-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathplasma form code.txt
232 lines (202 loc) · 7.34 KB
/
plasma form code.txt
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
<!DOCTYPE html>
<html>
<head>
<title> "your oraganisation name"</title>
<script type="text/javascript" src="validate.js"></script>
</head>
<body background="shield-flag-india-vector-illustration-shield-flag-india-">
<form method="post" autocomplete="off" name="google-sheet">
<form action="#" name="PLASMA DONATION" onSubmit="return(validate());">
<table cellpadding="8" width="80%" bgcolor="FF9966" align="center"
cellspacing="8">
<tr>
<td colspan=8>
<center><font size=5><b>PLASMA DONATION FORM</b></font></center>
</td>
</tr>
<tr>
<td>FULLNAME</td>
<td><input type="text" name="fullname" id="fullname"
size="50"></td>
</tr>
<tr>
<td> ADDRESS</td>
<td><input type="text" name="address" id="address"
size="50"></td>
</tr>
<tr>
<td>Gender</td>
<td><input type="text" name="gender" id="gender"
size="50"></td>
</tr>
<tr>
<td>State</td>
<td><select Name="state">
<option value="." selected>select..</option>
<option value="andhra pradesh">ANDHRA PRADESH</option>
<option value="arunachal pradesh">ARUNACHAL PRADESH</option>
<option value="assam">ASSAM</option>
<option value="bihar">BIHAR</option>
<option value="chattisgarh">CHATTISGARH</option>
<option value="delhi">DELHI</option>
<option value="goa">GOA</option>
<option value="gujarat">GUJARAT</option>
<option value="haryana">HARYANA</option>
<option value="himachal pradesh">HIMACHAL PRADESH</option>
<option value="jharkhand">JHARKHAND</option>
<option value="jammu kashmir">JAMMU KASHMIR</option>
<option value="karnataka">KARNATAKA</option>
<option value="kerla">KERLA</option>
<option value="ladakh">LADAKH</option>
<option value="madhyapradesh">MADHYAPRADESH</option>
<option value="maharashtra">MAHARASHTRA</option>
<option value="manipur">MANIPUR</option>
<option value="meghalaya">MEGHALAYA</option>
<option value="mizoram">MIZORAM</option>
<option value="nagaland">NAGALAND</option>
<option value="odisha">ODISHA</option>
<option value="punjab">PUNJAB</option>
<option value="puducchery">PUDUCCHERY</option>
<option value="rajasthan">RAJASTHAN</option>
<option value="sikkim">SIKKIM</option>
<option value="tamilnadu">TAMILNADU</option>
<option value="telangana">TELANGANA</option>
<option value="tripura">TRIPURA/option>
<option value="uttar pradesh">UTTAR PRADESH</option>
<option value="uttarakhand">UTTARAKHAND</option>
<option value="west bengal">WEST BENGAL</option>
</select></td>
</tr>
<tr>
<td>City</td>
<td><select name="city">
<option value="." selected>type or select</option>
<option value="pune">PUNE</option>
<option value="Mumbai">MUMBAI</option>
<option value="kolhapur">KOLHAPUR</option>
<option value="sangli">SANGLI</option>
<option value="satara">SATARA</option>
<option value="nashik">NASHIK</option>
<option value="nagpur">NAGPUR</option>
<option value="thane">THANE</option>
<option value="pimpri">PIMPRI</option>
<option value="ahmednagar">AHMEDNAGAR</option>
<option value="satara">SATARA</option>
<option value="aurangabad">AURANGABAD</option>
<option value="latur">LATUR</option>
<option value="solapur">SOLAPUR</option>
<option value="dhule">DHULE</option>
<option value="yavatmal">YAVATMAL</option>
<option value="gadchiroli">GADCHIROLI</option>
<option value="jalgaon">JALGAON</option>
<option value="wardha">WARDHA</option>
<option value="bengaluru">BENGALURU</option>
<option value="chennai">CHENNAI</option>
<option value="hydrabad">HYDRABAD</option>
<option value="kochi">KOCHI</option>
<option value="mysore">MYSORE</option>
