www.rockycurlec.dev.trackerteer.com
Open in
urlscan Pro
31.24.224.21
Public Scan
URL:
https://www.rockycurlec.dev.trackerteer.com/
Submission: On August 02 via automatic, source certstream-suspicious — Scanned from GB
Submission: On August 02 via automatic, source certstream-suspicious — Scanned from GB
Form analysis 5 forms found in the DOM
<form class="space-y-6" id="login_form">
<input type="hidden" id="redirect" name="redirect">
<div>
<label for="email" class="block text-sm font-medium text-gray-900 text-dark">Your email</label>
<input type="email" name="email" id="email" class="bg-white-50 border border-gray-300 text-dark text-sm rounded-lg focus:ring-green-500 focus:border-green-500 block w-full p-2.5 dark:border-gray-500 dark:placeholder-gray-400 dark:text-white"
placeholder="name@company.com" required="">
</div>
<div>
<label for="password" class="block mb-2 text-sm font-medium text-gray-900 text-dark">Your password</label>
<input type="password" name="password" id="password" placeholder="••••••••"
class="text-dark bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-green-500 focus:border-green-500 block w-full p-2.5 dark:border-gray-500 dark:placeholder-gray-400 dark:text-white" required="">
</div>
<div class="flex justify-center">
<!-- <div class="flex items-start">
<div class="flex items-center h-5">
<input id="remember" type="checkbox" value="" class="w-4 h-4 border border-gray-300 rounded bg-gray-50 focus:ring-3 focus:ring-green-300 dark:border-gray-500 dark:focus:ring-green-600 dark:ring-offset-gray-800 dark:focus:ring-offset-gray-800" required>
</div>
<label for="remember" class="ml-2 text-sm font-medium text-dark-700">Remember me</label>
</div> -->
<a href="javasript:void(0);" id="forget_password" class="text-sm text-green-700 hover:underline dark:text-green-500">Lost Password?</a>
</div>
<button type="submit"
class="w-full text-white bg-green-700 hover:bg-green-800 focus:ring-4 focus:outline-none focus:ring-green-300 font-medium rounded-lg text-sm px-5 py-2.5 text-center dark:bg-green-600 dark:hover:bg-green-700 dark:focus:ring-green-800">Login to
your account</button>
<div class="text-sm font-medium text-gray-500 dark:text-gray-600"> Not registered? <a href="https://www.rockycurlec.dev.trackerteer.com/register" class="text-green-700 hover:underline dark:text-green-500">Create account</a>
</div>
</form><form class="space-y-5" id="fp_form">
<div class="relative w-full" style="position:relative;">
<div id="loader" class="flex hidden items-center justify-center w-full h-full top-0 left-0 absolute bg-gray-200 bg-opacity-50 rounded rounded-md">
<div class="spinner-border" style="width:3rem;height:3rem;" role="status">
<span class="sr-only">Loading...</span>
</div>
</div>
<label for="email" class="block text-sm font-medium text-gray-900 text-dark">Your email</label>
<input type="email" name="email" id="email" class="bg-white-50 border border-gray-300 text-dark text-sm rounded-lg focus:ring-green-500 focus:border-green-500 block w-full p-2.5 dark:border-gray-500 dark:placeholder-gray-400 dark:text-white"
placeholder="name@company.com" required="">
<p class="err_msg hidden text-red-700 text-sm mt-1 text-center"></p>
</div>
<button type="submit"
class="w-full text-white bg-green-700 hover:bg-green-800 focus:ring-4 focus:outline-none focus:ring-green-300 font-medium rounded-lg text-sm px-5 mb-2 py-2.5 text-center dark:bg-green-600 dark:hover:bg-green-700 dark:focus:ring-green-800">Submit</button>
</form><form id="operator_form" class="hidden form-box w-full max-w-lg mx-auto pt-3 justify-center">
<input type="hidden" value="operator" name="user_type">
<input type="hidden" id="operator_lat" name="lat">
<input type="hidden" id="operator_lng" name="lng">
<!-- <div data-type="1" class="w-full box box1 flex flex-col px-2">
<h1 class="mb-3 px-2 text-lg">Operator Information</h1>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-business">
Business Name
</label>
<input name="business_name" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Business Name">
</div>
</div>
<div class="flex flex-wrap mb-6">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password">
Phone Number
</label>
<input name="phone_number" required oninput="validateNumericInput(event)" maxlength="11" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Phone Number">
</div>
</div>
<div class="flex flex-wrap mb-2">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password">
Mobile Number
</label>
<input name="mobile_number" required oninput="validateNumericInput(event)" maxlength="11" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Mobile Number">
</div>
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password">
