<link type="text/css" href="assets/plugins/gridforms/gridforms/gridforms.css" rel="stylesheet"> 		
<div class="page-content">
                            <ol class="breadcrumb">
                                
<li><a href="index.html">Home</a></li>
<li>Advanced Forms</li>
<li class="active"><a href="form-gridforms.html">Grid Forms</a></li>

                            </ol>
                            <div class="container-fluid">
                                 


<div data-widget-group="group1" class="ui-sortable">
    <div class="row">
    	<div class="col-md-12">
			<div class="panel panel-white" data-widget="{&quot;draggable&quot;: &quot;false&quot;}" data-widget-static="" style="visibility: visible; opacity: 1; display: block; transform: translateY(0px);">
				<div class="panel-heading">
					<h2>Demo Form</h2>
					<!-- <div class="panel-ctrls" data-actions-container="" data-action-collapse='{"target": ".panel-body"}'></div> -->
				</div>
				<div class="panel-body">
					<form class="grid-form" action="action-pages/icap/add-icap-action.php" method="post">
						<fieldset>
							<legend>ICAP Details</legend>
							<div data-row-span="2">
								<div data-field-span="1" style="height: 61px;" class="">
									<label>Firm Name</label>
									<input type="text" name="firm_name">
								</div>
								<div data-field-span="1" style="height: 61px;" class="">
									<label>Contact Person</label>
									<input type="text" name="contact_person">
								</div>
								
								
							</div>
							
						</fieldset>

					

						<fieldset>

							
							<div data-row-span="4">
								<div data-field-span="2" style="height: 62px;">
									<label>Address</label>
									<input type="text" name="address">
								</div>
								<div data-field-span="1" style="height: 62px;">
									<label>State</label>
<script type="text/javascript">
$(document).ready(function(e) {
 
  
    $('#state').change(function(e){
		  $.post('module/insert1.php',{state:$(this).val()},function(data){
			   $('#city').html(data);
			  });
		});
		
     $('#sem').change(function(e){
		  $.post('module/insert.php',{subject:$(this).val()},function(data){
		  		
			   $('#subject').html(data);
			  });
		});		
});
</script>
									<select id="state" name="state" class="form-control" style="border:none" required="">
           <option value="">SELECT STATE</option>
        <?php 
		  $GetState=mysql_query('SELECT * FROM `state` ORDER BY `state` ASC');
		  while($GetState1=mysql_fetch_array($GetState)) 
		  {
		  
		   ?>
          
          <option value="<?php echo $GetState1['ids']; ?>"><?php echo $GetState1['state']; ?></option>
          <?php } ?> 
          </select>
								</div>
								
								
								<div data-field-span="1" style="height: 62px;">
									<label>City</label>
									<select id="city" name="city" class="form-control"  style="border:none" required="">
           <option value="">SELECT CITY</option>
         </select>
								</div>
							</div>
							<div data-row-span="4">
								<div data-field-span="2" data-field-error="Please enter a valid email address" style="height: 61px;">
									<label>E-mail</label>
									<input type="text" name="email">
								</div>
								<div data-field-span="2" style="height: 61px;">
									<label>Mobile No.</label>
									<input type="text" name="mobile">
								</div>
								
							</div>
							<div data-row-span="2">
								<div data-field-span="1" style="height: 61px;">
									<label>Username</label>
									<input type="text" name="username">
								</div>
								<div data-field-span="1" style="height: 61px;">
									<label>Password</label>
									<input type="text" name="password">
								</div>
								
							</div>

							
						</fieldset>
						
						<div class="clearfix pt-md">
							<div class="pull-right">
								<button class="btn-primary btn" type="submit">Submit</button>
								<button class="btn-default btn" type="reset">Cancel</button>
							</div>
						</div>
					</form>
				</div>
			</div>
		</div>
	</div>
</div>
	

                            </div> <!-- .container-fluid -->
                        </div>
						
						
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