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<!

DOCTYPE html>

<html lang="en" style="height: 100%;">

<head>

<meta charset="utf-8">

<meta name="viewport" content="width=device-width, initial-scale=1">

<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet"


integrity="sha384-EVSTQN3/azprG1Anm3QDgpJLIm9Nao0Yz1ztcQTwFspd3yD65VohhpuuCOmLASjC"
crossorigin="anonymous">

<title>User Registration Form</title>

</head>

<body style="

background: linear-gradient(90deg, rgb(36, 0, 0) 0%, rgb(154, 14, 51) 35%, rgb(255, 0, 17) 100%);

font-family: 'Poppins', sans-serif;

margin: 0;

box-sizing: border-box;

">

<div class="container-fluid" style="height: 100%;">

<form class="mx-auto" id="registrationForm" style="

border-radius: 20px;

margin-top: 100px !important;

width: 50% !important;

background-color: white !important;

padding: 50px;

">

<h2 class="text-center" style="


text-align: center;

font-weight: bold;

font-size: 2rem !important;

">Consumer Registration</h2>

<div class="row">

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="selectTitle" class="form-label" style="

font-weight: 800 !important;

">Title</label>

<select class="form-select" id="selectTitle" required style="

width: 100%;

border: none;

border-radius: 4px 4px 0 0;

background-color: rgba(255, 255, 255, 0.8);

padding: 8px;

color: rgba(0, 0, 0, .87);

">

<option value="" disabled selected>Select Title</option>

<option value="Mr.">Mr.</option>

<option value="Ms.">Ms.</option>

<option value="Mrs.">Mrs.</option>

</select>

</div>

<div class="col-md-6 mb-3" style="

text-align: left;

">
<label for="inputCustomerName" class="form-label" style="

font-weight: 800 !important;

">Customer Name</label>

<input type="text" class="form-control" id="inputCustomerName" placeholder="Enter


Customer Name" maxlength="50" required style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;

border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

</div>

<div class="row">

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="selectCountryCode" class="form-label" style="

font-weight: 800 !important;

">Country Code</label>

<select class="form-select" id="selectCountryCode" style="

width: 100%;

border: none;

border-radius: 4px 4px 0 0;

background-color: rgba(255, 255, 255, 0.8);

padding: 8px;
color: rgba(0, 0, 0, .87);

"required >

<option value="" disabled selected>Select Country Code</option>

<option value="+1">+1 (United States)</option>

<option value="+44">+44 (United Kingdom)</option>

<option value="+91">+91 (India)</option>

</select>

</div>

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="inputMobileNumber" class="form-label" style="

font-weight: 800 !important;

">Mobile Number</label>

<input type="tel" class="form-control" id="inputMobileNumber" placeholder="Enter Mobile


Number" pattern="[0-9]{10}" required style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;

border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

</div>

<div class="row">

<div class="col-md-6 mb-3" style="


text-align: left;

">

<label for="inputEmail" class="form-label" style="

font-weight: 800 !important;

">Email</label>

<input type="email" class="form-control" id="inputEmail" placeholder="Enter Email" required


style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;

border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="inputUserId" class="form-label" style="

font-weight: 800 !important;

">User ID</label>

<input type="text" class="form-control" id="inputUserId" placeholder="Enter User ID"


minlength="5" maxlength="20" required style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;
border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

</div>

<div class="row">

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="inputPassword" class="form-label" style="

font-weight: 800 !important;

">Password</label>

<input type="password" class="form-control" id="inputPassword" placeholder="Enter


Password" maxlength="30" required style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;

border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

<div class="col-md-6 mb-3" style="

text-align: left;

">

<label for="inputConfirmPassword" class="form-label" style="

font-weight: 800 !important;


">Confirm Password</label>

<input type="password" class="form-control" id="inputConfirmPassword"


placeholder="Confirm Password" maxlength="30" required style="

width: 100%;

color: rgba(0, 0, 0, .87);

border-bottom-color: rgba(0, 0, 0, .42);

box-shadow: none !important;

border: none;

border-bottom: 1px solid;

border-radius: 4px 4px 0 0;

">

</div>

</div>

<div class="row">

<div class="col-md-4 mb-3" style="

text-align: center;

">

<button type="submit" class="btn btn-primary mt-4" style="

width: 100%;

border: none;

border-radius: 50px;

background: linear-gradient(90deg, rgba(2,0,36,1) 0%, rgba(75,14,154,1) 35%,


rgba(0,212,255,1) 100%);

">Register</button>

</div>

<div class="col-md-4 mb-3" style="

text-align: center;

">
<button type="reset" class="btn btn-primary mt-4" style="

width: 100%;

border: none;

border-radius: 50px;

background: linear-gradient(90deg, rgba(2,0,36,1) 0%, rgba(75,14,154,1) 35%,


rgba(0,212,255,1) 100%);

">Reset</button>

</div>

</div>

</form>

</div>

<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/js/bootstrap.bundle.min.js"
integrity="sha384-MrcW6ZMFYlzcLA8Nl+NtUVF0sA7MsXsP1UyJoMp4YLEuNSfAP+JcXn/tWtIaxVXM"
crossorigin="anonymous"></script>

<script>

document.getElementById('registrationForm').addEventListener('submit', function(event) {

event.preventDefault();

alert('Consumer Registration successful.');

});

</script>

</body>

</html>

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