Business Permit
</label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required name="business_permit" id="business_permit" class="hidden">
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password">
Certificate of Registration
</label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required name="certificate_registration" id="certificate_registration" class="hidden">
</div>
</div> -->
<div data-type="2" class="w-full box box2 flex flex-col px-2 border-b border-gray-300 pb-4">
<h2 class="pt-2 mb-3 px-2 text-lg">User Information</h2>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label required="" class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> First Name </label>
<input name="firstname" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="First Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Last Name </label>
<input name="lastname" required="" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="Last Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Mobile Number </label>
<input name="mobile_number" required="" maxlength="11" class="numberCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500"
id="grid-password" type="text" placeholder="Mobile Number">
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Email Address </label>
<input name="email" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="email"
placeholder="email@email.com">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Password </label>
<input name="password" required="" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="password"
placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Verify Password </label>
<input name="password_confirmation" required="" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name"
type="password" placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
<div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Valid ID </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="business_permit" id="business_permit" class="hidden required">
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> National ID </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="certificate_registration" id="certificate_registration" class="hidden required">
</div>
</div>
<div class="flex">
<div class="flex-col w-full store_info px-3" data-lat="" data-long="">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">House #:</label>
<input type="text" name="number" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Building:</label>
<input type="text" name="building" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Street:</label>
<input type="text" name="street" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">District:</label>
<input type="text" name="district" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
</div>
<div class="flex-col w-full store_info px-3">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">Zip Code</label>
<input type="text" name="zipcode" class="numberCheck w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">City:</label>
<input type="text" readonly="" name="city" class="city w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="city" value="">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">State:</label>
<input type="text" readonly="" name="state" class="state w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="state" value="">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Country:</label>
<input type="text" readonly="" name="country" class="country w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="country" value="">
</div>
</div>
</div>
<div class="map_area w-full px-3 pb-3">
<label for="" class="text-md font-bold mb-0 w-25">Area:</label>
<input type="text" id="operator_input" placeholder="Search Address" class="mb-4 w-full border bg-white border-gray-900 rounded-md p-2 text-center">
<div id="operator" class="map flex w-full h-[300px] border border-gray-600 rounded-lg outline-none"></div>
</div>
</div>
<!-- <div data-type="3" class="px-2 box box3">
<h2 class="pt-2 mb-3 px-2 text-lg mt-2">Business Operation</h2>
<div class="flex items-center mb-3 px-3">
<label for="disabled-checkbox" class="mb-0 mr-2 text-sm font-medium text-dark dark:text-gray-500">Availble for Pickup</label>
<input value="1" name="avail_pickup" id="disabled-checkbox" type="checkbox" class="w-4 h-4 text-blue-600 bg-gray-100 border-gray-300 rounded focus:ring-blue-500 dark:focus:ring-blue-600 dark:ring-offset-gray-800 focus:ring-2 dark:bg-gray-700 dark:border-gray-600">
</div>
<div class="flex items-center mb-3 px-3">
