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============Database=============
<?php

$conn = mysqli_connect('localhost', 'root','' , 'test' );

if(!$db){

echo mysqli_error($db);
return;
}
echo 'Connection OK';
?>


=============Table================
`SNo`, `Customer Id`, `Card`, `First Name`, `Last Name`, `Gender`, `DOB`, `Age`, `Mobile`, `Address`, `Email Id`, `C Type`, `RefrenceId`, `Country`, `State`, `City`, `entry_date`


==========================
<?php
include_once('conn.php');
session_start();

if(isset($_POST['submit'])){

$CustomerID= mysqli_real_escape_string($db ,$_POST['cid']);
$Card = mysqli_real_escape_string($db ,$_POST['ccode']);
$FirstName= mysqli_real_escape_string($db ,$_POST['fname']);
$LastName= mysqli_real_escape_string($db ,$_POST['lname']);
$Gender= mysqli_real_escape_string($db ,$_POST['gen']);
$DOB= mysqli_real_escape_string($db ,$_POST['dob']);
$Age= mysqli_real_escape_string($db ,$_POST['age']);
$Mobile= mysqli_real_escape_string($db , $_POST['mob1']);
$Address= mysqli_real_escape_string($db ,$_POST['add']);
$EmailId= mysqli_real_escape_string($db ,$_POST['emailid']);
$Cardtyp= mysqli_real_escape_string($db ,$_POST['ctype']);
$RefrenceId= mysqli_real_escape_string($db ,$_POST['refno']);
$Country= mysqli_real_escape_string($db ,$_POST['country']);
$State= mysqli_real_escape_string($db ,$_POST['state']);
$City= mysqli_real_escape_string($db ,$_POST['city']);

$sql= "INSERT INTO opd
VALUES('','$CustomerID','$Card','$FirstName','$LastName','$Gender','$DOB','$Age','$Mobile','$Address','$EmailId','$Cardtyp','$RefrenceId','$Country','$State','$City','".date("Y-m-d")."')";

$qury = mysqli_query($db ,$sql);
if(!$qury)

echo mysqli_error();
else
echo "<script> alert('Data inserted Successfully');
</script>"; header('location:opd_new.php');
}
?>
===============================================
<?php
include_once('db.php');
$DB_host = 'localhost';
$DB_user = 'root';
$DB_pass = '';
$DB_name = 'test';

try
{
$DB_con = new PDO("mysql:host={$DB_host};dbname={$DB_name}",$DB_user,$DB_pass);
$DB_con->setAttribute(PDO::ATTR_ERRMODE, PDO::ERRMODE_EXCEPTION);
}
catch(PDOException $e)
{
$e->getMessage();
}
?>

<form action="new_1.php" method="post" name="a" onsubmit="return validateForm();"><table width="102%" border="0">
<thead>
<tr>
<td>Customer Id </td>
<td><input type="text" name="cid" class="text-input" value="<?php echo $rw; ?>" AUTO_INCREMENT="on" readonly="true" /></td>
<td>Card No</td>
<td><input type="text" name="ccode" class="text-input" value="<?php echo $number; ?>" readonly="readonly"/></td>
<td> </td>
</tr>
<tr>

<td><span class="style5">First Name</span></td>
<td><input type="text" name="fname" id="fname" class="text-input" onchange="toTitleCase(this)" /></td>
<td><span class="style5">Last Name</span></td>

<td><input type="text" name="lname" id="lname" class="text-input" onchange="toTitleCase(this)" /></td>
<td> </td>
</tr>

<tr>

<td><span class="style5">Gender </span></td>

<td><select name="gen" >
<option value="Male">Male</option>
<option value="Female">Female</option>
</select></td>
<td>DOB</td>

<td><input type="text" id="dob" name="dob" class="tcal tcalinput" onfocus="test();" onblur="setAge();" onkeyup="this.onblur();" onpaste="this.onblur();" oninput="this.onblur();" value="<?php echo date("Y-m-d"); ?>"/></td>
<td> </td>
</tr>
<tr>
<td><span class="style5">Age</span></td>
<td><input type="text" id="age" name="age" class="text-input" maxlength="3" /></td>
<td><span class="style5">Mobile</span></td>
<td><input type="text" name="mob1" class="text-input" maxlength="10" /></td>
<td> </td>
</tr>
<tr>
<td><span class="style5">Address</span></td>
<td><textarea name="add" style="height:22" ></textarea></td>
<td><span class="style5">Email Id </td>
<td><input type="text" name="emailid" class="text-input" /></td>
<td> </td>
</tr>
<tr>
<td>Profession</td>
<td><select id="ctype" name="ctype" style="width:36mm" >
<option value="Select">Select</option>
<option value="Student">Student</option>
<option value="Employee">Employee</option>
<option value="Doesn'tMatter">Doesn'tMatter</option>
<option value="Accounting,Banking,Finance">Accounting,Banking,Finance</option>
</select></td>
<td>Reference By </td>
<td><input type="text" id="refno" name="refno" class="text-input"/></td>
<td> </td>
</tr><tr><td>Country</td>
<td><span class="desc1">
<select name="country" class="country">
<option selected="selected">--Select Country--</option>
<?php
$stmt = $DB_con->prepare("SELECT * FROM country");
$stmt->execute();
while($row=$stmt->fetch(PDO::FETCH_ASSOC))
{
?>
<option value="<?php echo $row['country_id']; ?>"><?php echo $row['country_name']; ?></option>
<?php
}
?>
</select></td>
<td>State</td>
<td><span class="desc1">
<select name="state" class="state">
<option selected="selected">--Select State--</option>
</select></td></tr>
<tr>
<td>City</td>
<td><span class="desc1">
<select name="city" class="city">
<option selected="selected">--Select City--</option>
</select> </td> </tr>

<tr>

<td width="139"> </td>

<td width="319"> </td>
<td width="214"><input type="submit" id="submit" name="submit" value="Submit"></td>

<td width="281"> </td>
<td width="55"> </td>
</tr>
</thead>
</table>
</form>

 

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