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claims.html
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<!DOCTYPE html>
<html lang="zxx">
<head>
<meta charset="UTF-8">
<meta name="description" content="Yoga Studio Template">
<meta name="keywords" content="Yoga, unica, creative, html">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<meta http-equiv="X-UA-Compatible" content="ie=edge">
<title>Local Directory | Template</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Bootstrap 4 DatePicker</title>
<script src="https://code.jquery.com/jquery-3.3.1.min.js"></script>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous">
<script src="https://unpkg.com/[email protected]/js/gijgo.min.js" type="text/javascript"></script>
<link href="https://unpkg.com/[email protected]/css/gijgo.min.css" rel="stylesheet" type="text/css" />
<!-- Google Font -->
<link href="https://fonts.googleapis.com/css?family=Lato:100,300,400,700,900&display=swap" rel="stylesheet">
<!-- Css Styles -->
<link rel="stylesheet" href="css/bootstrap.min.css" type="text/css">
<link rel="stylesheet" href="css/font-awesome.min.css" type="text/css">
<link rel="stylesheet" href="css/flaticon.css" type="text/css">
<link rel="stylesheet" href="css/nice-select.css" type="text/css">
<link rel="stylesheet" href="css/owl.carousel.min.css" type="text/css">
<link rel="stylesheet" href="css/magnific-popup.css" type="text/css">
<link rel="stylesheet" href="css/slicknav.min.css" type="text/css">
<link rel="stylesheet" href="css/style.css" type="text/css">
</head>
<body>
<!-- Page Preloder -->
<div id="preloder">
<div class="loader"></div>
</div>
<!-- Header Section Begin -->
<header class="header-section">
<div class="container-fluid">
<div class="logo">
<a href="./index.html"><img src="img/logo_edit.png" alt=""></a>
</div>
<div class ="logo">
<a href ="#"> </a>
</div>
<nav class="main-menu mobile-menu">
<ul>
<li><a href="index.html">Home</a></li>
<li class="active"><a href="claims.html">Claims</a></li>
<li><a href="status.html">Status</a></li>
<li><a href="policy.html">Policy</a></li>
<li><a href="contact.html">About Us</a></li>
</ul>
</nav>
<div id="mobile-menu-wrap"></div>
</div>
</header>
<!-- Header End -->
<!-- bg Section Begin -->
<section class="hero-section-claims set-bg" data-setbg="img/bg.jpg">
<div class="container">
<div class="row">
<div class="col-lg-12">
<div class="hero-text">
<h1>Claims System</h1>
</div>
</div>
</div>
</div>
</section>
<!-- bg Section End -->
<!--------style-->
<style>
* {
box-sizing: border-box;
}
body {
background-color: #f1f1f1;
}
#regForm {
background-color: #ffffff;
margin: 100px auto;
font-family: Raleway;
padding: 40px;
width: 70%;
min-width: 300px;
}
h1 {
text-align: center;
}
input {
padding: 10px;
width: 100%;
font-size: 17px;
font-family: Raleway;
border: 1px solid #aaaaaa;
}
/* Mark input boxes that gets an error on validation: */
input.invalid {
background-color: #ffdddd;
}
/* Hide all steps by default: */
.tab {
display: none;
}
button {
background-color: #4CAF50;
color: #ffffff;
border: none;
padding: 10px 20px;
font-size: 17px;
font-family: Raleway;
cursor: pointer;
}
button:hover {
opacity: 0.8;
}
#prevBtn {
background-color: none;
}
/* Make circles that indicate the steps of the form: */
.step {
height: 15px;
width: 15px;
margin: 0 2px;
background-color: #bbbbbb;
border: none;
border-radius: 50%;
display: inline-block;
opacity: 0.5;
}
.step.active {
opacity: 1;
}
/* Mark the steps that are finished and valid: */
.step.finish {
background-color: #4CAF50;
}
</style>
<!--------style End-->
<!--------js-->
<script>
var currentTab = 0; // Current tab is set to be the first tab (0)
showTab(currentTab); // Display the current tab
function showTab(n) {
// This function will display the specified tab of the form...
var x = document.getElementsByClassName("tab");
x[n].style.display = "block";
//... and fix the Previous/Next buttons:
if (n == 0) {
document.getElementById("prevBtn").style.display = "none";
} else {
document.getElementById("prevBtn").style.display = "inline";
}
if (n == (x.length - 1)) {
document.getElementById("nextBtn").innerHTML = "Submit";
} else {
document.getElementById("nextBtn").innerHTML = "Next";
}
//... and run a function that will display the correct step indicator:
fixStepIndicator(n)
}
function nextPrev(n) {
// This function will figure out which tab to display
var x = document.getElementsByClassName("tap");
// Exit the function if any field in the current tab is invalid:
if (n == 1 && !validateForm()) return false; /************change here from false********/
// Hide the current tab:
x[currentTab].style.display = "none";
// Increase or decrease the current tab by 1:
currentTab = currentTab + n;
// if you have reached the end of the form...
