<?php

	include 'header.php';
	include 'navbar.php';

?>
		
              <div class="card">
                <div class="card-body">
                  <h4 class="card-title">Support</h4>
                  <form class="cmxform" id="signupForm" method="get" action="#">
                    <fieldset>
                      <div class="form-group">
                        <label for="memberID">Member ID</label>
                        <input id="memberID" class="form-control" name="memberID" type="text" value="123123629" readonly>
                      </div>
					  <div class="form-group">
                        <label for="firstName">Firstname</label>
                        <input id="firstName" class="form-control" name="firstName" type="text" value="T27" readonly>
                      </div>
                      <div class="form-group">
                        <label for="lastName">Lastname</label>
                        <input id="lastName" class="form-control" name="lastName" type="text" value="T27" readonly>
                      </div>
					  <div class="form-group">
                        <label for="mobileNumber">Mobile Number</label>
                        <input id="mobileNumber" class="form-control" name="mobileNumber" type="text">
                      </div>
                      <div class="form-group">
                        <label for="email">Email</label>
                        <input id="email" class="form-control" name="email" type="email">
                      </div>
					  <div class="form-group">
                        <label for="enquiry">Query</label>
						<textarea id="enquiry" name="enquiry" class="form-control" maxlength="100" rows="3" placeholder="Ask your query!"></textarea>
                      </div>
                      <input class="btn btn-primary" type="submit" value="Submit">
                    </fieldset>
                  </form>
                </div>
              </div>
            </div>
          </div>









<?php
	include 'footer.php';
?>