1
<?php
if(isset($_POST['submit']))
{
$fname=$_POST['fname'];
$lname=$_POST['lname'];
$age=$_POST['age'];
$address=$_POST['address'];
$salary=$_POST['salary'];
$borrow=$_POST['borrow'];
echo "form submitted successfully";
}
else
{
echo "form not submitted";
}
?>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
"http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<title>Loan Application Form</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body>
<b>ICICI Credit Bank Loan Application Form</b>
<br/>
<br/>
<form action="../My%20Documents/loan.php" method="post">
First Name<input name="fname" type="text" size="20" maxlength="10">
Last Name<input name="lname" type="text" size="20" maxlength="10">
Age<input name="age" type="text" size="5" maxlength="5">
<br/>
<br/>
Address<textare a name="address" cols="30" rows="5"></textarea>
<br/>
<br/>
What is your current salary?
<select name="salary">
<option value="0" selected>Under $10,000</option>
<option value="10000">$ 10,000-$25,000</option>
<option value="25000">$ 25,000-$50,000</option>
<option value="50000">O ver $50,000</option>
</select>
<br/>
<br/>
How much you want to borrow?
<br/>
<br/>
<input name="borrow" type="radio" value="1000">Ou r $1,000 package at 8.0% interst
<br/>
<input name="borrow" type="radio" value="5000">Ou r $5,000 package at 11.5% interst
<br/>
<input name="borrow" type="radio" value="10,000"> Our $10,000 package at 15.0% interst
<br/>
<br/>
<input name="submit" type="submit" value="Click here to Submit application">
<input name="reset" type="reset" value="Reset application form">
</form>
</body>
</html>
