book_admin/application/admin/view/reward/inviterecord/agentapply.html

<style>
    #add-form{
        width: 50%;
        margin:0 auto;
    }
    h3{
        text-align: center;
    }
    .line{
        border-bottom: 2px solid #ccc;
        margin:30px 0 10px;
    }
    .notice{
        text-align: center;
        font-size: 14px;
    }
    .submit{
        margin-top: 20px;
        text-align: center;
    }
    .submit button{
        height: 50px;
        line-height: 40px;
        border-radius: 25px;
        width: 60%;
        margin:0 auto;
        background-color: #00b3ea;
        color:#fff;
        font-size: 16px;
        font-weight: 700;
    }
    .form-horizontal .form-group input{width: 80%}
    @media (max-width: 640px){
		#add-form{
			width: auto;
			margin:0 auto;
		}
		.msg-box{
			margin: 6px 0 20px;
			position: static;
			display: block;
		}
		.form-horizontal .form-group input{width: 100%}
    }
</style>
<h3>{$platname}账号申请表</h3>
<div class="line"></div>
<p class="notice">注册账号需填写以下信息，请认真填写相关信息</p>
<form id="add-form" class="form-horizontal form-ajax agentapply" role="form" data-toggle="validator" method="POST" action="agentapply">
    <div class="panel panel-default">
        <div class="panel-heading"><b>基本信息</b></div>
        <input type="hidden" name="row[invite_id]" value="{$invite_id}">
        <div class="panel-body">
            <!--<div class="form-group">-->
                <!--<label for="role_id" class="control-label col-xs-12 col-sm-2">* {:__('Group')}:</label>-->
                <!--<div class="col-xs-12 col-sm-8">-->
                    <!--&lt;!&ndash;{     :build_select('group[]', $groupdata, [3], ['class'=>'form-control selectpicker', 'multiple'=>'', 'data-rule'=>'required'])       }&ndash;&gt;-->
                    <!--<input type="text" class="form-control" value="代理商" disabled>-->
                    <!--<input type="hidden" name="group[]" value="4">-->
                <!--</div>-->
            <!--</div>-->
            <div class="form-group">
                <label for="username" class="control-label col-xs-12 col-sm-2">* 用户名:</label>
                <div class="col-xs-12 col-sm-8">
                    <input type="text" class="form-control" id="username" name="row[username]" value=""
                           data-rule="required;username"/>
                </div>
            </div>
            <div class="form-group">
                <label for="nickname"  class="control-label col-xs-12 col-sm-2">* 昵称:</label>
                <div class="col-xs-12 col-sm-8">
                    <input type="text" maxlength="16" class="form-control" id="nickname" name="row[nickname]" autocomplete="off"
                           value="" data-rule="required"/>
                </div>
            </div>

            <div class="form-group">
                <label for="email" class="control-label col-xs-12 col-sm-2">{:__('Email')}:</label>
                <div class="col-xs-12 col-sm-8">
                    <input type="email" class="form-control" id="email" name="row[email]" value="" data-rule="email"/>
                </div>
            </div>
            <div class="form-group">
                <label for="phone" class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
                <div class="col-xs-12 col-sm-8">
                    <input type="tel" class="form-control" id="phone" name="row[phone]"
                           data-rule="mobile"/>
                </div>
            </div>
            <!--<div class="form-group">-->
                <!--<label for="content" class="control-label col-xs-12 col-sm-2">* {:__('Status')}:</label>-->
                <!--<div class="col-xs-12 col-sm-8">-->
                    <!--{:build_radios('row[status]', ['normal'=>__('Normal'), 'hidden'=>__('Hidden')])}-->
                <!--</div>-->
            <!--</div>-->

        </div>
    </div>

    <div class="panel panel-default">
        <div class="panel-heading"><b>收款方式</b></div>
        <div class="panel-body">
            <div class="form-group">
                <label for="c-pay_type" class="control-label col-xs-12 col-sm-2">* 收款方式:</label>
                <div class="col-xs-12 col-sm-8">
                    <select  id="c-pay_type" class="form-control selectpicker" name="row[pay_type]">
                        {foreach name="payTypeList" item="vo"}
                        <option value="{$key}" {in name="key" value="1"}selected{/in}>{$vo}</option>
                        {/foreach}
                    </select>
                </div>
            </div>
            <div class="form-group">
                <label for="c-card_holder" class="control-label c-card_holder col-xs-12 col-sm-2">* 收款人:</label>
                <div class="col-xs-12 col-sm-8">
                    <input id="c-card_holder" data-rule="required" class="form-control" name="row[name]" type="text">
                </div>
            </div>
            <div class="form-group">
                <label for="c-card_num" class="control-label c-card_num col-xs-12 col-sm-2">* 收款账号:</label>
                <div class="col-xs-12 col-sm-8">
                    <input id="c-card_num" data-rule="required" class="form-control" name="row[account]" type="text" >
                </div>
            </div>
        </div>
    </div>

    <div class="form-group layer-footer clearfix">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8 submit">
            <button  class="btn">{:__('提交申请')}</button>
        </div>
    </div>

</form>

    <p class="notice">如有疑问，请咨询联系人<span>{$invite_msg}</span></p>
<script>

</script>