<form action="modules/servers/axxessReseller/calls/upload.php" method="post" enctype="multipart/form-data" id="delivery-address" role="form">
    <table width="100%" cellspacing="0" cellpadding="0" class="configtable">
        <tr class="form-group">
            <td class="fieldlabel">Street Number<span style="color:#a94442">*</span></td>
            <td class="fieldarea has-feedback" style="padding: 5px"><input name="street_number" id="input_1" value="" required="required" size="30" class="form-control" type="text"></td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel">Town/city<span style="color:#a94442">*</span></td>
            <td class="fieldarea has-feedback" style="padding: 5px"><input name="city"  required="required" id="input_2" value="" size="30" class="form-control" type="text"></td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel">Postal Code<span style="color:#a94442">*</span></td>
            <td class="fieldarea has-feedback" style="padding: 5px"><input name="postal_code" required="required" id="input_3" value="" size="30" class="form-control" type="text"></td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel">Additional Notes</td>
            <td class="fieldarea" style="padding: 5px">
                <textarea name="notes" id="input_4" value="" class="form-control" style="padding: 5px"></textarea>
            </td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel">Upload Residential Proof<span style="color:#a94442">*</span></td>
            <td class="fieldarea has-feedback">
                <input name="residential" id="input_5" required="required" value="Upload Image" size="30" class="form-control" type="file" accept="image/*,application/pdf">
                <small style="color:red;">Image or pdf file not more than 500KB acceptable only.</small>
            </td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel">Upload Identity Proof<span style="color:#a94442">*</span></td>
            <td class="fieldarea has-feedback">
                <input name="identity" id="input_6" required="required" size="30" class="form-control" type="file" accept="image/*,application/pdf" >
                <small style="color:red;">Image or pdf file not more than 500KB acceptable only.</small>
            </td>
        </tr>
        <tr class="form-group">
            <td class="fieldlabel"></td>
            <td class="fieldarea has-feedback" style="padding: 5px; text-align: center">
                <button type="submit" id="upload_data" class="btn btn-primary"  value="Save" name="submit" data-loading-text="<i class=\'fa fa-spinner fa-spin\'></i> Processing...">Save</button>
                <input class="btn btn-default" type="reset" value="Reset" name="reset">
            </td>
        </tr>
    </table>                        
</form>