<label for="disabled-checked-checkbox" class="mb-0 mr-2 text-sm font-medium text-dark dark:text-gray-500">Is Always Open</label>
<input value="1" name="always_open" id="always_open" type="checkbox" class="always_open w-4 h-4 text-blue-600 bg-gray-100 border-gray-300 rounded focus:ring-blue-500 dark:focus:ring-blue-600 dark:ring-offset-gray-800 focus:ring-2 dark:bg-gray-700 dark:border-gray-600">
</div>
<div class="flex mb-3 flex-column px-3">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label>
<select name="opening_time" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg"></select>
</div>
<div class="flex mb-3 flex-column px-3">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label>
<select name="closing_time" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg"></select>
</div>
<div class="flex mb-3 flex-column px-3 hidden">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Estimated Delivery Time</label>
<input name="estimated_time" class="appearance-none block w-full bg-white text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="text" placeholder="Estimated Delivery Time">
</div>
</div> -->
<!-- <div class="px-4">
<input type="checkbox" name="agreeBox" id="agreeBox">
<label for="agreeBox" class="text-sm">I agree and accept the <a href="https://www.rockycurlec.dev.trackerteer.com/termsandconditions" class="text-blue-400" target="_blank">Terms of use</a> and <a href="https://www.rockycurlec.dev.trackerteer.com/privacy-policy" class="text-blue-400" target="_blank">Privacy Policy.</a>
</label>
</div> -->
<div class="flex justify-center items-center mt-2 px-3 hidden">
<button id="btn_register" type="submit" class="btn_register invisible cursor-pointer bg-blue-500 w-full hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded"> Sign Up </button>
</div>
<!-- <div class="flex justify-center items-center mb-5">
<button class="bg-blue-500 hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded">
Apply Now
</button> -->
<!-- </div -->
</form><form id="restaurant_form" class="hidden form-box w-full max-w-lg mx-auto pt-3 justify-center">
<input type="hidden" value="restaurant" name="user_type">
<input type="hidden" id="restaurant_lat" name="lat">
<input type="hidden" id="restaurant_lng" name="lng">
<div data-type="1" class="box1 w-full flex flex-col px-2 box">
<h1 class="mb-3 px-2 text-lg">Business Information</h1>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class=" block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-business"> Business Name <span class="text-red">*</span>
</label>
<input name="business_name" required="" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="Business Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class=" block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-business"> Store Branch <span class="text-red">*</span>
</label>
<input name="store_branch" required="" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="Store Branch">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap mb-6">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Business Phone Number <span class="text-red">*</span>
</label>
<input name="phone_number" required="" maxlength="11" class="numberCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500"
id="grid-password" type="text" placeholder="Phone Number">
</div>
</div>
<div class="flex flex-wrap mb-2">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Business Contact Number <span class="text-red">*</span>
</label>
<input name="mobile_number" required="" maxlength="11" class="numberCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500"
id="grid-password" type="text" placeholder="Mobile Number">
</div>
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Business Permit * </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="business_permit" id="business_permit" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 b-attach">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Certificate of Registration <span class="text-red">*</span>
</label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview w-full">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="certificate_registration" id="certificate_registration" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div data-type="2" class="box2 hidden w-full flex flex-col px-2 border-b border-gray-300 pb-4 box">
<h2 class="pt-2 mb-3 px-2 text-lg">User Information</h2>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> First Name </label>
<input name="firstname" required="" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="First Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Last Name </label>
