01.
<form
class
=
"form"
id=
"myform1"
name=
"form1"
method=
"post"
action=
""
>
02.
<div
class
=
"row"
>
03.
04.
<div
class
=
"form-group has-feedback"
>
05.
<label
for
=
"phone"
>เรื่องที่สอบถาม</label>
06.
<input type=
"text"
class
=
"form-control css-require"
name=
"question"
id=
"question"
>
07.
<span
class
=
"glyphicon form-control-feedback"
aria-hidden=
"true"
></span>
08.
</div>
09.
10.
<div>
11.
<label
for
=
""
>โอนสาย / รายละเอียดคำตอบ</label>
12.
</div>
13.
<div
class
=
"form-group has-feedback"
>
14.
15.
16.
<div
class
=
"form-control css-require"
style=
"height:185px"
>
17.
18.
<div>
19.
<label
for
=
""
>เบอร์เจ้าหน้าที่หน่วยงานร่วม</label>
20.
</div>
21.
22.
<div
class
=
"radio radio-inline"
style=
"padding-right: 15px;"
>
23.
<input type=
"radio"
id=
"inlineRadio5"
value=
"โอนสายไปยังเบอร์ 809"
name=
"answer"
class
=
"answer"
>
24.
<label
for
=
"inlineRadio5"
data-toggle=
"tooltip"
title=
"พีหนึ่ง กรมพัฒนาธุรกิจการค้า"
> 809 </label>
25.
</div>
26.
27.
<div
class
=
"radio radio-inline"
style=
"margin-top: 10px; padding-right: 15px;"
>
28.
<input type=
"radio"
id=
"inlineRadio17"
value=
"แจ้งเบอร์ 1169"
name=
"answer"
class
=
"answer"
>
29.
<label
for
=
"inlineRadio17"
data-toggle=
"tooltip"
title=
"DITP Service Center"
> 1169 </label>
30.
</div>
31.
32.
33.
</div>
34.
<span
class
=
"glyphicon form-control-feedback"
aria-hidden=
"true"
></span>
35.
</div>
36.
37.
38.
<div>
39.
<label
for
=
""
>เพศ</label>
40.
</div>
41.
<div
class
=
"form-group has-feedback"
style=
"width:175px;"
>
42.
<div
class
=
"form-control css-require"
>
43.
44.
<div
class
=
"radio radio-inline"
>
45.
<input type=
"radio"
id=
"inlineRadio99"
value=
"ชาย"
name=
"gender"
class
=
"gender"
>
46.
<label
for
=
"inlineRadio99"
> ชาย </label>
47.
</div>
48.
<div
class
=
"radio radio-inline"
>
49.
<input type=
"radio"
id=
"inlineRadio100"
value=
"หญิง"
name=
"gender"
class
=
"gender"
>
50.
<label
for
=
"inlineRadio100"
> หญิง </label>
51.
</div>
52.
</div>
53.
<span
class
=
"glyphicon form-control-feedback"
aria-hidden=
"true"
></span>
54.
</div>
55.
56.
</div>
57.
<div
class
=
"modal-footer"
>
58.
<button id=
"choose"
name=
"Submit"
value=
"Submit"
type=
"submit"
class
=
"btn btn-success pull-left"
onclick=
"addRecord()"
>เพิ่มข้อมูล</button>
59.
<button type=
"button"
class
=
"btn btn-default pull-right"
data-dismiss=
"modal"
>ยกเลิก</button>
60.
</div>
61.
62.
63.
</form>
64.
65.
</div>
66.
</div>