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- <template>
- <!-- eslint-disable max-len -->
- <form method="POST">
- <div class="container" style="text-align:left">
- <div class="reg-page">
- <div class="regform" style="text-align:left">
- <h4>Agency Details</h4>
- <div class="col-md-8" style="margin-bottom: 1em">
- <eva-icon name="people" fill="#60CBEB"></eva-icon>
- <input class="form-control" type="text" name="agencyname" placeholder="Agency Name" />
- </div>
- <div class="col-md-8" style="margin-bottom: 1em">
- <eva-icon name="book" fill="lightgrey"></eva-icon>
- <input
- class="form-control"
- type="text"
- name="eaabffcnumber"
- placeholder="EAAB FFC Number"
- />
- </div>
- <div class="col-md-8">
- <eva-icon name="clipboard" fill="lightgrey"></eva-icon>
- <input
- class="form-control"
- type="text"
- name="companyregnumber"
- placeholder="Company Registration Number"
- />
- </div>
- <hr />
- <div class="col-md-10" style="text-align:left">
- <h5 style="margin-bottom: 1em">Agency Administrator</h5>
- <div class="row" style="text-align:left">
- <div class="col-md-6" style="margin-bottom: 1em">
- <eva-icon name="person" fill="#60CBEB"></eva-icon>
- <input class="form-control" type="text" name="name" placeholder="Name" />
- </div>
- <div class="col-md-6" style="margin-bottom: 1em">
- <eva-icon name="person" fill="#60CBEB"></eva-icon>
- <input class="form-control" type="text" name="surname" placeholder="Surname" />
- </div>
- </div>
-
- <div class="row" style="text-align:left">
- <div class="col-md-8">
- <eva-icon name="email" fill="lightgrey"></eva-icon>
- <input class="form-control" type="text" name="email" placeholder="Email Address" />
- <div class="form-group row"></div>
- </div>
-
- <div class="col-md-6" style="text-align:left">
- <eva-icon name="smartphone" fill="lightgrey"></eva-icon>
- <input
- class="form-control"
- type="text"
- name="cellnumber"
- placeholder="Contact Number"
- />
- </div>
- </div>
- <hr />
- <div class="row">
- <div class="col-md-7" style="margin-bottom: 1em">
- <eva-icon name="person" fill="#60CBEB"></eva-icon>
- <input class="form-control" type="text" name="username" placeholder="Username" />
- </div>
- <div class="col-md-7" style="margin-bottom: 1em">
- <eva-icon name="lock" fill="#60CBEB"></eva-icon>
- <input class="form-control" type="text" name="password" placeholder="Password" />
- </div>
- <div class="col-md-7" style="margin-bottom: 1em">
- <eva-icon name="lock" fill="#60CBEB"></eva-icon>
- <input
- class="form-control"
- type="text"
- name="confirmpassword"
- placeholder="Confirm Password"
- />
- </div>
- </div>
- </div>
- <div class="form-group row"></div>
- <div class="row offset-md-1">
- <div class="col-md-2">
- <button class="btn btn-b-n" type="submit">Submit</button>
- </div>
- <div class="col-md-2 offset-md-1">
- <button class="btn btn-b-n" type="submit">Cancel</button>
- </div>
- </div>
- </div>
- </div>
- </div>
- </form>
- </template>
-
- <script>
- import RegisterPage from './registerPage.vue';
-
- export default {
- data() {
- return {
- RegisterHeader: 'Agency Administrator Details',
- };
- },
- name: 'Agency',
- components: { RegisterPage },
- };
- </script>
-
- <style>
- .goDown {
- margin-top: 150px;
- }
- </style>
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