<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <div> <div><strong>Supplier Statutory Details</strong></div> <p> </p> <div> <div> <div> <div class="col-md-4"><div> <label>PAN Number<strong>*</strong></label> <div><input type="text" /></div> </div> <div> <label>PAN Document<strong>*</strong></label><br /> <div><input type="text" /></div> </div> </div> </div> <div> </div> </div> <br /> <div> <div class="col-md-4"><div> <div> <label>Title</label> <div><select> <option>-- Select Title --</option> <option>Artificial Juridical Person</option> <option>Associastion of Person</option> <option>Body of Individuals</option> <option>Company</option> <option>Firm</option> <option>Government</option> <option>HUF</option> <option>Individual or Proprietor</option> <option>Local Authority</option> <option>Trust</option> </select></div> </div> <div> <label>Supplier Name<strong>*</strong></label> <div><input type="text" /></div> </div> <div> </div> </div> </div> <div> <div> <div class="col-md-4"><div> <div> <label>Are you Travel Agent?</label><br /> <input type="text" /><label>YES</label> <input type="text" /><label>NO</label></div> <div> <label>Travel Agency Document</label><br /> <div><input type="text" /></div> </div> </div> </div> <div> </div> </div> </div> <p> </p> <div> <div><button>Next</button></div> </div> <div> <br /> <div> <div> <div> <h4>MSME Information</h4> </div> <div> <div> <div class="col-md-4"><div> <div> <label>Are you MSME?</label><br /> <input type="text" /><label>YES</label> <input type="text" /><label>NO</label></div> <div> <label>UAM Number</label> <div><input type="text" /></div> </div> <div> </div> </div> <br /> <div> <div> <label>Memorandum Number</label> <div><input type="text" /></div> </div> <div> <label>MSME Type</label> <div> <select> <option>-- Select --</option> <option>Micro Enterprise</option> <option>Small Enterprise</option> <option>Medium Enterprise</option> </select></div> </div> </div> <br /> <div> <div class="col-xs-4"><div> <label>Date Of Issue</label> <div><input type="text" /><div> <label>Title</label> <div><select> <option>-- Select Title --</option> <option>Artificial Juridical Person</option> <option>Associastion of Person</option> <option>Body of Individuals</option> <option>Company</option> <option>Firm</option> <option>Government</option> <option>HUF</option> <option>Individual or Proprietor</option> <option>Local Authority</option> <option>Trust</option> </select></div> </div></div> </div> <div> <label>Validity Year</label> <div><input type="text" /> TO <input type="text" /></div> </div> <div> <label>MSME Certification</label><br /> <div><input type="text" /></div> </div> </div> </div> </div> </div> </div> <br /> <div> <div> <div><button>Next</button></div> <br /> <div> <div><strong>Registered Office Address</strong></div> <br /> <div> <div> <div><label>Address 1<strong>*</strong></label> <div><input type="text" /></div> </div> <div><label>Address 2</label> <div><input type="text" /></div> </div> <div><label>Address 3</label> <div><input type="text" /></div> </div> </div> <br /> <div> <div><label>Country<strong>*</strong></label> <div><select> <option>India</option> </select></div> </div> <div><label>State<strong>*</strong></label> <div><select> <option>-- Select State --</option> <option>Andaman & Nicobar</option> <option>Andhra Pradesh</option> <option>Arunachal Pradesh</option> <option>Assam</option> <option>Bihar</option> <option>Chandigarh</option> <option>Chhatisgarh</option> <option>Dadra, Nagarhaveli</option> <option>Daman & Diu</option> <option>Delhi</option> <option>Goa</option> <option>Gujarat</option> <option>Haryana</option> <option>Himachal Pradesh</option> <option>Jammu & Kashmir</option> <option>Jharkhand</option> <option>Karnataka</option> <option>Kerala</option> <option>Lakshwadeep</option> <option>Madhya Pradesh</option> <option>Maharashtra</option> <option>Manipur</option> <option>Meghalaya</option> <option>Mizoram</option> <option>Nagaland</option> <option>Orissa</option> <option>Pondicherry</option> <option>Punjab</option> <option>Rajasthan</option> <option>Sikkim</option> <option>Tamil Nadu</option> <option>Telangana</option> <option>Tripura</option> <option>Uttar Pradesh</option> <option>Uttaranchal</option> <option>West Bengal</option> </select></div> </div> <div> </div> </div> <br /> <div> <div><label>City<strong>*</strong></label> <div> </div> </div> <div><label>Pincode<strong>*</strong></label> <div> </div> </div> <div> </div> </div> <br /> <div> <div> <div><button>Next</button></div> </div> </div> </div> </div> <div><strong>Contact Information</strong></div> <br /> <div> <div> <div><label>First Name<strong>*</strong></label> <div><input type="text" /></div> </div> <div><label>Last Name<strong>*</strong></label> <div><input type="text" /></div> </div> <div> </div> </div> <br /> <div> <div><label>Mobile Number<strong>*</strong></label> <div><input type="text" />Get OTP</div> </div> <div><label>Alternate Contact Number</label> <div><input type="text" /></div> </div> <div> </div> </div> <br /> <div> <div><label>Email-ID<strong>*</strong></label> <div><input type="text" /></div> </div> <div><label>Alternate Email-ID</label> <div><input type="text" /></div> </div> <div> </div> </div> <br /> <div> <div><label>Website</label> <div><input type="text" /></div> </div> </div> <br /> <div> <div> <div><button>Next</button></div> </div> </div> </div> </div> <div> <div> <div> <div> <h4>Verify OTP</h4> </div> <div> <div><label>Mobile Number</label> <div><input type="text" /></div> <div><label>One Time Password</label><br /><input type="text" /><input type="text" /><input type="text" /><input type="text" /><input type="text" /><input type="text" /><br /><button> Clear </button></div> </div> <div> <div> <div><label> Resend OTP</label></div> <div><label>Verify </label></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div>