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apply-2.html
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<!DOCTYPE html>
<html lang="">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Title Page</title>
<!-- Bootstrap CSS -->
<link href="./css/bootstrap.css" rel="stylesheet">
<!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/libs/html5shiv/3.7.3/html5shiv.js"></script>
<script src="https://oss.maxcdn.com/libs/respond.js/1.4.2/respond.min.js"></script>
<![endif]-->
<style>
.navbar {
width: 100vw;
}
.nav-link {
color: black;
}
form input,
select {
border-radius: 5px;
border: 1px solid rgb(139, 139, 139);
height: 40px;
}
#next_btn {
color: #ffffff;
background: #00C268;
width: 100%;
padding: 10px;
border: 0;
}
#confirm_btn {
color: #ffffff;
background: #00C268;
width: 100px;
padding: 5px;
border: 1px solid #00C268;
border-radius: 50px;
}
.progressbar {
counter-reset: step;
}
.progressbar li {
list-style-type: none;
float: left;
width: 48%;
position: relative;
}
.progressbar li:before {
content: counter(step);
counter-increment: step;
width: 30px;
height: 30px;
line-height: 30px;
display: block;
text-align: center;
background: rgb(197, 196, 196);
color: #ffffff;
margin: 0px;
top: 0px;
border-radius: 50%;
position: absolute;
}
.progressbar li.active {
border-right: 1px solid rgb(133, 133, 133);
}
.progressbar li.active:before {
color: #ffffff;
background: #00C268;
}
</style>
</head>
<body>
<nav class="navbar navbar-expand">
<div class="container">
<a href="index.html" class="navbar-brand mr-16pt">
<span class="avatar avatar-sm navbar-brand-icon mr-0 mr-lg-8pt">
<span class="avatar-title "><img src="./images/logo.png" alt="logo" class="img-fluid" /></span>
<span class="avatar-title "><img src="./images/GreenDot.png" alt="logo" class="img-fluid" /></span>
</span>
<span class="d-none d-lg-block"></span>
</a>
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarsExample02" aria-controls="navbarsExample02" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarsExample02">
<ul class="navbar-nav mx-auto w-50 justify-content-around">
<li class="nav-item active">
<a class="nav-link" href="#">Home <span class="sr-only">(current)</span></a>
</li>
<li class="nav-item">
<a class="nav-link" href="#">Order Status</a>
</li>
<li class="nav-item">
<a class="nav-link" href="#">Cart</a>
</li>
<li class="nav-item">
<a class="nav-link" href="#">Apply</a>
</li>
</ul>
<ul class="navbar-nav navbar-right">
<li class="nav-item active mr-1">
<a class="nav-link first_btn" href="#">Change Password</a>
</li>
<li class="nav-item ml-1">
<a class="nav-link second_btn" href="#">Log out</a>
</li>
</ul>
</div>
</div>
</nav>
<div class="container text-center justify-content-center align-items-center" style="width: 500px;">
<ul class=" progressbar ">
<li>Enter your details</li>
<li class="active">Shipping Information</li>
</ul>
</div>
<div class="container" style="margin-top: 50px; margin-left: 600px;">
<form action="" style="width: 400px;">
<strong style="margin-left:150px;">Shipping Information</strong>
<div class=" form-group ">
<label for="full name ">Shipping to</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Request for</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Name</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Wes Reference Number</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Address</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">No of Sets</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Country</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">States</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Zip Code</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="form-group ">
<label for="full name ">Mobile Number</label><br>
<input type="text " placeholder="" style="width: 400px; border: solid 1px rgb(175, 173, 173);">
</div>
<div class="mb-3 p-3 text-center" style="font-size:12px; width: 400px; background: #00c26710; border: 1px solid #00c2674d;">
<p>Payment for service Request</p>
<div class="row justify-content-between">
<div class="col-5 text-left">
<p>Service Charge</p>
<p>Shipping Fee</p>
<p>Total Fees</p>
<br>
<p>Institutional fees</p>
</div>
<div class="col-5 text-right">
<p>N 5,000.00</p>
<p>N 500.00</p>
<p>N 5,500.00</p>
<br>
<p>N/A</p>
</div>
</div>
</div>
<input type="button" value="Next " id="next_btn" data-toggle="modal" data-target="#exampleModal">
</form>
</div>
<!--add to cart success modal-->
<div class="modal fade" id="exampleModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true" style="background: #00c26733;">
<div class="modal-dialog" role="document" style="margin-top: 200px;">
<div class="modal-content p-5">
<div class="modal-body text-center align-items-center justify-content-center">
<div class="mx-auto" style="width: 100px;">
<img class="img-fluid img-responsive" src="./images/cart.png" alt="warning">
</div>
<p>
<strong>
Added to cart
</strong>
</div>
<div style="width: 100%;" class="text-center">
<button type="button" class="btn btn-primary" id="confirm_btn" data-dismiss="modal" style="width: 150px; ">Continue</button>
</div>
</div>
</div>
</div>
<!-- jQuery -->
<script src="./js/jquery-3.5.1.js "></script>
<!-- Bootstrap JavaScript -->
<script src="./js/bootstrap.js "></script>
</body>
</html>