📄 add_customer.htm
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<html>
<head>
<title>Index</title>
</head>
<body>
<p><img src = "Logo.jpg" width "264" heigth = "63"></p><h2 align="center">User Registration form</h2>
<form name="registration" method="post" action="confirm.php" enctype="multipart/form-data">
<table width="400" border="1" align="center" cellpadding="5" cellspacing="0" bgcolor="#CCCCCC">
<tr>
<td width="47%">
<div align="right">Full Name </div>
</td>
<td colspan="2">
<div align="left">
<input type="text" name="name" size="25" maxlength="25">
</div>
</td>
</tr>
<tr>
<td width="47%" height="57">
<div align="right">Address</div>
</td>
<td height="57" colspan="2">
<textarea name="address" cols="21" rows="4"></textarea>
</td>
</tr>
<tr>
<td width="47%">
<div align="right">Email</div>
</td>
<td height="2" colspan="2">
<input type="text" name="email" size="25" maxlength="50">
</td>
</tr>
<tr>
<td width="47%">
<div align="right">Password</div>
</td>
<td height="2" >
<input type="Password" name="password" size="25" maxlength="15">
</td>
</tr>
<tr>
<td width="47%">
<div align="right">Confirm Password</div>
</td>
<td height="2" >
<input type="password" name="cpassword" size="25" maxlength="15">
</td>
</tr>
<tr>
<td width="47%">
<div align="right">Date of Birth</div>
</td>
<td height="2" >
<select name=birth_month>
<option selected
value=1>January
<option value=2>February
<option
value=3>March
<option value=4>April
<option value=5>May
<option value=6>June
<option value=7>July
<option value=8>August
<option value=9>September
<option value=10>October
<option value=11>November
<option value=12>December</option>
</select>
<select
name=birth_day>
<option selected value=1>01
<option
value=2>02
<option value=3>03
<option value=4>04
<option value=5>05
<option value=6>06
<option value=7>07
<option value=8>08
<option value=9>09
<option value=10>10
<option value=11>11
<option value=12>12
<option value=13>13
<option value=14>14
<option value=15>15
<option value=16>16
<option value=17>17
<option value=18>18
<option value=19>19
<option value=20>20
<option value=21>21
<option value=22>22
<option value=23>23
<option value=24>24
<option value=25>25
<option value=26>26
<option value=27>27
<option value=28>28
<option value=29>29
<option value=30>30
<option value=31>31</option>
</select>
<input maxlength=4 name=birth_year size=4>
(yyyy) </td>
</tr>
<tr>
<td width="47%">
<div align="right">Gender</div>
</td>
<td>
<table border=0 width="100%">
<tr>
<td height="2" width="26%">
<input type="radio" name="gender" value="Male">
Male </td>
<td height="2" width="27%">
<input type="radio" name="gender" value="Female">
Female</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="3">
<div align="center">
<input type="submit" name="Submit" value="Submit">
</div>
</td>
</tr>
</table>
</form>
</body>
</html>
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