PK
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<title>techcam</title>
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<body>
<!-- Navbar ================================================== -->
<?php
include('header.php');
?>
<!-- Header End====================================================================== -->
<div id="mainBody">
<div class="container">
<div class="row">
<!-- Sidebar ================================================== -->
<div id="sidebar" class="span3">
<ul id="sideManu" class="nav nav-tabs nav-stacked">
<li class="subMenu open"><a> CCTV CAMERA</a>
<ul>
<li><a class="active" href="products.html"><i class="icon-chevron-right"></i>Cameras (100) </a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Computers, Tablets & laptop (30)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Mobile Phone (80)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Sound & Vision (15)</a></li>
</ul>
</li>
<li class="subMenu"><a> DVR</a>
<ul style="display:none">
<li><a href="products.html"><i class="icon-chevron-right"></i>Women's Clothing (45)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Women's Shoes (8)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Women's Hand Bags (5)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Men's Clothings (45)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Men's Shoes (6)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Kids Clothing (5)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Kids Shoes (3)</a></li>
</ul>
</li>
<li class="subMenu"><a>Bio-Matrix</a>
<ul style="display:none">
<li><a href="products.php"><i class="icon-chevron-right"></i>Angoves (35)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Bouchard Aine & Fils (8)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>French Rabbit (5)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Louis Bernard (45)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>BIB Wine (Bag in Box) (8)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Other Liquors & Wine (5)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Garden (3)</a></li>
<li><a href="products.html"><i class="icon-chevron-right"></i>Khao Shong (11)</a></li>
</ul>
</li>
<li><a href="products.html">Fire-Alarm</a></li>
<li><a href="products.html">Networking</a></li>
</ul>
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<div class="thumbnail">
<img src="themes/images/payment_methods.png" title="Bootshop Payment Methods" alt="Payments Methods">
<div class="caption">
<h5>Payment Methods</h5>
</div>
</div>
</div>
<!-- Sidebar end=============================================== -->
<div class="span9">
<ul class="breadcrumb">
<li><a href="index.php">Home</a> <span class="divider">/</span></li>
<li class="active">Registration</li>
</ul>
<h3> Registration</h3>
<div class="well">
<!--
<div class="alert alert-info fade in">
<button type="button" class="close" data-dismiss="alert">×</button>
<strong>Lorem Ipsum is simply dummy</strong> text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s
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<div class="alert fade in">
<button type="button" class="close" data-dismiss="alert">×</button>
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<form class="form-horizontal" >
<h4>Your personal information</h4>
<div class="control-group">
<label class="control-label">Title <sup>*</sup></label>
<div class="controls">
<select class="span1" name="days">
<option value="">-</option>
<option value="1">Mr.</option>
<option value="2">Mrs</option>
<option value="3">Miss</option>
</select>
</div>
</div>
<div class="control-group">
<label class="control-label" for="inputFname1">First name <sup>*</sup></label>
<div class="controls">
<input type="text" id="inputFname1" placeholder="First Name">
</div>
</div>
<div class="control-group">
<label class="control-label" for="inputLnam">Last name <sup>*</sup></label>
<div class="controls">
<input type="text" id="inputLnam" placeholder="Last Name">
</div>
</div>
<div class="control-group">
<label class="control-label" for="input_email">Email <sup>*</sup></label>
<div class="controls">
<input type="text" id="input_email" placeholder="Email">
</div>
</div>
<div class="control-group">
<label class="control-label" for="inputPassword1">Password <sup>*</sup></label>
<div class="controls">
<input type="password" id="inputPassword1" placeholder="Password">
</div>
</div>
<div class="control-group">
<label class="control-label">Date of Birth <sup>*</sup></label>
<div class="controls">
<select class="span1" name="days">
<option value="">-</option>
<option value="1">1 </option>
<option value="2">2 </option>
<option value="3">3 </option>
<option value="4">4 </option>
<option value="5">5 </option>
<option value="6">6 </option>
<option value="7">7 </option>
</select>
<select class="span1" name="days">
<option value="">-</option>
<option value="1">1 </option>
<option value="2">2 </option>
<option value="3">3 </option>
<option value="4">4 </option>
<option value="5">5 </option>
<option value="6">6 </option>
<option value="7">7 </option>
</select>
<select class="span1" name="days">
<option value="">-</option>
<option value="1">1 </option>
<option value="2">2 </option>
<option value="3">3 </option>
<option value="4">4 </option>
<option value="5">5 </option>
<option value="6">6 </option>
<option value="7">7 </option>
