RCS-Website/index_2.html at master · bhavikk/RCS-Website · GitHub

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<!DOCTYPE html>
<html>
<head>
	<title></title>
</head>
<body>
	<h2 style="text-align: center"> CUSTOMER OPENING </h2>
	<form name="regForm" action="ClientServlet"  method="post">

	Customer Name:
	<input type="text" name="name" title="Please enter your name" required/> <br>

	Prefix:
		<select name="prefix">
		<option>-select-</option>
        <option value="Mr">Mr.</option>
        <option value="Mrs">Mrs.</option>
        </select><br><br>


	Gender:
		<select name="gender">
		<option>-select-</option>
        <option value="Male">Male</option>
		<option value="Female">Female</option>
		<option value="Others">Others</option>
        </select><br><br>


	Telephone Number:
		<input type="number" name="phone" title="Please enter valid 10 digit contact no." required/><br>


	Occupation code:
		<select name="occupationcode">
		<option>-select-</option>
		<option value="10">Teacher</option>
		<option value="20">Doctor</option>
		<option value="30">Engineer</option>
		<option value="40">Business</option>
		<option value="50">Housewife</option>
		<option value="60">Others</option>
		</select><br><br>


	PAN number:
		<input type="text" name="pan" maxlength="10" title="Please enter valid PAN number. E.g. AAAAA9999A" required/><br>


	Date of birth: <input type="date" name="dob" required ><br>


		<input type="submit"  value="Submit"/>
</form>
</body>
</html>