if (currentTab >= x.length) {
// ... the form gets submitted:
document.getElementById("regForm").submit();
return false;
}
// Otherwise, display the correct tab:
showTab(currentTab);
}
function validateForm() {
// This function deals with validation of the form fields
var x, y, i, valid = true;
x = document.getElementsByClassName("tap");
y = x[currentTab].getElementsByTagName("input");
// A loop that checks every input field in the current tab:
for (i = 0; i < y.length; i++) {
// If a field is empty...
if (y[i].value == "") {
// add an "invalid" class to the field:
y[i].className += " invalid";
// and set the current valid status to false
valid = false;
}
}
// If the valid status is true, mark the step as finished and valid:
if (valid) {
document.getElementsByClassName("step")[currentTab].className += " finish";
}
return valid; // return the valid status
}
function fixStepIndicator(n) {
// This function removes the "active" class of all steps...
var i, x = document.getElementsByClassName("step");
for (i = 0; i < x.length; i++) {
x[i].className = x[i].className.replace(" active", "");
}
//... and adds the "active" class on the current step:
x[n].className += " active";
}
</script>
<!--------js End-->
<!-- Contact Section Begin -->
<form id="regForm" action="">
<div class="col-lg-12 text-lg-right">
<h5>fill every filed that have asterisk</h5>
<samll>กรอกทุกจุดที่มีดอกจัน</small>
</div>
<!-- One "tab" for each step in the form: -->
<div class="tab">
<div class="col-lg-12 form-group">
<label for="validationCustomCusCode">Customer code (รหัสลูกค้า) <i class="fa fa-asterisk" aria-hidden="true"></i></label>
<div class ="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend">@</i></span>
</div>
<input type="text" class = "form-control" id="validationCustomCusCode" placeholder="" style="text-transform: uppercase" required>
<div class="invalid-feedback">
Please input customer code.
</div>
</div>
<small id="helpId" class="text-muted">
<i class="fas fa-engine-warning">
do not fill @ - ไม่ต้องเติม @
</i>
</small>
</div>
<div class="col-lg-12 form-group">
<label for="validationCustomEngName">Name - Surname (ชื่อ-นามสกุล) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label>
<div class ="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><i class="fa fa-user-circle" aria-hidden="true"></i></span>
</div>
<input type="text" class = "form-control" id="validationCustomEngName" placeholder="" style="text-transform: uppercase" required>
<div class="invalid-feedback">
Please input your name.
</div>
</div>
<small id="helpId" class="text-muted">
<i class="fas fa-engine-warning">
name before surname and do not fill name title- ชื่อก่อนนามสกุลไม่ต้องเติมคำนำหน้าชื่อ
</i>
</small>
</div>
<div class="col-lg-12 form-group">
<label for="validationCustomTel">Contact number (เบอร์โทรที่ติดต่อได้) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label>
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><i class="fa fa-tablet" aria-hidden="true"></i></span>
</div>
<input type="number" class="form-control" id="validationCustomTel" placeholder="xxxxxxxxxx" required>
<div class="invalid-feedback">
Please input number.
</div>
</div>
<small id="helpId" class="text-muted">
<i class="fas fa-engine-warning">
do not use hyphen - พิมพ์ติดกันทั้งบรรทัดไม่ต้องเติมยัติภังค์ (-)
</i>
</small>
</div>
<div class="col-lg-12">
<div class="input-group-prepend">
<span class="input-group-text"><i class="fa fa-address-card" aria-hidden="true"></i><label for="validationCustomUsername"> present address (ที่อยู่ที่สามารถติดต่อได้) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label></span>
</div>
<input type="text" class="form-control" id="validationCustomAdd" placeholder="" required>
<div class="invalid-feedback">
Please input your address.