<input name="lastname" required="" class="charCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="Last Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Email Address </label>
<input name="email" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="email"
placeholder="email@email.com">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Password </label>
<input name="password" required="" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="password"
placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Verify Password </label>
<input name="password_confirmation" required="" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name"
type="password" placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
<div class="flex">
<div class="flex-col w-full store_info px-3">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">House #:</label>
<input type="text" required="" name="number" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Building:</label>
<input type="text" required="" name="building" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Street:</label>
<input type="text" required="" name="street" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">District:</label>
<input type="text" required="" name="district" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
</div>
<div class="flex-col w-full store_info px-3">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">Zip Code</label>
<input type="text" required="" name="zipcode" class="numberCheck w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">City:</label>
<input type="text" readonly="" name="city" class="city w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="city">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">State:</label>
<input type="text" readonly="" name="state" class="state w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="state">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Country:</label>
<input type="text" readonly="" name="country" class="country w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="country">
</div>
</div>
</div>
<div class="map_area w-full px-3 pb-3">
<label for="" class="text-md font-bold mb-0 w-25">Area:</label>
<input type="text" id="restaurant_input" placeholder="Search Address" class="mb-4 w-full border bg-white border-gray-900 rounded-md p-2 text-center">
<div id="restaurant" class="map flex w-full h-[300px] border border-gray-600 rounded-lg outline-none"></div>
</div>
</div>
<div data-type="3" class="box3 hidden px-2 box">
<h2 class="mb-3 px-2 text-lg mt-2">Business Operation</h2>
<div class="flex items-center mb-3 px-3">
<label for="disabled-checkbox" class="mb-0 mr-2 text-sm font-medium text-dark dark:text-gray-500">Availble for Pickup</label>
<input value="1" name="avail_pickup" id="disabled-checkbox" type="checkbox"
class="w-4 h-4 text-blue-600 bg-gray-100 border-gray-300 rounded focus:ring-blue-500 dark:focus:ring-blue-600 dark:ring-offset-gray-800 focus:ring-2 dark:bg-gray-700 dark:border-gray-600">
</div>
<div class="flex items-center mb-3 px-3">
<label for="disabled-checked-checkbox" class="mb-0 mr-2 text-sm font-medium text-dark dark:text-gray-500">Is Always Open</label>
<input value="1" name="always_open" id="always_open" type="checkbox"
class="always_open w-4 h-4 text-blue-600 bg-gray-100 border-gray-300 rounded focus:ring-blue-500 dark:focus:ring-blue-600 dark:ring-offset-gray-800 focus:ring-2 dark:bg-gray-700 dark:border-gray-600">
</div>
<!-- <div class="flex mb-3 flex-column px-3">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label>
<select name="opening_time" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg"></select>
</div>
<div class="flex mb-3 flex-column px-3">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label>
<select name="closing_time" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg"></select>
</div> -->
<!-- <div class="flex mb-3 flex-column px-3 hidden">
<label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Estimated Delivery Time</label>
<input name="estimated_time" class="appearance-none block w-full bg-white text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="text" placeholder="Estimated Delivery Time">
</div> -->
<div id="dayEntries" class="flex flex-col">
<table>
<thead>
<tr>
<th class="text-center text-nowrap">Opening Day</th>
<th class="text-center text-nowrap">Opening Time</th>
<th class="text-center text-nowrap">Closing Day</th>
<th class="text-center text-nowrap">Closing Time</th>
<th class="text-center text-nowrap">Closed</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Monday</h5>
<input type="hidden" name="opening_day[]" value="Monday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Tuesday</h5>
