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a-add-claim.html
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a-add-claim.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Add claim</title>
<!--/tags -->
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="keywords" content="" />
<script type="application/x-javascript">
addEventListener("load", function () {
setTimeout(hideURLbar, 0);
}, false);
function hideURLbar() {
window.scrollTo(0, 1);
}
</script>
<!--//tags -->
<link href="css/bootstrap.css" rel="stylesheet" type="text/css" media="all" />
<link href="css/style.css" rel="stylesheet" type="text/css" media="all" />
<link href="css/font-awesome.css" rel="stylesheet">
<!-- //for bootstrap working -->
<link href="http://fonts.googleapis.com/css?family=Work+Sans:200,300,400,500,600,700" rel="stylesheet">
<link href='http://fonts.googleapis.com/css?family=Lato:400,100,100italic,300,300italic,400italic,700,900,900italic,700italic'
rel='stylesheet' type='text/css'>
</head>
<body>
<!-- header -->
<div class="header" id="home">
<div class="content white agile-info">
<nav class="navbar navbar-default navbar-fixed-top" role="navigation">
<div class="container">
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#bs-example-navbar-collapse-1">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="a-first-c.html">
<h1><span class="fa fa-signal" aria-hidden="true"></span> Hibernia-Sino <label><span> Travel Insurance</span> </label></h1>
</a>
</div>
<!--/.navbar-header-->
<div class="collapse navbar-collapse" id="bs-example-navbar-collapse-1">
<nav class="link-effect-2" id="link-effect-2">
<ul class="nav navbar-nav">
<li class="active"><a href="a-first1.html" class="effect-3"><span>Home</span></a></li>
<li class="effect-3"><a><span >Claim center</span></a></li>
<li>
<!--图标按钮-->
<!--<button type="button" class="btn btn-default btn-lg" style="font-size: 13px" >-->
<!--<span class="glyphicon glyphicon-log-out" aria-hidden="true"></span> Log out-->
<!--</button>-->
<button type="button" class="btn btn-default btn-lg" style="font-size: 13px" >
<span >Log out</span>
</button>
</li>
<li>
<div class="dropdown">
<!--图标按钮-->
<!--<button class="btn btn-default dropdown-toggle" type="button" id="dropdownMenu1" data-toggle="dropdown" aria-haspopup="true" aria-expanded="true" style="height: 38px">-->
<!--<span class="glyphicon glyphicon-globe" aria-hidden="true"></span>-->
<!--<span class="caret"></span>-->
<!--</button>-->
<button class="btn btn-default dropdown-toggle" type="button" id="dropdownMenu1" data-toggle="dropdown" aria-haspopup="true" aria-expanded="true" style="height: 38px">
<span>language</span>
<span class="caret"></span>
</button>
<ul class="dropdown-menu" aria-labelledby="dropdownMenu1">
<li><a href="#">English</a></li>
<li><a href="#">中文</a></li>
</ul>
</div>
</li>
</ul>
</nav>
</div>
<!--/.navbar-collapse-->
<!--/.navbar-->
</div>
</nav>
</div>
</div>
<div class="inner_page_agile" style="margin-bottom: 40px">
<h3><span>Add A New Claim</span></h3>
<p><span>Please fall in the claim information</span></p>
</div>
<div class="form-horizontal center-block" style="background-color: #eeeded;width: 55%;padding-top: 30px;padding-bottom: 100px;border-radius: 20px;margin-bottom: 30px">
<form>
<label class="col-sm-6 control-label" style="padding-top: 0px" ><span>Order number:</span></label>
<div class="col-sm-6 input-group">
<span type="text" style="width: 300px">123445677</span>
<!--<p class="help-block">It will be used when log in</p>-->
</div>
<label class="col-sm-6 control-label" style="padding-top: 0px" ><span>Item picture :</span></label>
<div class="col-sm-6 input-group">
<input type="file" class="form-control" style="width: 180px;opacity: initial;border: 0px;background-color: transparent;margin-left: -125px"/>
</div>
<label class="col-sm-6 control-label" style="padding-top: 0px" ><span>Item name :</span></label>
<div class="col-sm-6 input-group">
<input type="text" class="form-control" style="width: 150px">
<!--<p class="help-block">It will be used when log in</p>-->
</div>
<label class="col-sm-6 control-label" style="padding-top: 0px"><span>Item description :</span></label>
<div class="col-sm-6 input-group">
<textarea class="form-control" style="width: 250px" rows="3"></textarea>
</div>
<label class="col-sm-6 control-label" style="padding-top: 0px"><span>Item price :</span></label>
<div class="col-sm-6 input-group" style="width: 150px">
<span class="input-group-addon">$</span>
<input type="text" class="form-control" onkeyup ="keepTwoDecimalFull(this)">
<span class="input-group-addon">.00</span>
</div>
<label class="col-sm-6 control-label" style="padding-top: 0px" ><span>Lost date:</span></label>
<div class="col-sm-6 input-group">
<div style="float:left"><input type="Date" class="form-control" id="Lost_date" name="Date" style="width: 150px" ></div>
</div>
<div class="col-sm-12 ">
<!-- submit Button -->
<button class="btn btn-success center-block " style=" margin-top:10px;margin-bottom: 125px;width: 20%;height: 40px;font-size: 15px;"><a href="#"><span>Submit</span></a></button>
</div>
</form>
</div>
<div class="col-sm-12 center-block ">
<!-- Back Button -->
<button class="btn btn-inverse" style="margin-left: 7%;margin-top: -110px;margin-bottom: 125px;width: 10%;height: 40px;font-size: 15px;"><a href="#"><span><< Back</span></a></button>
</div>
<!-- footer -->
<div class="footer_top_agileits" style="padding-top: 30px">
<div class="container">
<div class="col-md-6 footer_grid">
<h3><span>About Us</span></h3>
<p><span>Nam libero tempore cum vulputate id est id, pretium semper enim. Morbi viverra congue nisi vel pulvinar posuere sapien
eros.</span>
</p>
</div>
<div class="col-md-6 footer_grid">
<h3><span>Contact Info</span></h3>
<ul class="address">
<li><i class="fa fa-map-marker" aria-hidden="true"></i><span>Beijing-Dublin International College,<span>Beijing,China.</span></span></li>
<li><i class="fa fa-envelope" aria-hidden="true"></i><a href="mailto:[email protected]">[email protected]</a></li>
<li><i class="fa fa-phone" aria-hidden="true"></i>+8613888888888</li>
</ul>
</div>
<div class="clearfix"> </div>
<div class="clearfix"> </div>
</div>
</div>
<div class="footer_w3ls">
<div class="container">
<div class="footer_bottom">
<div class="col-md-9 footer_bottom_grid">
<div class="footer_bottom1">
<a href="index.html">
<h2><span class="fa fa-signal" aria-hidden="true"></span> Hibernia-Sino <label><span>Travel Insurance</span></label></h2>
</a>
<p><span>Copyright © Hibernia-Sino All rights reserved.</span></p>
</div>
</div>
<div class="clearfix"> </div>
</div>
</div>
</div>
<!-- //footer -->
<a href="#home" class="scroll" id="toTop" style="display: block;"> <span id="toTopHover" style="opacity: 1;"> </span></a>
<!-- js -->
<script type="text/javascript" src="js/jquery-2.1.4.min.js"></script>
<script type="text/javascript" src="js/bootstrap.js"></script>
</body>
</html>