statewise/partner_reg.html at main · satch421/statewise · GitHub

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<!doctype html>

<style>
    @import url('scriptcss3.css');
</style>

<html>
<head>
   <title>Partner Registration</title>
</head>

<figure>
<img src="ewise.png">
</figure>


<u1 id="nav">
  <a href="index.html">Home</a>
	<a href="assoc_tk.html">  Associate Toolbox</a>
	<a href="phealth.html">  Partner Health</a>
	<a href="ppayor.html">  Partner Payor</a>
	<a href="">  Partner Vendor</a>
	<a href="about.html">  About the Architecture</a>

<h1>Please provide this requested information.</h1>

<h1>        </h1>

<body>
  <section>
      <h2>        </h2>
      Your name <input type=search>
      Your phone <input type=search>
      Login email <input type=email>
      <h2>        </h2>
      Password <input type=search>
      Password reenter <input type=search>
      <h2>        </h2>
      Organization Name <input type=search>
      <h2>        </h2>
      Organization Address <input type=search>
      <h2>        </h2>

  </section>

<h2>        </h2>

    <section id="Registration qualifier">
        <p><label for="inp02">Which type of partner will you be?
            <select name="work" id="inp02">
            <option value="0">-- Please Select --</option>
            <option value="1">We provide health services (Health Partner).</option>
            <option value="2">We provide payment for health services (Payor Partner).</option>
            <option value="3">We provide products supporting health services (Vendor).</option>

        </p>
     </section>

<h1>        </h1>

<h2>        </h2>
      Your title <input type=search>

<h1>        </h1>

<h2>        </h2>

    <section id="Technology qualifier">
         <p><label for="inp10">Which platform can you support for social login?
            <select name="work" id="inp10">
            <option value="0">-- Please Select --</option>
            <option value="1">FaceBook.</option>
            <option value="2">Github.</option>
            <option value="3">Microsoft Active Directory.</option>
            <option value="1">OIDC.</option>
            <option value="1">SAML.</option>

        </p>
    </section>

<h2>            </h2>

<input type="submit" onclick="location.href='partreg_success.html'; return false;" value="Submit"/>

</body>

<div id='photo1'>

    <img src='cart.png'>

</div>

<h2>            </h2>

<h2>            </h2>

<footer>
(c) 2021 eWISE LLC
</footer>