87 lines
4.8 KiB
PHP
87 lines
4.8 KiB
PHP
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<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<title>Add New Lead</title>
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<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/css/bootstrap.min.css" rel="stylesheet">
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<link rel="stylesheet" href="assets/css/custom.css">
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</head>
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<body>
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<div class="container mt-5">
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<div class="row justify-content-center">
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<div class="col-md-8">
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<div class="card">
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<div class="card-header">
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<h3>Add New Lead</h3>
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</div>
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<div class="card-body">
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<form action="handle_add_lead.php" method="POST">
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="first_name" class="form-label">First Name</label>
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<input type="text" class="form-control" id="first_name" name="first_name" required>
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</div>
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<div class="col-md-6 mb-3">
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<label for="last_name" class="form-label">Last Name</label>
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<input type="text" class="form-control" id="last_name" name="last_name" required>
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</div>
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</div>
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<div class="mb-3">
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<label for="phone_number" class="form-label">Phone Number</label>
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<input type="text" class="form-control" id="phone_number" name="phone_number" required>
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</div>
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<div class="mb-3">
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<label for="email" class="form-label">Email (optional)</label>
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<input type="email" class="form-control" id="email" name="email">
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</div>
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<div class="mb-3">
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<label for="street_address" class="form-label">Street Address</label>
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<input type="text" class="form-control" id="street_address" name="street_address" required>
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</div>
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="city" class="form-label">City</label>
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<input type="text" class="form-control" id="city" name="city" required>
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</div>
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<div class="col-md-4 mb-3">
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<label for="state" class="form-label">State</label>
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<input type="text" class="form-control" id="state" name="state" required>
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</div>
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<div class="col-md-2 mb-3">
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<label for="zip_code" class="form-label">ZIP Code</label>
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<input type="text" class="form-control" id="zip_code" name="zip_code" required>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 mb-3">
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<label for="did_number" class="form-label">DID Number</label>
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<input type="text" class="form-control" id="did_number" name="did_number" required>
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</div>
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<div class="col-md-6 mb-3">
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<label for="vertical" class="form-label">Vertical</label>
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<input type="text" class="form-control" id="vertical" name="vertical" required>
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</div>
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</div>
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<div class="mb-3">
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<label for="notes" class="form-label">Notes & Comments</label>
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<textarea class="form-control" id="notes" name="notes" rows="3"></textarea>
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</div>
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<input type="hidden" name="campaign_name" value="Default Campaign">
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<input type="hidden" name="agent_name" value="Default Agent">
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<button type="submit" class="btn btn-primary">Submit Lead</button>
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<a href="index.php" class="btn btn-secondary">Cancel</a>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.2/dist/js/bootstrap.bundle.min.js"></script>
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</body>
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</html>
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