Location: PHPKode > projects > Shell Providers Customer/Accounts DB > shelldb/forms/bill_edit.php
<p align="center">Edit Bill</p>
<form name="bill_edit" method="post" action="../process/bill_edit.php">
  <table width="100%" border="1">
    <tr>
      <td width="15%">Bill ID</td>
      <td width="85%">
        <input type="text" name="bill_id" size="60">
      </td>
    </tr>
    <tr>
      <td width="15%"> 
        <p>Bill Date</p>
        </td>
      <td width="85%"> Year(YYYY) 
        <input type="text" name="year" size="10" maxlength="4">
        Month (MM) 
        <input type="text" name="month" size="10" maxlength="2">
        Day (DD) 
        <input type="text" name="day" size="10" maxlength="2">
      </td>
    </tr>
    <tr>
      <td width="15%">Bill Amount</td>
      <td width="85%">
        <input type="text" name="bill_amount" size="60">
      </td>
    </tr>
    <tr>
      <td width="15%">Bill Currency</td>
      <td width="85%">
        <input type="text" name="bill_currency" size="60">
      </td>
    </tr>
    <tr>
      <td width="15%">Bill Paid</td>
      <td width="85%"> 
        <select name="bill_paid">
          <option value="no">No</option>
          <option value="yes">Yes</option>
        </select>
      </td>
    </tr>
    <tr>
      <td width="15%">Acc ID</td>
      <td width="85%">
        <input type="text" name="acc_id" size="60">
      </td>
    </tr>
  </table>
  <div align="center"><br>
    <input type="submit" name="Submit" value="Submit">
    <input type="reset" name="Reset" value="Reset">
  </div>
</form>
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