JSFiddle - React, Tailwind, and code Playground

by Sanjeev Kumar

HTML

<!DOCTYPE html>
<html>

<head>
	<script src="https://ajax.googleapis.com/ajax/libs/jquery/2.2.4/jquery.min.js"></script>
	<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.1/css/bootstrap.min.css" />
</head>

<body>
	<div class="container">
		<div class="col-md-3">
			<form id="form" action="" method="get" enctype="multipart/form-url-encoded">

				<div class="form-group hidden">
					<label>current_lat_lng</label>
					<input type="text" name="current_lat_lng" value="12.9501597, 77.6419549" class="form-control">
				</div>

				<div class="form-group hidden">
					<label>authorization</label>
					<input type="text" name="authorization" value="Bearer <replace-user-bearer-token>" class="form-control">
				</div>

				<div class="form-group hidden">
					<label>X-APP-TOKEN</label>
					<input type="text" name="X-APP-TOKEN" value="<replace-your-X-APP-TOKEN>" class="form-control">
				</div>

				<div class="form-group hidden">
					<label>booking_ref_no(CRN/OSN)</label>
					<input type="text" class="form-control" name="booking_ref_no" value="1233445555">
				</div>

				<div class="form-group hidden">
					<label>brand</label>
					<input type="text" class="form-control" name="brand" value="ola_cabs">
				</div>

				<br/>
				<div class="form-group">
					<button class="btn btn-default" id="SubmitSelfServe" onclick="submitForm(this)" type="submit" value="Submit">Raise issue</button>
				</div>
			</form>
		</div>
	</div>
</body>
</html>
<script type="text/javascript">
	var form = document.getElementById("form");

	function submitForm(e) {
		form.action =  "https://help.olacabs.com/self_serve/v1?page=myrides/";
	}

</script>