</select>
</div>
</div>
<div class="alert alert-block alert-error fade in">
<button type="button" class="close" data-dismiss="alert">×</button>
<strong>Lorem Ipsum is simply</strong> dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s
</div>
<h4>Your address</h4>
<div class="control-group">
<label class="control-label" for="inputFname">First name <sup>*</sup></label>
<div class="controls">
<input type="text" id="inputFname" placeholder="First Name">
</div>
</div>
<div class="control-group">
<label class="control-label" for="inputLname">Last name <sup>*</sup></label>
<div class="controls">
<input type="text" id="inputLname" placeholder="Last Name"/>
</div>
</div>
<div class="control-group">
<label class="control-label" for="company">Company</label>
<div class="controls">
<input type="text" id="company" placeholder="company"/>
</div>
</div>
<div class="control-group">
<label class="control-label" for="address">Address<sup>*</sup></label>
<div class="controls">
<input type="text" id="address" placeholder="Adress"/> <span>Street address, P.O. box, company name, c/o</span>
</div>
</div>
<div class="control-group">
<label class="control-label" for="address2">Address (Line 2)<sup>*</sup></label>
<div class="controls">
<input type="text" id="address2" placeholder="Adress line 2"/> <span>Apartment, suite, unit, building, floor, etc.</span>
</div>
</div>
<div class="control-group">
<label class="control-label" for="city">City<sup>*</sup></label>
<div class="controls">
<input type="text" id="city" placeholder="city"/>
</div>
</div>
<div class="control-group">
<label class="control-label" for="state">State<sup>*</sup></label>
<div class="controls">
<select id="state" >
<option value="">-</option>
<option value="1">Alabama</option><option value="2">Alaska</option><option value="3">Arizona</option><option value="4">Arkansas</option><option value="5">California</option><option value="6">Colorado</option><option value="7">Connecticut</option><option value="8">Delaware</option><option value="53">District of Columbia</option><option value="9">Florida</option><option value="10">Georgia</option><option value="11">Hawaii</option><option value="12">Idaho</option><option value="13">Illinois</option><option value="14">Indiana</option><option value="15">Iowa</option><option value="16">Kansas</option><option value="17">Kentucky</option><option value="18">Louisiana</option><option value="19">Maine</option><option value="20">Maryland</option><option value="21">Massachusetts</option><option value="22">Michigan</option><option value="23">Minnesota</option><option value="24">Mississippi</option><option value="25">Missouri</option><option value="26">Montana</option><option value="27">Nebraska</option><option value="28">Nevada</option><option value="29">New Hampshire</option><option value="30">New Jersey</option><option value="31">New Mexico</option><option value="32">New York</option><option value="33">North Carolina</option><option value="34">North Dakota</option><option value="35">Ohio</option><option value="36">Oklahoma</option><option value="37">Oregon</option><option value="38">Pennsylvania</option><option value="51">Puerto Rico</option><option value="39">Rhode Island</option><option value="40">South Carolina</option><option value="41">South Dakota</option><option value="42">Tennessee</option><option value="43">Texas</option><option value="52">US Virgin Islands</option><option value="44">Utah</option><option value="45">Vermont</option><option value="46">Virginia</option><option value="47">Washington</option><option value="48">West Virginia</option><option value="49">Wisconsin</option><option value="50">Wyoming</option></select>
</div>
</div>
<div class="control-group">
<label class="control-label" for="postcode">Zip / Postal Code<sup>*</sup></label>
<div class="controls">
<input type="text" id="postcode" placeholder="Zip / Postal Code"/>
</div>
</div>
<div class="control-group">
<label class="control-label" for="country">Country<sup>*</sup></label>
<div class="controls">
<select id="country" >
<option value="">-</option>
<option value="1">Country</option>
</select>
</div>
</div>
<div class="control-group">
<label class="control-label" for="aditionalInfo">Additional information</label>
<div class="controls">
<textarea name="aditionalInfo" id="aditionalInfo" cols="26" rows="3">Additional information</textarea>
</div>
</div>
<div class="control-group">
<label class="control-label" for="phone">Home phone <sup>*</sup></label>
<div class="controls">
<input type="text" name="phone" id="phone" placeholder="phone"/> <span>You must register at least one phone number</span>
</div>
</div>
<div class="control-group">
<label class="control-label" for="mobile">Mobile Phone </label>
<div class="controls">
<input type="text" name="mobile" id="mobile" placeholder="Mobile Phone"/>
</div>
</div>
<p><sup>*</sup>Required field </p>
<div class="control-group">
<div class="controls">
<input type="hidden" name="email_create" value="1">
<input type="hidden" name="is_new_customer" value="1">
<input class="btn btn-large btn-success" type="submit" value="Register" />
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
<!-- MainBody End ============================= -->
<!-- Footer ================================================================== -->
<?php
include('footer.php');
?>
PK 99