|
|
| (88 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| <form>
| |
| {| class="smwtable-clean th-top-right border"
| |
| |-
| |
| ! <label for="firstname">Name {{r|*}}</label>
| |
| | <input type="text" name="firstname" placeholder="first name" required="required" />
| |
| <input type="text" name="lastname" placeholder="last name" required="required" />
| |
| |-
| |
| ! <label for="birthdate">Date of birth {{r|*}}</label>
| |
| | <input type="date" name="birthdate" value="{{CURRENTYEAR}}-{{CURRENTMONTH}}-{{CURRENTDAY}}" min="2000-01-01" max="2999-12-31" required="required" />
| |
| |-
| |
| ! <label for="birthcountry">Country of birth {{r|*}}</label>
| |
| | <select name="birthcountry" selected="" placeholder="select" options="{{ListOfCountries}}" />
| |
| |-
| |
| ! <label for="street">Address {{r|*}}</label>
| |
| | <input style="width: 100%;" type="text" name="street" placeholder="Street address" /><br>
| |
| <input style="width: 100%;" type="text" name="street2" placeholder="Address line 2" /><br>
| |
| <input style="width: 50%;" type="text" name="city" placeholder="City" /><input style="width: 50%;" type="text" name="stateprov" placeholder="State / Province" /><br>
| |
| <input style="width: 50%;" type="text" name="postalcode" placeholder="Zip/Postal code" required="required" /><select style="width: 50%;" name="country" selected="" options="{{ListOfCountries}}" />
| |
| |}
| |
|
| |
|
| <input type="submit" value="submit" />
| |
| </form>{{#widget:FlexForm.css}}
| |
