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85 lines
3.2 KiB
85 lines
3.2 KiB
4 years ago
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<?php
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@include('components/breadcrumb/breadcrumb.php');
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setlocale(LC_MONETARY, 'it_IT.UTF-8');
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?>
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<div class="component-checkout">
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<div class="container">
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<div class="row">
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<div class="col-12 col-md-8 pb-5">
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<span class="title">Dettagli fatturazione</span>
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<span class="subtitle">Sei già nostro cliente? Accedi</span>
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<div class="row">
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Nome *</span>
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<input type="text" name="first_name" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Cognome *</span>
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<input type="text" name="last_name" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">E-mail *</span>
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<input type="email" name="email" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Telefono</span>
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<input type="tel" name="phone" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Indirizzo *</span>
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<input type="text" name="address" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Città *</span>
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<input type="text" name="city" class="input-text">
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</div>
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<div class="col-12 col-md-4 pr-2 pr-md-4 mr-auto">
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<span class="label">CAP *</span>
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<input type="text" name="zip_code" class="input-text">
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</div>
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<div class="col-12 col-md-4 pr-2 pr-md-4 mr-auto">
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<span class="label">Provincia *</span>
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<select name="province" class="input-select">
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<?php
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foreach($PROV as $k => $p) {
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echo "<option value=\"".$k."\">".$p."</option>";
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}
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?>
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</select>
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Scegli una password *</span>
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<input type="password" name="password" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Conferma password *</span>
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<input type="password" name="password_confirm" class="input-text">
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</div>
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<div class="col-12 col-md-6 pr-2 pr-md-4">
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<span class="label">Vuoi spedire ad un indirizzo diverso?</span>
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<label class="radio">
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<span class="radio-label text-grey">No</span>
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<input type="radio" name="other_address" value="no" checked>
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<span class="mark"></span>
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</label>
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<label class="radio">
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<span class="radio-label text-grey">Si</span>
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<input type="radio" name="other_address" value="yes">
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<span class="mark"></span>
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</label>
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</div>
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</div>
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</div>
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<div class="col-12 col-md-4 pb-5">
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<span class="title">Il tuo ordine</span>
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<span class="subtitle"></span>
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</div>
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</div>
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</div>
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</div>
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