<input type="hidden" name="opening_day[]" value="Tuesday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Wednesday</h5>
<input type="hidden" name="opening_day[]" value="Wednesday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Thursday</h5>
<input type="hidden" name="opening_day[]" value="Thursday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Friday</h5>
<input type="hidden" name="opening_day[]" value="Friday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Saturday</h5>
<input type="hidden" name="opening_day[]" value="Saturday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Saturday">Saturday</option>
<option value="Sunday">Sunday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
<tr>
<td>
<h5 class="font-semibold text-sm tet-black pt-2 text-center">Sunday</h5>
<input type="hidden" name="opening_day[]" value="Sunday">
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Opening Time</label> -->
<select name="opening_time[]" id="opening_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<select id="closingDay" name="closing_day[]" class="form-control bg-white py-2">
<option value="Sunday">Sunday</option>
<option value="Monday">Monday</option>
</select>
</td>
<td>
<div class="flex mb-3 flex-column px-3">
<!-- <label for="disabled-checked-checkbox" class="mb-1 mr-2 text-sm font-medium text-dark dark:text-gray-500">Closing Time</label> -->
<select name="closing_time[]" id="closing_time" class="time-select block w-full py-2 bg-white px-3 text-dark border border-gray-300 rounded-lg">
<option value="12:00 AM">12:00 AM</option>
<option value="12:30 AM">12:30 AM</option>
<option value="01:00 AM">01:00 AM</option>
<option value="01:30 AM">01:30 AM</option>
<option value="02:00 AM">02:00 AM</option>
<option value="02:30 AM">02:30 AM</option>
<option value="03:00 AM">03:00 AM</option>
<option value="03:30 AM">03:30 AM</option>
<option value="04:00 AM">04:00 AM</option>
<option value="04:30 AM">04:30 AM</option>
<option value="05:00 AM">05:00 AM</option>
<option value="05:30 AM">05:30 AM</option>
<option value="06:00 AM">06:00 AM</option>
<option value="06:30 AM">06:30 AM</option>
<option value="07:00 AM">07:00 AM</option>
<option value="07:30 AM">07:30 AM</option>
<option value="08:00 AM">08:00 AM</option>
<option value="08:30 AM">08:30 AM</option>
<option value="09:00 AM">09:00 AM</option>
<option value="09:30 AM">09:30 AM</option>
<option value="10:00 AM">10:00 AM</option>
<option value="10:30 AM">10:30 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="11:30 AM">11:30 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="12:30 PM">12:30 PM</option>
<option value="01:00 PM">01:00 PM</option>
<option value="01:30 PM">01:30 PM</option>
<option value="02:00 PM">02:00 PM</option>
<option value="02:30 PM">02:30 PM</option>
<option value="03:00 PM">03:00 PM</option>
<option value="03:30 PM">03:30 PM</option>
<option value="04:00 PM">04:00 PM</option>
<option value="04:30 PM">04:30 PM</option>
<option value="05:00 PM">05:00 PM</option>
<option value="05:30 PM">05:30 PM</option>
<option value="06:00 PM">06:00 PM</option>
<option value="06:30 PM">06:30 PM</option>
<option value="07:00 PM">07:00 PM</option>
<option value="07:30 PM">07:30 PM</option>
<option value="08:00 PM">08:00 PM</option>
<option value="08:30 PM">08:30 PM</option>
<option value="09:00 PM">09:00 PM</option>
<option value="09:30 PM">09:30 PM</option>
<option value="10:00 PM">10:00 PM</option>
<option value="10:30 PM">10:30 PM</option>
<option value="11:00 PM">11:00 PM</option>
<option value="11:30 PM">11:30 PM</option>
</select>
</div>
</td>
<td>
<label class="pt-2 text-center justify-center flex">
<input type="checkbox" class="closedCheckbox mr-1">
<input type="hidden" name="closed[]" value="0">
</label>
</td>
</tr>
</tbody>
</table>
<!-- <div class="dayEntry">
<label>
<input type="checkbox" name="closed[]" class="closedCheckbox mr-1">
Monday
</label>
<label for="opening_time">Opening Time:</label>
<input type="time" name="opening_time[]" class="openingTime">
<label for="closing_time">Closing Time:</label>
<input type="time" name="closing_time[]" class="closingTime">
</div>
<div class="dayEntry">
<label>
<input type="checkbox" name="closed[]" class="closedCheckbox mr-1">
Tuesday
</label>
<label for="opening_time">Opening Time:</label>
<input type="time" name="opening_time[]" class="openingTime">
<label for="closing_time">Closing Time:</label>
<input type="time" name="closing_time[]" class="closingTime">
</div> -->
</div>
</div>
<!-- <div class="px-4">
<input type="checkbox" name="agreeBox" id="agreeBox">
