>
                                </div>
                              </div>
                            </div>
                          </div>
                        <button type="submit" class="btn btn-primary btn-sm">
                            <i class="fa fa-dot-circle-o"></i> Submit
                        </button>
                        <button type="reset" class="btn btn-danger btn-sm">
                            <i class="fa fa-ban"></i> Reset
                        </button>
                        </form>
             </div>
             </div>
         </div>
     </div>
 </div>
     <!-- content-wrapper ends -->
     <!-- partial:../../partials/_footer.html -->
     <footer class="footer">
 <div class="d-sm-flex justify-content-center justify-content-sm-between">
         <span class="text-muted text-center text-sm-left d-block d-sm-inline-block">Copyright Â© 2018 <a href="https://www.urbanui.com/" target="_blank">Urbanui</a>. All rights reserved.</span>
         <span class="float-none float-sm-right d-block mt-1 mt-sm-0 text-center">Hand-crafted & made with <i class="mdi mdi-heart text-danger"></i></span>
 </div>
     </footer>
     <!-- partial -->
 </div>
 <!-- main-panel ends -->
 </div>
 <!-- page-body-wrapper ends -->
</div>
<!-- container-scroller -->
<!-- plugins:js -->
<script src="/vendors/js/vendor.bundle.base.js"></script>
<script src="/vendors/js/vendor.bundle.addons.js"></script>
<!-- endinject -->
<!-- inject:js -->
<script src="/js/off-canvas.js"></script>
<script src="/js/hoverable-collapse.js"></script>
<script src="/js/misc.js"></script>
<script src="/js/settings.js"></script>
<script src="/js/todolist.js"></script>
<!-- endinject -->
<!-- Custom js for this page-->
<script src="/js/form-validation.js"></script>
<script src="/js/bt-maxLength.js"></script>
<!-- End custom js for this page-->
</body>
<!-- Mirrored from www.urbanui.com/gleam/pages/forms/validation.html by HTTrack Website Copier/3.x [XR&CO'2014], Mon, 10 Sep 2018 06:27:19 GMT -->
</html>