38 lines
1.7 KiB
Plaintext
38 lines
1.7 KiB
Plaintext
% layout 'user';
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% title 'Home';
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% content_for javascript => begin
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%= javascript '/static/user/js/home.js';
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% end
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<div class="card">
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<h3 class="card-header">Submit Receipt</h3>
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<div class="card-block">
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<form id="receipt-form" action="<%= url_for '/portal/upload' %>">
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<input id="tran-type" type="hidden" name="transaction_type" value="3" hidden>
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<div class="form-group">
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<label for="org-name">Organisation Name</label>
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<input id="org-name" type="text" class="form-control" name="organisation_name" placeholder="Organisation Name" required>
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</div>
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<div class="form-group">
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<label for="org-street">Street Address</label>
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<input id="org-street" type="text" class="form-control" name="street_name" placeholder="eg. 7 High Street">
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</div>
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<div class="form-group">
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<label for="org-town">Town</label>
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<input id="org-town" type="text" class="form-control" name="town" placeholder="eg. Lancaster" required>
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</div>
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<div class="form-group">
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<label for="org-postcode">Postcode</label>
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<input id="org-postcode" type="text" class="form-control" name="postcode" placeholder="eg. LA1 1AA">
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</div>
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<div class="form-group">
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<label for="tran-value">Receipt Value</label>
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<input id="tran-value" type="number" step="any" class="form-control" name="transaction_value" placeholder="eg. 5.99">
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</div>
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<div class="form-group">
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<label for="tran-file">Receipt Picture</label>
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<input id="tran-file" type="file" class="form-control-file" name="file">
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</div>
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<button type="submit" class="btn btn-primary">Add Receipt</button>
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</div>
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</div>
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