<label for="agreeBox" class="text-sm">I agree and accept the <a href="https://www.rockycurlec.dev.trackerteer.com/termsandconditions" class="text-blue-400" target="_blank">Terms of use</a> and <a href="https://www.rockycurlec.dev.trackerteer.com/privacy-policy" class="text-blue-400" target="_blank">Privacy Policy.</a>
</label>
</div> -->
<div class="flex justify-center items-center mt-2 px-3 hidden">
<button id="btn_register" type="submit" class="btn_register invisible cursor-pointer bg-blue-500 w-full hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded"> Sign Up </button>
</div>
<!-- <div class="flex justify-center items-center mb-5">
<button class="bg-blue-500 hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded">
Apply Now
</button> -->
<!-- </div -->
</form><form id="rider_form" class="hidden form-box w-full max-w-lg mx-auto pt-3 justify-center">
<input type="hidden" value="rider" name="user_type">
<input type="hidden" id="rider_lat" name="lat">
<input type="hidden" id="rider_lng" name="lng">
<h2 class="mb-3 px-2 text-lg text-header capitalize">Rider Information</h2>
<div class="w-full box1 box" data-type="1">
<div class="flex flex-wrap">
<div class="w-full px-3 pb-3 flex items-center mb-2 myt-3">
<input type="checkbox" id="disability" name="disability" class="mb-2">
<label for="disability" class="block uppercase tracking-wide ml-2 mb-2 text-gray-700 text-sm font-bold mb-2"> Person with Disability </label>
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> First Name </label>
<input name="firstname" required="" class="checkVal appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="First Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Last Name </label>
<input name="lastname" required="" class="checkVal appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password"
type="text" placeholder="Last Name">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Nationality </label>
<input name="nationality" class="checkVal appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="Nationality">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Email Address </label>
<input name="email" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="email"
placeholder="email@email.com">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Mobile Number </label>
<input name="mobile_number" required="" maxlength="10" class="numberCheck appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500"
id="mobile" type="text" placeholder="******************">
</div>
</div>
</div>
<div class="w-full box1 box" data-type="1">
<div class="flex">
<div class="flex-col w-full store_info px-3" data-lat="" data-long="">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">House #:</label>
<input type="text" name="number" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Building:</label>
<input type="text" name="building" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Street:</label>
<input type="text" name="street" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">District:</label>
<input type="text" name="district" class=" w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
</div>
<div class="flex-col w-full store_info px-3">
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25 text-nowrap">Zip Code</label>
<input type="text" name="zipcode" class="numberCheck w-full border border-gray-600 bg-white p-2 rounded-lg font-bold text-md" value="">
<p class="text-black text-xs italic">Note : Please type N/A if value is not applicable.</p>
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">City:</label>
<input type="text" readonly="" name="city" class="city w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="city" value="">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">State:</label>
<input type="text" readonly="" name="state" class="state w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="state" value="">
</div>
<div class="flex flex-col items-start w-full max-w-2xl mb-3">
<label for="" class="text-md font-bold mb-0 w-25">Country:</label>
<input type="text" readonly="" name="country" class="country w-full bg-gray-300 border border-gray-600 p-2 rounded-lg font-bold text-md" id="country" value="">
</div>
</div>
</div>
<div class="map_area w-full px-3 pb-3">
<label for="" class="text-md font-bold mb-0 w-25">Area:</label>
<input type="text" id="rider_input" placeholder="Search Address" class="mb-4 w-full border bg-white border-gray-900 rounded-md p-2 text-center">
<div id="rider" class="map flex w-full h-[300px] border border-gray-600 rounded-lg outline-none"></div>
</div>
</div>
<!-- <div class="flex flex-wrap ">
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password">
City
</label>
<input name="city" required class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="City">
