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<div class="col-lg-3"> <div class="row mb-2"> <div class="col-lg-12 bg-f5f5f5 p-2 rounded border"> <h5>Categories</h5> <ul class="list-group list-group-flush"> <?php $CATEGORY = $this->categoriess->selectfrontcategory('tbl_category'); foreach ($CATEGORY as $category) { ?> <li class="list-group-item pl-0 py-2 bg-f5f5f5"><a href="<?php echo base_url($category->url); ?>" style="color:#000;"><?php echo $category->name; ?></a></li> <?php } ?> </ul> </div> </div> <div class="row"> <div class="col-lg-12 px-0 rounded border"> <form action="<?php echo base_url('welcome/formsubmission'); ?>" method="post" enctype="multipart/form-data"> <input type="hidden" value="5" id="captcha" name="captcha"> <input type="hidden" value="From Quick Enquiry" name="fromPage"> <div class="form-box border"> <div class="row"> <div class="col-md-12"> <h3 class="text-center">Quick Enquiry</h3> </div> <div class="col-md-6 col-6"> <div class="form-group rounded mb-3"> <label>Name</label> <input type="text" class="form-control mr-2" name="name" placeholder="Your Name"> </div> </div> <div class="col-md-6 col-6"> <label for="sell">Gender</label> <select class="form-control" id="sell" name="gender"> <option>Gender</option> <option>Male</option> <option>Female</option> <option>Transgender</option> </select> </div> </div> <div class="row"> <div class="col-md-6 col-6"> <div class="form-group rounded mb-3"> <label>Email Id</label> <input type="email" class="form-control mr-2" name="email" placeholder="Email Id"> </div> </div> <div class="col-md-6 col-6"> <div class="form-group rounded mb-3"> <label>Phone No</label> <input type="tel" class="form-control mr-2" name="phone" placeholder="Mobile No"> </div> </div> </div> <div class="row"> <div class="col-md-12"> <div class="form-group rounded mb-3"> <label>Date of birth</label> <input type="date" class="form-control mr-2" name="dob" placeholder="Date of birth"> </div> </div> <div class="col-md-12"> <div class="form-group rounded mb-3"> <label>Time of birth</label> <input type="time" class="form-control mr-2" name="tob" placeholder="Time of birth"> </div> </div> </div> <div class="row"> <div class="col-md-6 col-6"> <div class="form-group rounded mb-3"> <label>Birth Place</label> <input type="text" class="form-control mr-2" name="birth_place" placeholder="Birth place"> </div> </div> <div class="col-md-6 col-6"> <div class="form-group rounded mb-3"> <label>State</label> <input type="text" class="form-control mr-2" name="state" placeholder="Your State"> </div> </div> </div> <div class="form-group"> <div class="g-recaptcha" data-sitekey="6LdlQXsjAAAAAB0xX4Mthj8jGYoeNA0AcRGThExO"></div> </div> <!--<div class="form-group">--> <!-- <div class="g-recaptcha" data-sitekey="6LfQvZYjAAAAALz09sUNqgG_agO_Z80SAcWTgeoI" style="display: flex;justify-content: center;"></div>--> <!--</div>--> <div class="row"> <div class="col-lg-12"> <div class="form-group rounded mb-3"> <button class="btn" name="submit" type="submit">Get Now</button> </div> </div> </div> </div> </form> </div> </div> </div>
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