<form class="form-horizontal" action="" method="post">
	  <div class="form-row">

      <label for="disabledInput" class="col-sm-4 control-label">Customer ID</label>
      <div class="col-md-6">
        <input class="form-control" id="disabledInput" type="text" placeholder="" disabled>
      </div>
      <label class="col-sm-4 control-label">Customer Name</label>
      <div class="col-sm-6">
        <input class="form-control" name="cname" id="focusedInput" type="text" placeholder="Customer Name" required>
      </div>
	  <label class="col-sm-4 control-label">Father Name</label>
      <div class="col-sm-6">
        <input class="form-control" name="cfname" id="focusedInput" type="text" placeholder="Father Name" required>
      </div>
	  </div>
	  	  	  <div class="form-row">
<label class="col-sm-3 control-label" for="sel1">Select Address:</label>
      <div class="col-sm-3">
  <select class="form-control"  name="address">
<?php $sql="SELECT * FROM address ORDER BY id";
if ($result=mysqli_query($con,$sql)){ 
while($row = $result->fetch_assoc()) { 
echo '<option value="'.$row['c_address'].'">'.$row['c_address'].'</option>';
    }}?>    
  </select>
</div></div>
	  <div class="form-row">
 <label class="col-sm-2 control-label">Email</label>
      <div class="col">
        <input class="form-control" name="email" id="focusedInput" type="email" placeholder="Email" >
      </div>
 <label class="col-sm-2 control-label">CNIC No.</label>
      <div class="col">
        <input class="form-control" name="cnic" id="focusedInput" type="text" placeholder="ID Card No." required>
      </div>
</div>
	  	  <div class="form-row">

	  <label class="col-sm-2 control-label">Cell No.</label>
      <div class="col">
        <input class="form-control" name="phone1" id="focusedInput" type="text" placeholder="Mobile No." required>
      </div>
  <label class="col-sm-2 control-label">Phone No.</label>
      <div class="col">
        <input class="form-control" name="phone2" id="focusedInput" type="text" placeholder="Phone No.">
      </div>
</div>
	  	  <div class="form-row">

  <label class="col-sm-3 control-label" for="sel1">Select Pkg Plan:</label>
      <div class="col-sm-3">
  <select class="form-control" id="sel1" name="pkg">
<?php $sql="SELECT * FROM pkg ORDER BY pkg_id";
if ($result=mysqli_query($con,$sql)){ 
while($row = $result->fetch_assoc()) { 
echo '<option value="'.$row['pkg_id'].'">'.$row['pkg_name'].'</option>';
    }}?>    
  </select>
</div>
  <label class="col-sm-2 control-label">Date</label>

      <div class="col">
	          <input class="form-control" name="date" id="focusedInput" type="date" placeholder="Date" required>

</div>

</div>
<div class="form-row">

  <label class="col-sm-3 control-label" for="sel1">Status</label>
      <div class="col-sm-3">

  <select class="form-control" id="sel1" name="status">
    <option value="active">Active</option>
    <option value="close">Deactive</option>
  </select>
</div>
</div>
</br>
  <div class="row justify-content-center">
    <div class="col-1">
   <input class="btn btn-primary" type="submit" name="submit" value="Submit" />
</div>
</div>
  </form>