</div>
</div> -->
<div class="w-full box1 box" data-type="1">
<div class="flex flex-wrap mt-3 attachments">
<h2 class="mb-3 px-2 text-lg text-header capitalize">Rider Attachments</h2>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Brand </label>
<input name="brand" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="Brand">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Model </label>
<input name="model" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="Model">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Plate Number </label>
<input name="plate_number" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="Plate Number">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Color </label>
<input name="color" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="Color">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Drivers License Number </label>
<input name="licensenumber" required="" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text"
placeholder="License Number">
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 ">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Drivers License </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="license" id="license" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 ">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Original Receipt (OR) </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="or" id="or" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 ">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Certificate of Registration (CR) </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="cr" id="cr" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
<div class="w-full px-3 pb-3 mb-2 border-b border-gray-300 pb-3 ">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-password"> Vaccination Card </label>
<img src="https://www.rockycurlec.dev.trackerteer.com/asset/noimage.png" alt="" class="img-preview">
<a href="javascript:void(0);" class="block mt-2 btn-attach bg-blue-500 rounded-lg text-white text-center px-3 py-2">
Attach
</a>
<p class="error" id="errorText"></p>
<input type="file" required="" name="vaccine" id="vaccine" class="hidden">
<!-- <input name="licensenumber" class="appearance-none block w-full bg-white text-gray-700 border border-gray-200 rounded py-2 px-4 leading-tight focus:outline-none focus:bg-white focus:border-gray-500" id="grid-password" type="text" placeholder="Last Name"> -->
<!-- <p class="text-gray-600 text-xs italic">Make it as long and as crazy as you'd like</p> -->
</div>
</div>
<div class="flex flex-wrap mt-5">
<h2 class="mb-3 px-2 text-lg text-header capitalize">Rider Account</h2>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Password </label>
<input name="password" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="password"
placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
<div class="w-full px-3 pb-3 mb-6 md:mb-0 relative">
<label class="block uppercase tracking-wide text-gray-700 text-xs font-bold mb-2" for="grid-first-name"> Verify Password </label>
<input name="password_confirmation" class="fld_password checkVal appearance-none block w-full bg-white-200 text-gray-700 border rounded py-2 px-4 mb-3 leading-tight focus:outline-none focus:bg-white" id="grid-first-name" type="password"
placeholder="******************">
<i class="viewPass fa fa-eye-slash hidden absolute top-9 right-5 text-gray-400 hover:text-gray-600 cursor-pointer"></i>
</div>
</div>
</div>
<!-- <div class="flex justify-center items-center mb-5">
<button data-action="" class="btn-apply bg-blue-500 hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded">
Be A Rider
</button>
</div> -->
<div class="flex justify-center items-center mt-2 px-3 hidden">
<button id="btn_register" type="submit" class="btn_register invisible cursor-pointer bg-blue-500 w-full hover:bg-blue-700 text-white font-bold py-2 px-4 border border-blue-700 rounded"> Sign Up </button>
</div>
</form>Text Content
