95 lines
5.7 KiB
PHP
95 lines
5.7 KiB
PHP
<!doctype html>
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<html lang="ja">
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<head>
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<title>｜So-Manager</title>
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<meta charset="utf-8">
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<link rel="icon" href="assets/img/favicon.ico">
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<link href="https://cdnjs.cloudflare.com/ajax/libs/typicons/2.0.9/typicons.css" rel="stylesheet">
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<link href="https://fonts.googleapis.com/earlyaccess/roundedmplus1c.css" rel="stylesheet" />
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<link href="../bootstrap/css/bootstrap.min.css" rel="stylesheet">
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<link href="assets/css/style.css" rel="stylesheet">
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<script src="assets/js/ie-emulation-modes-warning.js"></script>
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</head>
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<body id="" class="">
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<div id="font-scale" class="home">
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@include('layouts.header');
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<!-- ▼ メイン部分 ▼ -->
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<main role="main" id="" class="">
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<section id="" class="container mt20 mb20">
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<div class="row">
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<div class="col-12 col-lg-10 offset-0 offset-lg-1 mt20 mb20">
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<div class="card border-success">
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<div class="card-header border-success">
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<h5 class="card-title text-success">新規会員登録</h5>
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</div>
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<div class="card-body mt30">
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<p class="h4">会員情報を入力してください。</p>
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<section id="" class="container mt50 mb50">
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<form class="row form" action="{{route('swo2_4')}}" method="post">
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<input type="hidden" name="_token" value="oEhAfdqtNNAs2vOfjZqveVaH3G1fF62yb8qJIshV" >
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_name" class="required">お名前</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" name="user_name" id="user_name" value="" placeholder="自転車 太郎">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_phonetic" class="required">フリガナ</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" name="user_phonetic" id="user_phonetic" value="" placeholder="ジテンシャ タロウ">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_homephone" class="required">電話番号（必須）</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<div class="row justify-content-between col-12 m-0 p-0">
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<input type="text" maxlength="5" name="user_homephone[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="user_homephone[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="user_homephone[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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</div>
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_mobile">予備電話番号（任意）</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<div class="row justify-content-between col-12 m-0 p-0">
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<input type="text" maxlength="5" name="user_mobile[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="user_mobile[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="user_mobile[]" value="" class="form-control form-control-lg check_key_int col-3"/>
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</div>
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_primemail" class="required">メールアドレス</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" readonly="readonly" id="user_primemail" value="watanabe@s-force.co.jp" name="user_primemail" placeholder="name@example.com">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label for="user_primemail2" class="required">メールアドレスの確認</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" readonly="readonly" id="user_primemail2" name="user_primemail_confirmation" value="watanabe@s-force.co.jp" placeholder="name@example.com">
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</div>
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<div class="col-12 col-md-6 offset-0 offset-md-3 mt10">
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<a href="{{route('swo2_4')}}" class="btn btn-block btn-lg btn-success">入力確認</a>
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</div>
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</form>
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</section>
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</div>
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</div>
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</div>
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</div>
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</section>
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</main>
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<!-- ▲ メイン部分 ▲ -->
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@include('layouts.info');
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@include('layouts.footer');
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</div>
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</body>
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</html>
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