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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<!-- Required meta tags-->
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<meta name="description" content="Colorlib Templates">
<meta name="author" content="Colorlib">
<meta name="keywords" content="Colorlib Templates">
<!-- Title Page-->
<title>Clear My Record Tulsa</title>
<!-- Icons font CSS-->
<link href="vendor/mdi-font/css/material-design-iconic-font.min.css" rel="stylesheet" media="all">
<link href="vendor/font-awesome-4.7/css/font-awesome.min.css" rel="stylesheet" media="all">
<!-- Font special for pages-->
<link href="https://fonts.googleapis.com/css?family=Roboto:100,100i,300,300i,400,400i,500,500i,700,700i,900,900i" rel="stylesheet">
<!-- Vendor CSS-->
<link href="vendor/select2/select2.min.css" rel="stylesheet" media="all">
<link href="vendor/datepicker/daterangepicker.css" rel="stylesheet" media="all">
<!-- Main CSS-->
<link href="css/main.css" rel="stylesheet" media="all">
</head>
<script>
// register ServiceWorker, remember to use absolute path!
if (navigator.serviceWorker) {
navigator.serviceWorker.register('/clear-my-record/sw.js', {scope: '/clear-my-record/'})
}
</script>
<body>
<div class="page-wrapper bg-blue p-t-100 p-b-100 font-robo">
<div class="wrapper wrapper--w680">
<div class="card card-1">
<div class="card-heading"></div>
<div class="card-body">
<h2 class="title">Petitioner Info</h2>
<form method="POST">
<section class="petitioner-name">
<h3>Name</h3>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<input id="petitioner-first" class="input--style-1" type="text" placeholder="FIRST" name="firstname">
</div>
</div>
<div class="col-2">
<div class="input-group">
<input id="petitioner-middle" class="input--style-1" type="text" placeholder="MIDDLE" name="middlename">
</div>
</div>
</div>
<div class="input-group">
<input id="petitioner-last" class="input--style-1" type="text" placeholder="LAST" name="lastname">
</div>
</section>
<section class="petitioner-address">
<h3>Address</h3>
<div class="col-1">
<div class="input-group">
<input id="petitioner-street1" class="input--style-1" type="text" placeholder="ADDRESS LINE 1" name="street1">
</div>
</div>
<div class="col-1">
<div class="input-group">
<input id="petitioner-street2" class="input--style-1" type="text" placeholder="ADDRESS LINE 2" name="street2">
</div>
</div>
<div class="row row-space">
<div class="col-3">
<div class="input-group">
<input id="petitioner-city" class="input--style-1" type="text" placeholder="CITY" name="city">
</div>
</div>
<div class="col-3">
<div class="input-group">
<div class="rs-select2 js-select-simple select--no-search">
<select id='petitioner-state' name="state">
<option disabled="disabled" selected="selected">STATE</option>
<option value='AR'>AR</option>
<option value='OK'>OK</option>
<option value='TX'>TX</option>
</select>
<div class="select-dropdown"></div>
</div>
</div>
</div>
<div class="col-3">
<div class="input-group">
<input id="petitioner-zip" class="input--style-1" type="text" placeholder="ZIPCODE" name="ZIP">
</div>
</div>
</div>
</section>
<section class="petitioner-information">
<h3>Personal Information</h3>
<div class="col-1">
<div class="input-group">
<input id="petitioner-social" class="input--style-1" type="text" placeholder="SOCIAL SECURITY NUMBER" name="social">
</div>
</div>
<div class="col-1">
<div class="input-group">
<input id="petitioner-dateOfBirth" class="input--style-1 js-datepicker" type="text" placeholder="DATE OF BIRTH" name="dateOfBirth">
<i class="zmdi zmdi-calendar-note input-icon js-btn-calendar"></i>
</div>
</div>
<div class="col-1">
<div class="input-group">
<input id="petitioner-phone1" class="input--style-1" type="text" placeholder="PHONE NUMBER" name="phone1">
</div>
</div>
</section>
<section class="petitioner-case">
<h3>Case Info</h3>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<input id="petitioner-dateOfArrest" class="input--style-1 js-datepicker" type="text" placeholder="DATE OF ARREST" name="dateOfArrest">
<i class="zmdi zmdi-calendar-note input-icon js-btn-calendar"></i>
</div>
</div>
<div class="col-2">
<div class="input-group">
<div class="rs-select2 js-select-simple select--no-search">
<select id='petitioner-county' name="county">
<option disabled="disabled" selected="selected">COUNTY</option>
<option value="Tulsa">Tulsa</option>
<option value="Rodgers">Rodgers</option>
<option value="Osage">Osage</option>
</select>
<div class="select-dropdown"></div>
</div>
</div>
</div>
</div>
<div class="input-group">
<div class="rs-select2 js-select-simple select--no-search">
<select id="petitioner-case-agency" name="class">
<option disabled="disabled" selected="selected">ARRESTING AGENCY</option>
<option value="Tulsa">Tulsa</option>
<option value="Broken Arrow">Broken Arrow</option>
<option value="Jenks">Jenks</option>
</select>
<div class="select-dropdown"></div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<input id="petitioner-case-no" class="input--style-1" type="text" placeholder="CASE Number" name="caseNo">
</div>
</div>
</div>
<div class="input-group">
<input id="petitioner-charges" class="input--style-1" type="textarea" placeholder="CHARGES" name="charges">
</div>
</section>
<div class="p-t-20">
<button class="btn btn--radius btn--green download-pdf" type="submit">Submit</button>
</div>
</form>
</div>
</div>
</div>
</div>
<!-- Jquery JS-->
<script src="vendor/jquery/jquery.min.js"></script>
<!-- Vendor JS-->
<script src="vendor/select2/select2.min.js"></script>
<script src="vendor/datepicker/moment.min.js"></script>
<script src="vendor/datepicker/daterangepicker.js"></script>
<!-- Main JS-->
<script src="js/global.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jspdf/1.5.3/jspdf.debug.js" integrity="sha384-NaWTHo/8YCBYJ59830LTz/P4aQZK1sS0SneOgAvhsIl3zBu8r9RevNg5lHCHAuQ/" crossorigin="anonymous"></script>
</body><!-- This templates was made by Colorlib (https://colorlib.com) -->
</html>
<!-- end document-->