search Open main menu * ABOUT US * My Cart 0 * CONTACT US * Login * logout * my orders * my account Close modal Your email Your password Lost Password? Login to your account Not registered? Create account Loading... Your email Submit YOU WILL RECEIVE AN EMAIL WITH INSTRUCTIONS TO RESET YOUR PASSWORD. Login Now JOIN OUR GROWING TEAM We understand your cravings, which is why Rocky Go will bring deliciousness straight to your doorstep! RIDER We understand your cravings, which is why we will bring deliciousness straight to your doorstep... apply as rider OPERATOR Who would want to have a hassle-free ordering delivery? ROCKY GO is here to help! RESTAURANT For Restaurant owners who want to take and grow their business online... apply as restaurant DOWNLOAD OUR APP! FOR RIDER FOR CUSTOMER WHY CHOOSE US Rocky Go is a fully featured mobile food ordering and home delivery app designed to make food ordering and home delivery simple. It offers a user-friendly platform that allows customers to place orders from their favorite restaurants with ease. KEY FEATURES SECURE PAYMENT OPTIONS The app provides a range of safe and convenient payment methods, from credit cards to mobile payments, for a seamless transaction experience. REAL-TIME TRACKING Customers can view the status of their order and track the delivery progress live, ensuring they're informed every step of the way. ORDER HISTORY AND FAVORITES Users can easily review past orders and mark their favorite items for quick future orders. INTUITIVE ORDERING A simple, efficient interface for selecting and ordering meals. LOADING... APPLICATION USER INFORMATION First Name Last Name Mobile Number Email Address Password Verify Password Valid ID Attach National ID Attach House #: Note : Please type N/A if value is not applicable. Building: Note : Please type N/A if value is not applicable. Street: Note : Please type N/A if value is not applicable. District: Note : Please type N/A if value is not applicable. Zip Code Note : Please type N/A if value is not applicable. City: State: Country: Area: Sign Up BUSINESS INFORMATION Business Name * Store Branch * Business Phone Number * Business Contact Number * Business Permit * Attach Certificate of Registration * Attach USER INFORMATION First Name Last Name Email Address Password Verify Password House #: Note : Please type N/A if value is not applicable. Building: Note : Please type N/A if value is not applicable. Street: Note : Please type N/A if value is not applicable. District: Note : Please type N/A if value is not applicable. Zip Code Note : Please type N/A if value is not applicable. City: State: Country: Area: BUSINESS OPERATION Availble for Pickup Is Always Open Opening Day Opening Time Closing Day Closing Time Closed MONDAY 12:00 AM12:30 AM01:00 AM01:30 AM02:00 AM02:30 AM03:00 AM03:30 AM04:00 AM04:30 AM05:00 AM05:30 AM06:00 AM06:30 AM07:00 AM07:30 AM08:00 AM08:30 AM09:00 AM09:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM01:00 PM01:30 PM02:00 PM02:30 PM03:00 PM03:30 PM04:00 PM04:30 PM05:00 PM05:30 PM06:00 PM06:30 PM07:00 PM07:30 PM08:00 PM08:30 PM09:00 PM09:30 PM10:00 PM10:30 PM11:00 PM11:30 PM Monday Tuesday 12:00 AM12:30 AM01:00 AM01:30 AM02:00 AM02:30 AM03:00 AM03:30 AM04:00 AM04:30 AM05:00 AM05:30 AM06:00 AM06:30 AM07:00 AM07:30 AM08:00 AM08:30 AM09:00 AM09:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM01:00 PM01:30 PM02:00 PM02:30 PM03:00 PM03:30 PM04:00 PM04:30 PM05:00 PM05:30 PM06:00 PM06:30 PM07:00 PM07:30 PM08:00 PM08:30 PM09:00 PM09:30 PM10:00 PM10:30 PM11:00 PM11:30 PM TUESDAY 12:00 AM12:30 AM01:00 AM01:30 AM02:00 AM02:30 AM03:00 AM03:30 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AM05:00 AM05:30 AM06:00 AM06:30 AM07:00 AM07:30 AM08:00 AM08:30 AM09:00 AM09:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM01:00 PM01:30 PM02:00 PM02:30 PM03:00 PM03:30 PM04:00 PM04:30 PM05:00 PM05:30 PM06:00 PM06:30 PM07:00 PM07:30 PM08:00 PM08:30 PM09:00 PM09:30 PM10:00 PM10:30 PM11:00 PM11:30 PM Sunday Monday 12:00 AM12:30 AM01:00 AM01:30 AM02:00 AM02:30 AM03:00 AM03:30 AM04:00 AM04:30 AM05:00 AM05:30 AM06:00 AM06:30 AM07:00 AM07:30 AM08:00 AM08:30 AM09:00 AM09:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM01:00 PM01:30 PM02:00 PM02:30 PM03:00 PM03:30 PM04:00 PM04:30 PM05:00 PM05:30 PM06:00 PM06:30 PM07:00 PM07:30 PM08:00 PM08:30 PM09:00 PM09:30 PM10:00 PM10:30 PM11:00 PM11:30 PM Sign Up RIDER INFORMATION Person with Disability First Name Last Name Nationality Email Address Mobile Number House #: Note : Please type N/A if value is not applicable. Building: Note : Please type N/A if value is not applicable. Street: Note : Please type N/A if value is not applicable. District: Note : Please type N/A if value is not applicable. Zip Code Note : Please type N/A if value is not applicable. City: State: Country: Area: RIDER ATTACHMENTS Brand Model Plate Number Color Drivers License Number Drivers License Attach Original Receipt (OR) Attach Certificate of Registration (CR) Attach Vaccination Card Attach RIDER ACCOUNT Password Verify Password Sign Up Prev Next I agree and accept the Terms of use and Privacy Policy. Prev Submit Copyright 2020. All rights reserved. FOLLOW US: Terms and Conditions Privacy Policy Copyright 2023, Trackerteer. All rights reserved. About Us | Terms and Conditions | Privacy Policy