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Try.php
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<!DOCTYPE html>
<html>
<head>
<title>Try</title>
</head>
<body>
<?php
if(isset($_POST['btn']))
{
echo $_POST['date'];
echo $_POST['dur'];
}
$imgNumber = rand(0,1);
echo $imgNumber;
?>
<form role= "form" class="form-group" method="POST" action="<?php echo $_SERVER['PHP_SELF']; ?>" >
<label for="Choice">Service or product :</label>
<input class="form-control signform" id="Choice" type="text" name="">
<label for = "Value">value :</label>
<input type="text" id="Value" class="form-control signform" name="">
<label for="sel1">Select list:</label>
<select class="form-control durationlist selectpicker" name="dur">
<option class="durationlistelement">Annual</option>
<option class="durationlistelement">Monthly</option>
<option class="durationlistelement">Daily</option>
<option class="durationlistelement">Each hour</option>
</select>
<label for = "date">Date Started :</label>
<input type="datetime-local" value="now" id="date" class="form-control signform" name="date">
<button type="submit" name="btn">Go</button>
</form>
</body>
</html>