Personal Details

Name *

Pincode*

District *

City *

State *

Email ID

Valid Email Required

Mobile No *

Enter Valid Mobile is required.
InValid Mobile Number

OTP *

Address *

</div>
                            </div>
                        </div>
                        <button style="margin-bottom: 20px;" type="submit" id="btnPreview" ng-click="ShowSignupPreview()" class="btn btn-success" ng-disabled="Form_SignupForm.$invalid">Preview</button>
                    </form>
                    <span class="text-center" style="color:red;">Note :  Please enter exact address as per the address proof Retailer will be uploading for KYC</span>
                </div>
            </div>

<div role="document">
                        <div class="join_now_box">
                            <form class="filter" name="formpreview2" novalidate>
                                <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 heading">
                                    <h5>Personal Details</h5>
                                    <span class="heading-back"></span>
                                </div>
                                <div class="row form-group">
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right"> Name </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtFName}} </label>
                                    </div>

<div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-sm-4 col-4 control-label label-right"> State  </label>
                                        <label class="col-sm-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.State}} </label>
                                    </div>
                                </div>
                                <div class="row form-group">
                                    <div class="col-lg-5 col-md-5 col-12  form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right">  District  </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtDistrict}} </label>
                                    </div>
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right">  City  </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtCity}} </label>
                                    </div>
                                </div>

<div class="row form-group">
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right"> PinCode </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtPINCode}} </label>
                                    </div>
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right"> Address </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtAddress}} </label>
                                    </div>
                                </div>
                                <div class="row form-group">
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right"> Mobile No </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtmobile}} </label>
                                    </div>
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <label class="col-md-4 col-4 control-label label-right"> Email </label>
                                        <label class="col-md-1 col-1 control-label"> : </label>
                                        <label class="col-md-6 col-4"> {{SignUp.txtEmail}} </label>
                                    </div>
                                </div>
                                <div class="modal-footer">
                                    <div class="col-lg-5 col-md-5 col-12 form-group mt-4 mb-4">
                                        <button type="button" id="btnBack" class="btn btn-danger " ng-click="BacktoSignupForm()">Back</button>
                                        <button type="submit" id="btnSubmit" class="btn btn-success" ng-show="ISSubmit" ng-click="signupsubmit()">Submit</button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>

<div class="join_now_box" ng-show="Confirmation">
                {{Message}}
            </div>
            <div class="col-lg-12 mb-3" ng-show="UpgradeToRetailer">
                <p>
                    <input type="checkbox" name="chkterms" ng-model="chkTC" />
                    I Agree & Understand :<strong>
                        <span ng-click="GetTermsandconditions()">
                            <a style="cursor:pointer" data-toggle="modal" data-target="#TCModal">
                                Terms and Conditions
                            </a>
                        </span>

</strong>
                </p>
            </div>
            <div class="mr-3" ng-show="UpgradeToRetailer">
                <input type="submit" ng-click="directtoMyAccount()" ng-disabled="chkTC==false" id="btnupload2" class="btn btn-success" value="Upgrade To Retailer" />
             
            </div>
            <div class="modal bs-example-modal-lg" id="TCModal" tabindex="-1" role="dialog" aria-labelledby="myLargeModalLabel">
                <div class="modal-dialog modal-lg" role="document">
                    <div class="modal-content">
                        <div class="modal-header">

<h4 class="modal-title" id="myModalLabel">Terms and Conditions</h4>
                            <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
                        </div>
                        <div class="modal-body">
                            <span ng-bind-html="TCData">
                            </span>
                        </div>
                        <div class="modal-footer">
                            <button type="button" class="btn btn-default" data-dismiss="modal">Close</button>
                        </div>
                    </div>
                </div>
            </div>
            <div class="overlay-loader" ng-show="loader">
                <img src="../Images/loader.gif" />
            </div>
        </div>

</section>
</div>

.join_now_box {
        margin-top: 15px;
        /* box-shadow: 1px 0px 11px rgb(0 0 0 / 25%); */
        border: 1px solid #eee;
        padding: 15px;
        margin-bottom: 15px;
        background-color: #ffffffe6;
    }
    .has-error .form-control {
        background-image: url(../images/required-invalid.png);
        background-repeat: no-repeat;
        border-color: #a94442;
        -webkit-box-shadow: inset 0 1px 1px rgba(0,0,0,.075);
        box-shadow: inset 0 1px 1px rgba(0,0,0,.075);
    }

.validation_info {
        margin: 30px auto;
        padding: 0;
        top: 42px;
        width: auto;
        background: #fefefe;
        font-size: .875em;
        border-radius: 5px;
        box-shadow: 0 1px 10px #ccc;
        border: 1px solid #ccc;
        position: absolute;
        z-index: 9;
    }

.invalid, .required {
        color: #ec3f41;
        padding-left: 22px;
        line-height: 20px;
        margin: 5px 10px;
    }

.invalid {
        background: url(../../images/required-invalid.png) 0 50% no-repeat;
    }

ul {
        padding: 0;
    }

ol, ul {
        margin-top: 0;
        margin-bottom: 10px;
    }

li {
        list-style: none;
    }
</style>