<?php
/**
 * Created by PhpStorm.
 * User: roysinclair
 * Date: 2016/07/11
 * Time: 6:59 PM
 */


?>

<div id="allPersonalInformation">


    <h1 class="text-center">Personal details</h1>
    <h5 class="text-center">Now for some basic information. We use these details to create your <br> online account and open your facility. </h5>

    <form role="form" id="sa-natural-basicInformation">
        <div class="form-body padding-top35px">


        <div class="form-group form-md-line-input" id="title">
                    <select class="form-control edited input-lg" id="form_control_1">
                        <option value="NONE" selected="">Please select</option>
                        <?php

                        $pdo = $SA->query("SELECT type FROM inputtitles");
                        $pdo->execute();
                        $results = $pdo->fetchAll();

                        foreach ($results as $row) {

                            echo '<option value="'.$row['type'].'">'.$row['type'].'</option>';

                        }

                        ?>
                    </select>
                    <label for="form_control_1">Title</label>
                    <span class="help-block hiddenContent"></span>
                </div>


                <div class="form-group form-md-line-input" id="name" >
                    <input type="text" class="form-control input-lg" value="">
                    <label for="form_control_1">Name</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input" id="lastName">
                    <input type="text" class="form-control input-lg" value=""  >
                    <label for="form_control_1">Last Name</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input" id="idNumber">
                    <input type="numbers" class="form-control input-lg" value="" maxlength="13">
                    <label for="form_control_1">ID Number</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input " id="birth">
                    <input type="text" class="form-control input-lg" value="" id="mask_date2">
                    <label for="form_control_1">Date of Birth</label>
                    <span class="help-block hiddenContent"></span>
                </div>



            </div>

        </form>


    <h1 class="text-center">Contact Information</h1>
    <h5 class="text-center">We’d like to keep in touch. Prefer to have your statements posted? <br> Let us know. </h5>

    <form role="form" id="sa-natural-contact">
        <div class="form-body padding-top35px">


            <div class="form-group form-md-line-input" id="Physical-Address-1" >
                <input type="text" class="form-control input-lg" value="">
                <label for="form_control_1">Physical Address <span class="required" aria-required="true">*</span></label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input" id="Physical-Address-2">
                <input type="text" class="form-control input-lg" value=""  >
                <label for="form_control_1">Physical Address </label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input" id="Physical-Suburb" >
                <input type="text" class="form-control input-lg" value="">
                <label for="form_control_1">Suburb/City <span class="required" aria-required="true">*</span></label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input" id="Physical-Code" >
                <input type="number" class="form-control input-lg" value="">
                <label for="form_control_1">Postal Code <span class="required" aria-required="true">*</span></label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input">
                <div class="col-md-10">
                    <div class="md-checkbox-inline">
                        <div class="md-checkbox">
                            <input type="checkbox" id="postalAddress" name="signIn" class="md-check">
                            <label for="postalAddress">
                                <span class="inc"></span>
                                <span class="check"></span>
                                <span class="box"></span> Postal and residential address the same ?</label>
                        </div>
                    </div>
                </div>
            </div>

            <div class="clearfix margin-bottom-40"></div>

            <!-- VISIBLE UNTIL postalAddress ? is CLICKED -->
            <div id="postalAddressContent">
                <div class="form-group form-md-line-input" id="Postal-Address-1" >
                    <input type="text" class="form-control input-lg" value="">
                    <label for="form_control_1">Postal Address line 1</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input" id="Postal-Address-2" >
                    <input type="text" class="form-control input-lg" value="">
                    <label for="form_control_1">Postal Address line 2</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input" id="Postal-Suburb" >
                    <input type="text" class="form-control input-lg" value="">
                    <label for="form_control_1">Suburb/City</label>
                    <span class="help-block hiddenContent"></span>
                </div>

                <div class="form-group form-md-line-input" id="Postal-Code" >
                    <input type="number" class="form-control input-lg" value="">
                    <label for="form_control_1">Postal Code <span class="required" aria-required="true">*</span></label>
                    <span class="help-block hiddenContent"></span>
                </div>
            </div>
            <!-- END: VISIBLE UNTIL postalAddress ? is CLICKED -->

            <div class="form-group form-md-line-input" id="Telephone-Work" >
                <input type="text" class="form-control input-lg" value="" id="mask_phone_work">
                <label for="form_control_1">Telephone Work</label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input" id="Telephone-Home" >
                <input type="text" class="form-control input-lg" value="" id="mask_phone_home">
                <label for="form_control_1">Telephone Home</label>
                <span class="help-block hiddenContent"></span>
            </div>

            <div class="form-group form-md-line-input" id="Telephone-Mobile" >
                <input type="text" class="form-control input-lg" value="" id="mask_phone_mobile">
                <label for="form_control_1">Telephone Mobile <span class="required" aria-required="true">*</span></label>
                <span class="help-block hiddenContent"></span>
            </div>


        </div>

        <div class="form-actions noborder hidden" id="update">
            <div class="padding-top52px"></div>
            <a href="#">
                <button type="button" class="btn purple btn-lg" id="updateButton">Update</button>
            </a>
        </div>

    </form>


</div>