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| <html lang="en"> | |
| <head> | |
| <meta charset="UTF-8"> | |
| <meta name="viewport" content="width=device-width, initial-scale=1.0"> | |
| <title>Aadhaar Card Appointment - Post Office</title> | |
| <style> | |
| body { | |
| font-family: Arial, sans-serif; | |
| background-color: #f4f4f4; | |
| padding: 20px; | |
| } | |
| .container { | |
| max-width: 600px; | |
| margin: auto; | |
| background-color: #fff; | |
| padding: 20px; | |
| box-shadow: 0 0 10px rgba(0,0,0,0.1); | |
| border-radius: 10px; | |
| } | |
| h2 { | |
| text-align: center; | |
| } | |
| label { | |
| font-weight: bold; | |
| } | |
| input, select, button { | |
| width: 100%; | |
| padding: 10px; | |
| margin: 10px 0; | |
| border: 1px solid #ccc; | |
| border-radius: 5px; | |
| } | |
| button { | |
| background-color: #007BFF; | |
| color: white; | |
| cursor: pointer; | |
| } | |
| button:hover { | |
| background-color: #0056b3; | |
| } | |
| </style> | |
| </head> | |
| <body> | |
| <div class="container"> | |
| <h2>Book Your Aadhaar Appointment</h2> | |
| <form action="submit_appointment.php" method="POST"> | |
| <!-- Personal Information Section --> | |
| <label for="name">Full Name:</label> | |
| <input type="text" id="name" name="name" required> | |
| <label for="mobile">Mobile Number:</label> | |
| <input type="tel" id="mobile" name="mobile" pattern="[0-9]{10}" required> | |
| <label for="email">Email Address (optional):</label> | |
| <input type="email" id="email" name="email"> | |
| <label for="aadhar">Aadhaar Number:</label> | |
| <input type="text" id="aadhar" name="aadhar" pattern="[0-9]{12}" required> | |
| <!-- Service Type --> | |
| <label for="service">Service Type:</label> | |
| <select id="service" name="service" required> | |
| <option value="new">New Aadhaar Enrollment</option> | |
| <option value="update">Update Existing Aadhaar</option> | |
| <option value="biometric">Biometric Update</option> | |
| </select> | |
| <!-- Appointment Date and Time --> | |
| <label for="date">Preferred Appointment Date:</label> | |
| <input type="date" id="date" name="date" required> | |
| <label for="time">Preferred Appointment Time:</label> | |
| <input type="time" id="time" name="time" required> | |
| <!-- Submit Button --> | |
| <button type="submit">Book Appointment</button> | |
| </form> | |
| </div> | |
| </body> | |
| </html> | |