You are on page 1of 2

<head>

<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />


<title>tagihan pelangan</title>
</head>
<body>
<table width="52%" border="0">
<tr>
<th bordercolor="#FFFFFF" scope="col">TAGIHAN PELANGGAN </th>
</tr>
</table>
<p>&nbsp;</p>
<table width="52%" border="0">
<tr>
<th width="17%" scope="col">&nbsp;</th>
<th width="22%" scope="col">&nbsp;</th>
<th width="12%" scope="col"><div align="left">Tanggal</div></th>
<th width="49%" scope="col"><div align="left">
<input type="text" name="textfield8" />
</div></th>
</tr>
<tr>
<th scope="row"><div align="left">Nama</div></th>
<td><form id="form1" name="form1" method="post" action="">
<label>
<input type="text" name="textfield" />
</label>
</form>
</td>
<td><div align="left">No. resi </div></td>
<td><div align="left">
<input type="text" name="textfield9" />
</div></td>
</tr>
<tr>
<th scope="row"><div align="left">Jenis tagihan </div></th>
<td><input type="text" name="textfield2" /></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row"><div align="left">Jumlah tagihan </div></th>
<td><input type="text" name="textfield3" /></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row"><div align="left">PPN</div></th>
<td><input type="text" name="textfield4" /></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row"><div align="left">Diskon</div></th>
<td><input type="text" name="textfield5" /></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row"><div align="left">Biaya tambahan </div></th>
<td><input type="text" name="textfield6" /></td>

<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row"><div align="left">Total</div></th>
<td><input type="text" name="textfield7" /></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<th scope="row">&nbsp;</th>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td><p>&nbsp;</p>
</td>
</tr>
</table>
<table width="52%" border="0">
<tr>
<th scope="col"><label>
<input name="add" type="submit" id="add" value="add" />
<input name="save" type="submit" id="save" value="save" />
<input name="edit" type="submit" id="edit" value="edit" />
<input name="delete" type="submit" id="delete" value="delete" />
<input name="print" type="submit" id="print" value="print" />
<input name="exit" type="submit" id="exit" value="exit" />
</label></th>
</tr>
</table>
</body>
</html>

You might also like