</div>
<small id="helpId" class="text-muted">
<i class="fas fa-engine-warning">
do not forget to fill postal code after address - ใส่รหัสไปรษณีย์ด้วย
</i>
</small>
</div>
<!--เพิ่มเติมม-เป็นช่องข้อมูลที่แก้ไขได้-->
</div>
<div class="tab">
<div class="col-lg-12">
<div class="input-group-prepend">
<span class="input-group-text"><i class="fas fa-shopping-cart "></i><label for="validationCustomDate"> Bought date (วันที่ซื้อสินค้า) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label></span>
</div>
<input id="datepicker" width="276" />
<script>
$('#datepicker').datepicker({
uiLibrary: 'bootstrap4'
});
</script>
</div>
<div class ="col-lg-12">
<div class="input-group-prepend">
<span class="input-group-text"><i class="fa fa-desktop" aria-hidden="true"></i><label for="validationCustomModel"> Model (รุ่น) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label></span>
</div>
<input type="text" class="form-control" id="validationCustomModel" placeholder="" required>
</div>
<div class ="col-lg-12">
<div class="input-group-prepend">
<span class="input-group-text"><i class="fa fa-eyedropper" aria-hidden="true"></i><label for="validationCustomColor"> Color (สี) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label></span>
</div>
<input type="text" class="form-control" id="validationCustomColor" placeholder="" required>
</div>
<div class ="col-lg-12">
<div class="input-group-prepend">
<span class="input-group-text"><span class="glyphicon glyphicon-remove"></span><label for="validationCustomColor"> Out of order (อาการเสีย) <i class="fa fa-asterisk" aria-hidden="true"></i></label></label></span>
</div>
<input type="text" class="form-control" id="validationCustomColor" placeholder="" required>
</div>
<!--เพิ่มเติมม--หน้านี้ให้กรอกแค่วันที่กับอาการเสียเพิ่ม drop down ของเลขใบเคลมที่ดึงมาจาก db -->
</div>
<div class="tab">Birthday:
<!--เพิ่มเติมม---ใช้ข้อมูลทั้งหมดจาก db ใส่กรอบแบบ disable-->
</div>
<div class="tab">Login Info:
<!--เพิ่มเติมม--popup ยืนยันว่าได้รับข้อมูลแล้ว-->
</div>
<div style="overflow:auto;">
<div style="float:right;">
<button type="button" id="prevBtn" onclick="nextPrev(-1)">Previous</button>
<button type="button" id="nextBtn" onclick="nextPrev(1)">Next</button>
<!--เพิ่มเติมม--เชื่อม submit กับไปหน้าจอหลัก ถ้าเป็นไปได้อยากให้ถ้าไม่กรอกข้อมูลตรงไหนจะเด้งกลับไปตรงนั้น-->
</div>
</div>
<!-- Circles which indicates the steps of the form: -->
<div style="text-align:center;margin-top:40px;">
<span class="step"></span>
<span class="step"></span>
<span class="step"></span>
<span class="step"></span>
</div>
</form>
<!-- Contact Section End -->
<!-- Footer Section Begin -->
<footer class="footer-section spad">
<div class="container">
<div class="row">
<div class="col-lg-12">
<form action="#" class="newslatter-form">
<input type="text" placeholder="Your email address">
<button type="submit">Subscribe to our Newsletter</button>
</form>
</div>
</div>
<div class="row">
<div class="col-lg-3 col-sm-6">
<div class="footer-widget">
<h4>Usefull Links</h4>
<ul>
<li>About us</li>
<li>Testimonials</li>
<li>How it works</li>
<li>Create an account</li>
<li>Our Services</li>
</ul>
</div>
</div>
<div class="col-lg-3 col-sm-6">
<div class="footer-widget">
<h4>Categories</h4>
<ul>
<li>Hotels</li>
<li>Restaurant</li>
<li>Spa & resorts</li>
<li>Concert & Events</li>
<li>Bars & Pubs</li>
</ul>
</div>
</div>
<div class="col-lg-3 col-sm-6">
<div class="footer-widget">
<h4>Usefull Links</h4>
<ul>
<li>About us</li>
<li>Testimonials</li>
<li>How it works</li>
<li>Create an account</li>
<li>Our Services</li>
</ul>
</div>
</div>
<div class="col-lg-3 col-sm-6">
<div class="footer-widget">
<h4>From the Blog</h4>
<div class="single-blog">
<div class="blog-pic">
<img src="img/f-blog-1.jpg" alt="">
</div>
<div class="blog-text">
<h6>10 Best clubs in town</h6>
<span>March 27, 2019</span>
</div>
</div>
<div class="single-blog">
<div class="blog-pic">
<img src="img/f-blog-2.jpg" alt="">
</div>
<div class="blog-text">
<h6>10 Best clubs in town</h6>
<span>March 27, 2019</span>
</div>
</div>
</div>
</div>
</div>
<div class="row footer-bottom">
<div class="col-lg-5 order-2 order-lg-1">
<div class="copyright"><p class="text-white">
<!-- Link back to Colorlib can't be removed. Template is licensed under CC BY 3.0. -->
Copyright ©<script>document.write(new Date().getFullYear());</script> All rights reserved | This template is made with <i class="fa fa-heart" aria-hidden="true"></i> by <a href="https://colorlib.com" target="_blank" >Colorlib</a>
<!-- Link back to Colorlib can't be removed. Template is licensed under CC BY 3.0. -->
</p></div>
</div>
<div class="col-lg-7 text-center text-lg-right order-1 order-lg-2">
<div class="footer-menu">
<a href="#">Home</a>
<a href="#">Explore</a>
<a href="#">More Cities</a>
<a href="#">News</a>
<a href="#">Contact</a>
</div>
</div>
</div>
</div>
</footer>
<!-- Footer Section End -->
<!-- Js Plugins -->
<script src="js/jquery-3.3.1.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/jquery.magnific-popup.min.js"></script>
<script src="js/jquery.slicknav.js"></script>
<script src="js/owl.carousel.min.js"></script>
<script src="js/jquery.nice-select.min.js"></script>
<script src="js/mixitup.min.js"></script>
<script src="js/main.js"></script>
<script src="js/step-form.js"></script>
</body>
</html>