<option value="bhopal">BHOPAL</option>
<option value="panjim">PANJIM</option>
<option value="jaipur">JAIPUR</option>
<option value="ahmedabad">AHMEDABAD</option>
<option value="chandigarh">CHANDIGARH</option>
<option value="belgaum">BELGAUM</option>
<option value="kolkata">KOLKATA</option>
<option value="patna">PATNA</option>
<option value="lucknow">LUCKNOW</option>
<option value="varanasi">PATNA</option>
<option value="bhubaneshwar">BHUBANESHWAR</option>
<option value="mohali">MOHALI</option>
<option value="howrah">HOWRAH</option>
<option value="manali">MANALI</option>
<option value="agra">AGRA</option>
<option value="madurai">MADURAI</option>
<option value="indore">INDORE</option>
<option value="kanpur">KANPUR</option>
<option value="coimbatore">COIMBATORE</option>
<option value="ranchi">RANCHI</option>
<option value="meerut">MEERUT</option>
<option value="rajkot">RAJKOT</option>
<option value="srinagar">SRINAGAR</option>
<option value="dhanbad">DHANBAD</option>
<option value="amritsar">AMRITSAR</option>
</select></td>
</tr>
<tr>
<td>TYPE NAME OF CITY</td>
<td><input type="text" name="type name of city" id="type name of city"
size="30"></td>
</tr>
<tr>
<td>COVID RECOVERY DAYS</td>
<td><select name="covid recovery days">
<option value="." selected>select..</option>
<option value="20">20</option>
<option value="25">25</option>
<option value="30">30</option>
<option value="35">35</option>
</select></td>
</tr>
<tr>
<td>PINCODE</td>
<td><input type="text" name="pincode" id="pincode"
size="30"></td>
</tr>
<tr>
<td>EmailId</td>
<td><input type="text" name="emailid" id="emailid"
size="30"></td>
</tr>
<tr>
<td>MOBILE NO</td>
<td><input type="text" name="mobile no" id="mobile no"
size="30"></td>
</tr>
<tr>
<td>THIS IS YOUR 6 DIGIT UNIQUE CODE</td>
<td colspan="2">
<p id="sixdigitnumber"></p>
<script>var sixdigitsrandom = Math.floor(100000 + Math.random() * 900000);
document.getElementById("sixdigitnumber").innerHTML=sixdigitsrandom;
// alert(sixdigitsrandom);
</script>
</tr>
<tr>
<td>TYPE ABOVE 6 DIGIT CODE</td>
<td><input type= "text" name="type above 6 digit code" id="type above 6 digit code"
size="50"></td>
</tr>
<tr>
<td><input type="reset"></td>
<td colspan="2"><input type="submit" value="Submit Form" /></td>
</tr>
</table>
</form>
<hr>
<tr>
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRFJiEQwbsp997adt3nqYiVPKIJPZ9iv_4YGw&usqp=CAU"style=width:350px;height:400px;">
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcT2VzBvKbqbMye8SzPEDAUZPHEWw5Q0arJEUx2u9hiwqLMqaJtXUTberDPEc3XqS5G-IMU&usqp=CAU"style=width:350px;height:400px;">
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQWF3O7gzk94P1UWosUhO952FVTya41nehg8A&usqp=CAU"style=width:350px;height:400px;">
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcR3jnZwmMkBZmNItZKdYH8InlftOpSFvh9_Eg&usqp=CAU"style=width:350px;height:400px;">
<center>
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSrU25lBlR-KuW_XbTinz1PU35sPos6EtMozg&usqp=CAU"style=width:350px;height:400px;">
<img src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQ1JumrjebBI7hTf8DfaHMkYISOcGEdFu4qjw&usqp=CAU"style=width:350px;height:400px;">
</center>
</tr>
<hr>
<marquee><h8>this website is develped by
<hr>"type your name here"
<hr>
</h8></marquee>
<script>
const scriptURL = 'google sheet link for store submitted data'
const form = document.forms['google-sheet']
form.addEventListener('submit', e => {
e.preventDefault()
fetch(scriptURL, { method: 'POST', body: new FormData(form)})
.then(response => alert("Thanks for Contacting us..! We Will Contact You Soon..."))
.catch(error => console.error('Error!', error.message))
})
</script>
</body>
</html>