<div class="signup-w3ls">
<div class="signup-agile1">
<form action="#" method="post">
<div class="form-control">
<label class="header">Profile Photo:</label>
<input id="image" type="file" name="profile_photo" placeholder="Photo" required="" capture>
</div>
<div class="form-control">
<label class="header">Store Name :</label>
<input type="text" id="store_name" name="store_name" placeholder="Store Name" title="Please enter your First Name" required="">
</div>
<div class="form-control">
<label class="header">Store Type :</label>
<input type="text" id="store_type" name="store_type" placeholder="Store Type" title="Please enter your Last Name" required="">
</div>
<div class="form-control">
<label class="header">Owner Type :</label>
<input type="text" id="owner_type" name="owner_type" placeholder="Owner Type" title="Please enter a valid email" required="">
</div>
<div class="form-control">
<label class="header">Website :</label>
<input type="url" id="website" name="website" placeholder="Website" id="password1" required="">
</div>
<div class="form-control">
<label class="header">Contact Number :</label>
<input type="text" id="contact_number" name="contact_number" placeholder="Contact Number" required="">
</div>
<div class="form-control">
<label class="header">Contact Email :</label>
<input type="email" id="contact_email" name="contact_email" placeholder="Contact Email" required="">
</div>
<input type="submit" class="register" value="Register">
</form>
</div>
</div>