<?php include 'header1f.php';?>
  <div class="content-page">
    <div class="content">
      <div class="container">
	  <div class="row">
          <div class="col-sm-12">
            <div class="page-header-title">
            <button type="button" class="btn btn-dark waves-effect waves-light" onclick="location.href='qtn_status.php'">BACK </button>
              <div class="clearfix"></div>
            </div>
          </div>
        </div>
	  <? 
$sql = mysql_query("select * from customer_master where customer_id = '".$_REQUEST['customer_id']."' "); 
while($row = mysql_fetch_array($sql))
{
$customer_name = $row['customer_name'];
$id = $row['id'];
$address = $row['address'];	
}?> 
	<form name="frmdetail" action="insert_contacts.php" method="post" onSubmit="return executeOnSubmit();">	 
<input type="hidden" name="customer_id" value="<?php echo $_REQUEST['customer_id']?>" >
<input type="hidden" name="id" value="<? echo $id?>" >


                    
					<div class="row">
                        <div class="col-sm-12">
                            <div class="panel panel-primary">
                                <div class="panel-heading">
                                    <h3 class="panel-title">Contact Details</h3></div>
                                <div class="panel-body">
                                    <div class="row">
                                                    <div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Saul</label>
                                                      <select class="form-control" name="saul" id="saul" onChange="setGenderNew()">
																	    	<option selected="selected" value=""></option>
																	        <option value="Mr.">Mr.</option>
															                <option value="Ms.">Ms.</option>
															                <option value="Mrs.">Mrs.</option>
															                <option value="Dr.">Dr.</option>
															                <option value="Prof.">Prof.</option>
															                
															                
														                </select>
                                                    </div>
													</div>
													
											
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Name</label>
                                                     <input class="form-control" id="name" name="name" type="text" >
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Gender</label>
                                                           
														<select class="form-control" id="gender" name="gender">
																		    	<option selected="selected" value=""></option>
																		         <option value="Male">Male</option>
																			     <option value="Female">Female</option>
															                </select>
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Department</label>
                                                        <input class="form-control" id="department" name="department" type="text">
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Designation</label>
                                                        	<input class="form-control" id="designation" name="designation" type="text">
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Contact Types</label>
                                                         <select class="form-control" name="contact_types" id="contact_types">
																    <option selected="selected"> </option>
													                
																	<option value="Decision Maker">Decision Maker</option>
																	
																	<option value="Influencer">Influencer</option>
																	
																	<option value="Recommender">Recommender</option>
																	
																	<option value="User">User</option>
																	
																	<option value="Purchase Officer">Purchase Officer</option>
																	
																 </select>
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Email</label>
                                          <input class="form-control" id="email" name="email" onChange="getFieldValuesContNew('cemail');ValidateEmail('cemail');" type="text"> </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Office Phone</label>
                                                        <input class="form-control" id="office_phone" name="office_phone" onChange="getFieldValuesContNew('cphone');isnumericf('cphone')" type="text">
                                                    </div>
													</div>
												
												
												<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>Mobile No</label>
                                                        <input class="form-control" id="mobile_no" name="mobile_no" onChange="getFieldValuesContNew('mobile');isnumericf('mobile')" type="text">
                                                    </div>
													</div>
													
													<div class="col-sm-3 col-xs-12"><div class="form-group">
                                                        <label>B'day</label>
                                                        	<input type="text" id="datepicker" class="form-control date-picker" name="bday">
                                                    </div>
													</div>
													
													<div class="col-sm-6 col-xs-12"><div class="form-group">
                                                        <label>Remark</label>
                                                      	<textarea class="form-control" rows="2" id="remark" name="remark" style="resize: vertical;"></textarea>
                                                    </div>
													</div>
													
													<div class="col-sm-12 col-xs-12">
                                           
                                            <div class="m-t-20">
                                                    <div class="form-group">
                                                        <div>
                                                          <input class="btn btn-primary " type="submit" name="Submit" value="Save" >
						
															
                                                           
                                                        </div>
                                                    </div>
                                               
                                            </div>
                                        </div>
                                        
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
					
					
					
					
					</form>
        
        
      </div>
    </div>
   	<?php include 'footer1a.php';?>
