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<!doctype html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<link href="https://fonts.googleapis.com/css?family=Oswald:300,400|Roboto+Mono&display=swap" rel="stylesheet">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="css/bootstrap.min.css">
<!-- Style -->
<link rel="stylesheet" href="css/receipt.css">
<title>Form </title>
</head>
<body>
<div class="content" >
<div class="container">
<div style="border: 1px solid black;padding:10px">
<div class="row justify-content-center">
<div class="col-md-12">
<div class="row mb-5">
<div class="col-md-4 mr-auto">
<div >
<!-- <p class="thin-heading mb-2" style="margin: 10px 0px 0px 10px;">LOGO</h5>-->
<img src="images/sicsfullogo.png"/ style="padding: 25px;width: 100%;">
</div>
</div>
<div class="col-md-6 ">
<div class="col-md-6 form-group">
<!--<input type="text" class="form-control" name="SrishtiCampus" placeholder="Name & Address">-->
<!-- <p class="thin-heading mb-2" style="margin: 20px 0px 0px 0px;">Student Name</h5>-->
</div>
<!--<p>T: +1 (291) 939 9321 <br> E: info@mywebsite.com</p>-->
</div>
</div>
<strong><hr></strong>
<div class="row justify-content-center">
<div class="col-md-12">
<form class="mb-5" method="post" id="contactForm" name="contactForm">
<div class="row">
<div class="col-md-6 form-group">
<input type="text" class="form-control" value="Recepit.No : FSSG7497" name="Recepit : No" placeholder="Recepit.No :">
</div>
<div class="col-md-6 form-group">
<input type="text" class="form-control" value="Date : 06-05-2021 14:50:13" name="Date" placeholder="Date :">
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<input type="text" class="form-control" value="Name of candidate : Monisha " name="Name of candidate" placeholder="Name of candidate :">
</div>
<div class="col-md-6 form-group">
<input type="text" class="form-control" value="Phone : 8075394063" name="Date" placeholder="Phone : ">
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Payment Mode" value="Payment Mode : Online" placeholder="Payment Mode :">
</div>
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Date" value="Payment Gate Way Transaction Reference no : U1230001938349" placeholder="Payment Gate Way Transaction Reference no :">
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Payment Mode" value="Transaction Amount: 10000.00" placeholder="Transaction Amount:">
</div>
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Date" value="Status of Transaction : FAILED" placeholder="Status of Transaction :">
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Payment Mode" value="Purpose of Payment: Payment for python intership" placeholder="Purpose of Payment:">
</div>
<div class="col-md-6 form-group">
<input type="text" class="form-control" name="Date" value="Status description : FAILED" placeholder="Status description :">
</div>
</div>
<table style="float:right;">
<tfoot>
<div class="col-md-4 ">
<tr>
<td ></td>
<td >Item No</td>
<td style="padding:40px;">description</td>
<td>Amount</td>
<hr>
</tr>
</div>
<div class="col-md-4 ">
<tr>
<td ></td>
<td >1</td>
<td style="padding:40px;">Payment for pyton intership</td>
<td>10,000</td>
<hr>
</tr></div>
<div class="col-md-4 ">
<tr>
<td ></td>
<td></td>
<td style=" padding: 55px;">TOTAL</td>
<td>10,000</td>
</tr></div>
</tfoot>
</table>
<!-- <div class="row">
<div class="col-md-12 form-group">
<textarea class="form-control" name="message" id="message" cols="30" rows="2" placeholder="Write your message"></textarea>
</div>
</div>
<div class="row">
<div class="col-12">
<input type="submit" value="Send Message" class="btn btn-primary rounded-0 py-2 px-4">
<span class="submitting"></span>
</div>
</div>-->
</form>
<!--<div id="form-message-warning mt-4"></div>
<div id="form-message-success">
Your message was sent, thank you!
</div>-->
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>
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