<!doctype html>
<html
    lang="en"
    data-layout="vertical"
    data-topbar="light"
    data-sidebar="dark"
    data-sidebar-size="lg"
    data-sidebar-image="none"
    data-preloader="disable"
    data-theme="default"
    data-theme-colors="default">
<!-- Mirrored from themesbrand.com/velzon/html/master/forms-elements.html by HTTrack Website Copier/3.x [XR&CO'2014], Fri, 31 May 2024 06:31:50 GMT -->

<head>
    <meta charset="utf-8" />
    <title>Basic Elements | Velzon - Admin & Dashboard Template</title>
    <meta name="viewport" content="width=device-width, initial-scale=1.0" />
    <meta
        content="Premium Multipurpose Admin & Dashboard Template"
        name="description" />
    <meta content="Themesbrand" name="author" />
    <!-- App favicon -->
    <link rel="shortcut icon" href="assets/images/favicon.ico" />

    <!-- Layout config Js -->
    <script src="assets/js/layout.js"></script>
    <!-- Bootstrap Css -->
    <link
        href="assets/css/bootstrap.min.css"
        rel="stylesheet"
        type="text/css" />
    <!-- Icons Css -->
    <link href="assets/css/icons.min.css" rel="stylesheet" type="text/css" />
    <!-- App Css-->
    <link href="assets/css/app.min.css" rel="stylesheet" type="text/css" />
    <!-- custom Css-->
    <link href="assets/css/custom.min.css" rel="stylesheet" type="text/css" />
</head>

<body>
    <div id="layout-wrapper">

        <?php include "includes/header.php"; ?>
        <?php include "includes/sidebar.php"; ?>

        <div class="main-content">
            <div class="page-content">
                <div class="container-fluid">
                    <div class="row">
                        <div class="col-lg-12">
                            <div class="card">
                                <div class="card-header align-items-center d-flex">
                                    <h4 class="card-title mb-0 flex-grow-1">Domain Profile</h4>
                                </div>
                                <!-- end card header -->
                                <form>
                                    <div class="card-body">
                                        <div class="live-preview">
                                            <div class="row gy-4">

                                                <!-- Company Name -->
                                                <div class="col-md-6">
                                                    <label class="form-label">Company Name</label>
                                                    <input type="text" class="form-control" placeholder="Enter company name">
                                                </div>

                                                <!-- Business Type -->
                                                <div class="col-md-6">
                                                    <label class="form-label">Business Type</label>
                                                    <input type="text" class="form-control" placeholder="e.g. Private Ltd, Sole Proprietor">
                                                </div>

                                                <!-- Business Category -->
                                                <div class="col-md-6">
                                                    <label class="form-label">Business Category</label>
                                                    <input type="text" class="form-control" placeholder="e.g. IT, Retail, Manufacturing">
                                                </div>

                                                <!-- Client Name -->
                                                <div class="col-md-6">
                                                    <label class="form-label">Client Name</label>
                                                    <input type="text" class="form-control" placeholder="Enter client name">
                                                </div>

                                                <!-- Address -->
                                                <div class="col-12">
                                                    <label class="form-label">Address</label>
                                                    <textarea class="form-control" rows="2" placeholder="Enter full address"></textarea>
                                                </div>

                                                <!-- Country -->
                                                <div class="col-md-4">
                                                    <label class="form-label">Country</label>
                                                    <input type="text" class="form-control" placeholder="Enter country">
                                                </div>

                                                <!-- State -->
                                                <div class="col-md-4">
                                                    <label class="form-label">State</label>
                                                    <input type="text" class="form-control" placeholder="Enter state">
                                                </div>

                                                <!-- District -->
                                                <div class="col-md-4">
                                                    <label class="form-label">District</label>
                                                    <input type="text" class="form-control" placeholder="Enter district">
                                                </div>

                                                <!-- City -->
                                                <div class="col-md-4">
                                                    <label class="form-label">City</label>
                                                    <input type="text" class="form-control" placeholder="Enter city">
                                                </div>

                                                <!-- Pin Code -->
                                                <div class="col-md-4">
                                                    <label class="form-label">Pin Code</label>
                                                    <input type="text" class="form-control" placeholder="Enter pin code">
                                                </div>

                                                <!-- Interested -->
                                                <div class="col-md-4">
                                                    <label class="form-label">Interested</label>
                                                    <select class="form-select">
                                                        <option value="">Select</option>
                                                        <option value="yes">Yes</option>
                                                        <option value="no">No</option>
                                                    </select>
                                                </div>

                                                <!-- Submit Button -->
                                                <div class="col-12 text-end">
                                                    <button type="submit" class="btn btn-primary">Submit</button>
                                                </div>

                                            </div>
                                        </div>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                    <!--end col-->
                </div>
            </div>
        </div>
    </div>
    </div>
    <?php include "includes/footer.php"; ?>

</body>

</html>