<php lang="en">
<head>
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<title>La Pieza.DO | Registro</title>
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<link rel="stylesheet" href="assets/css/bootstrap.min.css">
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<link rel="stylesheet" type="text/css" href="assets/css/main.css">
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</head>
<body>
<div class="ugf-wrapper flat-grey-bg">
<div class="ugf-content-block">
<div class="logo">
<a href="../register.php">
<!-- <img class="" src="assets/images/logo-dark2.png" alt=""> -->
</a>
</div>
<div class="container-md">
<div class="row">
<div class="col-lg-7 offset-lg-5 p-sm-0">
<div class="ugf-content pt150">
<a href="personal-payments.php" class="prev-page"><i class="las la-arrow-left"></i> Volver Atrás</a>
<h2>Dirección de Facturación</h2>
<p>Escribe los detalles de facturación de tu negocio, también puedes elegir tu ubicación en el mapa!</p>
<form action="signup-complete.php" class="account-form">
<div class="row">
<div class="col-sm-6 p-sm-0">
<div class="form-group country-select">
<label for="inputCountry">Selecciona tu Provincia</label>
<div class="select-input choose-country">
<span></span>
<select id="inputCountry" class="form-control">
<option value="Seleccione" selected>Seleccione Provincia</option>
<option value="Azua">Azua</option>
<option value="Bahoruco">Bahoruco</option>
<option value="Barahona">Barahona</option>
<option value="Dajabón">Dajabón</option>
<option value="Duarte">Duarte</option>
<option value="El Seibo">El Seibo</option>
<option value="Elias Piña">Elias Piña</option>
<option value="Espaillat">Espaillat</option>
<option value="Hato Mayor">Hato Mayor</option>
<option value="Hermanas Mirabal">Hermanas Mirabal</option>
<option value="Independencia">Independencia</option>
<option value="La Altagracia">La Altagracia</option>
<option value="La Romana">La Romana</option>
<option value="La Vega">La Vega</option>
<option value="Maria Trinidad Sanchez">Maria Trinidad Sanchez</option>
<option value="Monseñor Nouel">Monseñor Nouel</option>
<option value="Monte Cristi">Monte Cristi</option>
<option value="Monte Plata">Monte Plata</option>
<option value="Pedernales">Pedernales</option>
<option value="Peravia">Peravia</option>
<option value="Puerto Plata">Puerto Plata</option>
<option value="Samaná">Samaná</option>
<option value="San Cristobal">San Cristobal</option>
<option value="San Jose de Ocoa">San Jose de Ocoa</option>
<option value="San Juan">San Juan</option>
<option value="San Pedro de Macorís">San Pedro de Macorís</option>
<option value="Sánchez Ramírez">Sánchez Ramírez</option>
<option value="Santiago">Santiago</option>
<option value="Santiago Rodríguez">Santiago Rodríguez</option>
<option value="Santo Domingo">Santo Domingo</option>
<option value="Valverde">Valverde</option>
<option value="Distrito Nacional">Distrito Nacional</option>
</select>
</div>
</div>
</div>
<div class="col-sm-6 p-sm-0">
<div class="form-group">
<label for="inputCity">Ciudad</label>
<input type="text" placeholder="ej. Distrito Nacional" class="form-control" id="inputCity">
</div>
</div>
<div class="col-sm-6 p-sm-0">
<div class="form-group">
<label for="inputAddress2">Direccíon</label>
<input type="text" placeholder="ej. Calle 1 No.2" class="form-control" id="inputAddress2">
</div>
</div>
<div class="col-sm-6 p-sm-0">
<div class="form-group">
<label for="inputAddress2">Direccíon 2</label>
<input type="text" placeholder="ej. Villa Juana" class="form-control" id="inputAddress2">
</div>
</div>
<div class="col-sm-6 p-sm-0">
<div class="form-group">
<label for="inputzipcode">Referencia</label>
<input type="text" placeholder="ej. Cerca de un edificio azul" class="form-control" id="inputzipcode">
</div>
</div>
<div class="col-sm-6 p-sm-0">
<div class="form-group">
<label for="inputPhone">Teléfono</label>
<input type="text" placeholder="ej. 123 456 7890" class="form-control" id="inputPhone">
</div>
</div>
</div>
<div class="form-group check-flex mb10">
<div class="custom-checkbox mb10">
<input type="checkbox" class="custom-control-input" id="inputCheck" required>
<label class="custom-control-label" for="inputCheck">Acepto los <a href="#">Terminos y Condiciones</a> y <a href="#">las Politicas de Privacidad</a></label>
</div>
</div>
<button class="btn"><span>FINALIZAR</span> <i class="las la-check"></i></button>
</form>
</div>
</div>
</div>
</div>
</div>
<div class="ugf-sidebar flex-bottom ugf-sidebar-bg-2 sidebar-steps">
<div class="steps">
<div class="step complete-step">
<span>1</span>
<p>Verificación de Correo</p>
</div>
<div class="step complete-step">
<span>2</span>
<p>Categoria</p>
</div>
<div class="step complete-step">
<span>3</span>
<p>Detalles de la Cuenta Personal</p>
</div>
<div class="step complete-step">
<span>4</span>
<p>Detalle de Pagos</p>
</div>
<div class="step step-onprocess">
<span>5</span>
<p>Detalle de Facturación</p>
</div>
</div>
</div>
</div>
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</body>
</php> |