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investc.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1" />
<title>Kuza Forms - Sell Anywhere, Grow your Business</title>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.min.css">
<link rel="stylesheet" href="css/forms.css">
</head>
<body>
<div class="container">
<div class="row" id="app">
<form action="" method="POST" role="form">
<div id="leftPage" class="col-lg-7 pd-tb-mini pd-r-50">
<img class="img-logo" src="http://www.investcorpgh.com/wp-content/uploads/2014/08/logo1.png" alt="">
<h3 class="mr-b-20">Customer information</h3>
<div class="row">
<div class="form-group col-sm-6">
<label for="" class="control-label">First Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your First Name">
</div>
<div class="form-group col-sm-6">
<label for="" class="control-label">Last Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your Last Name">
</div>
<div class="form-group col-sm-6">
<label for="" class="control-label">Email Address</label>
<input type="text" class="form-control" id="" placeholder="Enter your Email Address">
</div>
<div class="form-group col-sm-6">
<label for="" class="control-label">Phone #</label>
<input type="text" class="form-control" id="" placeholder="Enter your Phone #">
</div>
<div class="form-group col-sm-12">
<label for="" class="control-label">Company Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your Company Name">
</div>
</div>
<hr>
<h3 class="mr-b-20">Address / Shipping Information</h3>
<div class="row">
<div class="form-group col-sm-12">
<label for="" class="control-label">Address</label>
<input type="text" class="form-control" id="" placeholder="Enter your Address">
</div>
<div class="form-group col-sm-6">
<label for="" class="control-label">City / Town</label>
<input type="text" class="form-control" id="" placeholder="Enter your City / Town">
</div>
<div class="form-group col-sm-6">
<label for="" class="control-label">Region</label>
<input type="text" class="form-control" id="" placeholder="Enter your Region">
</div>
</div>
</div>
<div id="rightPage" class="col-lg-5">
<h3 class="mr-b-20">Investment Packages</h3>
<div class="row sm-gutter" v-for="(attendee, index) in attendees" :key="index">
<div class="form-group col-xs-8">
<label for="" class="control-label">Investment Package</label>
<select class="form-control" required="required">
<option value="">-- Select Package --</option>
<option value="">Kitiwa Investment</option>
<option value="">Retirement Investment</option>
<option value="">Campus Investment</option>
</select>
</div>
<div class="form-group col-xs-3">
<label for="" class="control-label">Amount</label>
<input type="text" class="form-control" placeholder="20.00">
</div>
<div class="form-group col-xs-1 dyn-btn">
<a href="#" class="text-danger"><i class="fa fa-times-circle"></i></a>
</div>
</div>
<div class="row sm-gutter" v-for="(attendee, index) in attendees" :key="index">
<div class="form-group col-xs-8">
<label for="" class="control-label">Investment Package</label>
<select class="form-control" required="required">
<option value="">-- Select Package --</option>
<option value="">Kitiwa Investment</option>
<option value="">Retirement Investment</option>
<option value="">Campus Investment</option>
</select>
</div>
<div class="form-group col-xs-3">
<label for="" class="control-label">Amount</label>
<input type="text" class="form-control" placeholder="20.00">
</div>
<div class="form-group col-xs-1 dyn-btn">
<a href="#" class="text-danger"><i class="fa fa-times-circle"></i></a>
</div>
</div>
<div class="row sm-gutter" v-for="(attendee, index) in attendees" :key="index">
<div class="form-group col-xs-8">
<label for="" class="control-label">Investment Package</label>
<select class="form-control" required="required">
<option value="">-- Select Package --</option>
<option value="">Kitiwa Investment</option>
<option value="">Retirement Investment</option>
<option value="">Campus Investment</option>
</select>
</div>
<div class="form-group col-xs-3">
<label for="" class="control-label">Amount</label>
<input type="text" class="form-control" placeholder="20.00">
</div>
<div class="form-group col-xs-1 dyn-btn">
<a href="#" class="text-danger"><i class="fa fa-times-circle"></i></a>
</div>
</div>
<div class="row">
<div class="col-xs-6">
<a href="#" class="btn btn-success">+ Add Product</a>
</div>
<div class="col-xs-6 col-sm-5 col-sm-offset-1 text-right">
<h4 class="mr-t-10 fs16 bold-4">Sub Total: Ghc 60.00</h4>
</div>
</div>
<hr class="mr-tb-20">
<div class="row">
<div class="form-group col-xs-12">
<textarea name="" class="form-control" placeholder="Additional notes or description." rows="5"></textarea>
</div>
</div>
<div class="row">
<div class="form-group col-md-12 mr-t-20 text-center">
<button type="submit" class="btn btn-lg btn-primary">Pay (Ghc 60.00)</button>
</div>
</div>
</div>
</form>
</div>
</div>
</body>
</html>