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		<title>Administrator | Global Waste Solution</title>
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			<?php
				include("top-header.php");
				include("right-sec.php");
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			<div id="page-wrapper" >
				<div id="page-inner">
					<div class="row">
						<div class="col-md-12">
							<h3 class="page-header">
								Enquiry Detail <small></small>
							</h3>
							<div class="table-sec">
								<div class="srch_box">
									<form action="">
										<div class="row">
											<div class="col-md-6 col-xs-12">
												<div class="enq_box">
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Enquiry no. <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Source of Enquiry <span>*</span></label>
															<select class="form-control">
																<option>Select Source of Enquiry</option>
																<option>Online</option>
															</select>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">		
														<div class="form-group form-select">
															<label>Enquiry About <span>*</span></label>
															<select class="form-control">
																<option>Mobile</option>
															</select>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Handle By <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
												</div>
												<div class="oth_box">	
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Remarks <span>*</span></label>
															<textarea type="text" alt="" name=""></textarea>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Customer Other Detail<span>*</span></label>
															<textarea type="text" alt="" name=""></textarea>
														</div>		
													</div>
													
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Time Frame <span>*</span></label>
															<select class="form-control">
																<option>1-2 Month</option>
															</select>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Priority<span>*</span></label>
															<select class="form-control">
																<option value="">Select Priority</option>
																<option value="High">High</option>
																<option value="Medium">Medium</option>
																<option value="Low">Low</option>         
															</select>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Final Quote <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>													
												</div>
											</div>	
											<div class="col-md-6 col-xs-12">
												<div class="pnl_box"> 
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Company Name <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Name <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Occupation <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Telephone no.<span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>	
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Mobile no.<span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>E-Mail Id <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
												</div>	
												<div class="lcn_box">	
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>Other Address <span>*</span></label>
															<textarea type="text" alt="" name=""></textarea>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>Permanent Address<span>*</span></label>
															<textarea type="text" alt="" name=""></textarea>
														</div>		
													</div>											
													<div class="col-md-6 col-xs-6">	
														<div class="form-group form-select">
															<label>State <span>*</span></label>
															<select class="form-control">
																<option value="">Select State</option>
																<option value="Andaman &amp; Nicobar">Andaman &amp; Nicobar</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="Chandigarh">Chandigarh</option>
																<option value="Chhattisgarh">Chhattisgarh</option>
																<option value="Dadra &amp;Nagar Haveli">Dadra &amp;Nagar Haveli</option>
																<option value="Daman &amp; Diu">Daman &amp; Diu</option>
																<option value="Delhi NCR">Delhi NCR</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="Jammu &amp; Kashmir">Jammu &amp; Kashmir</option>
																<option value="Jharkhand">Jharkhand</option>
																<option value="Karnataka">Karnataka</option>
																<option value="Kerala">Kerala</option>
																<option value="Lakshadweep">Lakshadweep</option>
																<option value="Madhya Pradesh">Madhya Pradesh</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="Orissa">Orissa</option>
																<option value="Pondicherry">Pondicherry</option>
																<option value="Punjab">Punjab</option>
																<option value="Rajasthan">Rajasthan</option>
																<option value="Sikkim">Sikkim</option>
																<option value="Tamil Nadu">Tamil Nadu</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>
														</div>		
													</div>
													<div class="col-md-6 col-xs-6">
														<div class="form-group form-select">
															<label>City <span>*</span></label>
															<input class="form-control" type="text" alt="" name="">
														</div>		
													</div>
												</div>
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