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registerAgencySection.vue 4.0KB

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  1. <template>
  2. <!-- eslint-disable max-len -->
  3. <form method="POST">
  4. <div class="container" style="text-align:left">
  5. <div class="reg-page">
  6. <div class="regform" style="text-align:left">
  7. <h4>Agency Details</h4>
  8. <div class="col-md-8" style="margin-bottom: 1em">
  9. <eva-icon name="people" fill="#60CBEB"></eva-icon>
  10. <input class="form-control" type="text" name="agencyname" placeholder="Agency Name" />
  11. </div>
  12. <div class="col-md-8" style="margin-bottom: 1em">
  13. <eva-icon name="book" fill="lightgrey"></eva-icon>
  14. <input
  15. class="form-control"
  16. type="text"
  17. name="eaabffcnumber"
  18. placeholder="EAAB FFC Number"
  19. />
  20. </div>
  21. <div class="col-md-8">
  22. <eva-icon name="clipboard" fill="lightgrey"></eva-icon>
  23. <input
  24. class="form-control"
  25. type="text"
  26. name="companyregnumber"
  27. placeholder="Company Registration Number"
  28. />
  29. </div>
  30. <hr />
  31. <div class="col-md-10" style="text-align:left">
  32. <h5 style="margin-bottom: 1em">Agency Administrator</h5>
  33. <div class="row" style="text-align:left">
  34. <div class="col-md-6" style="margin-bottom: 1em">
  35. <eva-icon name="person" fill="#60CBEB"></eva-icon>
  36. <input class="form-control" type="text" name="name" placeholder="Name" />
  37. </div>
  38. <div class="col-md-6" style="margin-bottom: 1em">
  39. <eva-icon name="person" fill="#60CBEB"></eva-icon>
  40. <input class="form-control" type="text" name="surname" placeholder="Surname" />
  41. </div>
  42. </div>
  43. <div class="row" style="text-align:left">
  44. <div class="col-md-8">
  45. <eva-icon name="email" fill="lightgrey"></eva-icon>
  46. <input class="form-control" type="text" name="email" placeholder="Email Address" />
  47. <div class="form-group row"></div>
  48. </div>
  49. <div class="col-md-6" style="text-align:left">
  50. <eva-icon name="smartphone" fill="lightgrey"></eva-icon>
  51. <input
  52. class="form-control"
  53. type="text"
  54. name="cellnumber"
  55. placeholder="Contact Number"
  56. />
  57. </div>
  58. </div>
  59. <hr />
  60. <div class="row">
  61. <div class="col-md-7" style="margin-bottom: 1em">
  62. <eva-icon name="person" fill="#60CBEB"></eva-icon>
  63. <input class="form-control" type="text" name="username" placeholder="Username" />
  64. </div>
  65. <div class="col-md-7" style="margin-bottom: 1em">
  66. <eva-icon name="lock" fill="#60CBEB"></eva-icon>
  67. <input class="form-control" type="text" name="password" placeholder="Password" />
  68. </div>
  69. <div class="col-md-7" style="margin-bottom: 1em">
  70. <eva-icon name="lock" fill="#60CBEB"></eva-icon>
  71. <input
  72. class="form-control"
  73. type="text"
  74. name="confirmpassword"
  75. placeholder="Confirm Password"
  76. />
  77. </div>
  78. </div>
  79. </div>
  80. <div class="form-group row"></div>
  81. <div class="row offset-md-1">
  82. <div class="col-md-2">
  83. <button class="btn btn-b-n" type="submit">Submit</button>
  84. </div>
  85. <div class="col-md-2 offset-md-1">
  86. <button class="btn btn-b-n" type="submit">Cancel</button>
  87. </div>
  88. </div>
  89. </div>
  90. </div>
  91. </div>
  92. </form>
  93. </template>
  94. <script>
  95. import RegisterPage from './registerPage.vue';
  96. export default {
  97. data() {
  98. return {
  99. RegisterHeader: 'Agency Administrator Details',
  100. };
  101. },
  102. name: 'Agency',
  103. components: { RegisterPage },
  104. };
  105. </script>
  106. <style>
  107. .goDown {
  108. margin-top: 150px;
  109. }
  110. </style>