PAL.C.T MINI SHELL
<div class='news_tittle'>
<h4> Pre-Order </h4>
</div>
<div class='col-xs-12'>
<form name=form action=aksi-pre-order.html method=POST enctype='multipart/form-data'>
<table>
<tr>
<td><span class=red>*</span> No. Order </td>
<td > : </td>
<td><input type=text name='no_order' size=30 class='form-control' value='<?php echo $_GET[id]; ?>'>
</td>
</tr>
<tr>
<td></td>
<td ></td>
<td><i> Pastikan No.Order anda benar </i></td>
</tr>
<tr>
<td> <span class=red>*</span> No. PO</td>
<td> :</td>
<td> <input type=text name=no_po size=30 class='form-control'></td>
</tr>
<tr>
<td> <span class=red>*</span> Tanggal PO</td>
<td> :</td>
<td> <input type=text name=tgl_po size=30 class='form-control'></td>
</tr>
<tr>
<td >Perusahaan</td>
<td> : </td>
<td><input type=text name=perusahaan size=30 class='form-control'></td>
</tr>
<tr>
<td><span class=red>*</span>Scan File</td>
<td> : </td>
<td><input type=file name='fupload' size=30></td>
</tr>
<tr>
<td></td><td></td><td> Scan File dapat berupa Foto maupun pdf </td>
</tr>
<tr>
<td><span class=red>*</span>Fax</td>
<td> : </td>
<td><input type=text name=fax class='form-control'></td>
</tr>
<tr><td colspan=2>
</td>
<td><br><input type='submit' class='btn btn-primary' value='Submit'></td>
</tr>
</table>
<br><i>Note : Form yang bertanda <span class='red'>*</span> harus di isi.</i>
</form>
</div>
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