<?php
defined('BASEPATH') OR exit('No direct script access allowed');
?>
<html>
<head>

    <link rel="stylesheet" type="text/css" href="<?php echo base_url()?>public/css/form.css"/>
    <link href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css" rel="stylesheet" >
</head>
 <body>
<div class="buyform">
    <div class="container" ng-app="fap">
        <div class="row">
            <div class="col-sm-4 text-center">
                <table width="100%" border="0" cellspacing="0" cellpadding="0">
                    <tr>
                        <td><h1>BUY ONE<BR>GET ONE</h1></td>
                        <td><h2>FREE</h2></td>
                    </tr>
                </table>
                <a class="scroll" href="#contact"><?php echo img('img/product.png')?></a>
                <h3>MRP Rs. <strike>2499</strike>/-</h3>
                <h4>OFFER PRICE Rs. 1499/-</h4>
                <h5 class="yellow-text text-uppercase">hurry limited time offer</h5>
            </div>
            <div class="col-sm-8 order-form">
                <SPAN id="contact"><h1 class="white-text text-shadow-black">Place Your Order Here. <span class="yellow-text">Save Rs. 1000/-</span></h1></SPAN>
                <div class="">
                    <form name="package-payment" id="package-payment" method="post" action="" class="form-horizontal" ng-controller="fcn" ng-submit="submitForm()">

                        <div class="col-sm-6">
                            <input placeholder="Name" name="name" id="name" class="custom_form_fields" required type="text" ng-model="user.name"">
                        </div>
                        <div class="col-sm-6">
                            <input placeholder="Address " name="address" id="address" class="custom_form_fields" required type="text" ng-model="user.address">
                        </div>

                        <div class="clearfix"></div>



                        <div class="col-sm-6">
                            <input placeholder="City" name="city" id="city" class="custom_form_fields" required type="text" ng-model="user.city">
                        </div>
                        <div class="col-sm-6">
                            <select placeholder="State" id="state" name="state" class="custom_form_fields" required="" ng-model="user.state">
                                <option value="">Select State</option>
                                <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
                                <option value="Andhra Pradesh">Andhra Pradesh</option>
                                <option value="Arunachal Pradesh">Arunachal Pradesh</option>
                                <option value="Assam">Assam</option>
                                <option value="Bihar">Bihar</option>
                                <option value="Chandigarh">Chandigarh</option>
                                <option value="Chhattisgarh">Chhattisgarh</option>
                                <option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
                                <option value="Daman and Diu">Daman and Diu</option>
                                <option value="Delhi">Delhi</option>
                                <option value="Goa">Goa</option>
                                <option value="Gujarat">Gujarat</option>
                                <option value="Haryana">Haryana</option>
                                <option value="Himachal Pradesh">Himachal Pradesh</option>
                                <option value="Jammu and Kashmir">Jammu and Kashmir</option>
                                <option value="Jharkhand">Jharkhand</option>
                                <option value="Karnataka">Karnataka</option>
                                <option value="Kerala">Kerala</option>
                                <option value="Lakshadweep">Lakshadweep</option>
                                <option value="Madhya Pradesh">Madhya Pradesh</option>
                                <option value="Maharashtra">Maharashtra</option>
                                <option value="Manipur">Manipur</option>
                                <option value="Meghalaya">Meghalaya</option>
                                <option value="Mizoram">Mizoram</option>
                                <option value="Nagaland">Nagaland</option>
                                <option value="Orissa">Orissa</option>
                                <option value="Pondicherry">Pondicherry</option>
                                <option value="Punjab">Punjab</option>
                                <option value="Rajasthan">Rajasthan</option>
                                <option value="Sikkim">Sikkim</option>
                                <option value="Tamil Nadu">Tamil Nadu</option>
                                <option value="Tripura">Tripura</option>
                                <option value="Uttaranchal">Uttaranchal</option>
                                <option value="Uttar Pradesh">Uttar Pradesh</option>
                                <option value="West Bengal">West Bengal</option>
                            </select>
                        </div>

                        <div class="clearfix"></div>

                        <div class="col-sm-6">
                            <input placeholder="Pincode" name="pincode" id="pincode" class="custom_form_fields" required maxlength="6" pattern="[0-9]{6}" type="tel" ng-model="user.pincode">
                        </div>
                        <div class="col-sm-6">
                            <input placeholder="Phone" name="phone" id="phone" class="custom_form_fields" required maxlength="10" type="tel" pattern="[789][0-9]{9}" ng-model="user.phone">
                        </div>

                        <div class="clearfix"></div>



                        <div class="col-sm-6 padd-top-1em">
                            <span class="custom_form_fields_reeadonly"><b>MRP Rs. <s>2499/-</s> &nbsp; &nbsp; <span class="brown-text">OFFER PRICE Rs. 1499/-</span></b></span>                        </div>

                        <div class="clearfix padd-top-2em">

                            <h6>Payment Type:&nbsp; <input value="cod" id="cod" name="payment_type" type="radio" checked="checked" ng-model="user.cod"><b> Cash on Delivery</b></h6>
                        </div>

                        <div class="col-sm-6"><br>

                        </div>





                        <div class="col-sm-12">
                            <button type="submit" id="submit-order" class="submitbtn">
                                <img src="img/buy-now.png" style="padding:10px 0px 20px; width:240px">                            </button>
                        </div>
                    </form>
                    <div class="col-sm-12 icon-form-box black-text text-uppercase">
                        <div class="col-sm-4">
                            <table width="100%" border="0" cellspacing="0" cellpadding="0">
                                <tr>
                                    <td class="icon-number">100%</td>
                                    <td>risk-free purchase</td>
                                </tr>
                            </table>
                        </div>

                        <div class="col-sm-3">
                            <table width="100%" border="0" cellspacing="0" cellpadding="0">
                                <tr>
                                    <td class="icon-number">COD</td>
                                    <td>cash-on delivery</td>
                                </tr>
                            </table>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>

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<script src="http://cdnjs.cloudflare.com/ajax/libs/angular-ui-bootstrap/0.9.0/ui-bootstrap-tpls.min.js"></script>
<script src="<?php echo base_url()?>public/js/form.js"></script>

 </body></html>

