40 lines
1.8 KiB
HTML
40 lines
1.8 KiB
HTML
<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
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<div class="form-group">
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<label class="control-label col-xs-12 col-sm-2">{:__('Bill_id')}:</label>
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<div class="col-xs-12 col-sm-8">
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<input id="c-bill_id" data-rule="required" data-source="bill/index" class="form-control selectpage" name="row[bill_id]" type="text" value="">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-xs-12 col-sm-2">{:__('Card_number')}:</label>
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<div class="col-xs-12 col-sm-8">
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<input id="c-card_number" class="form-control" name="row[card_number]" type="text">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-xs-12 col-sm-2">{:__('Card_password')}:</label>
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<div class="col-xs-12 col-sm-8">
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<input id="c-card_password" class="form-control" name="row[card_password]" type="text">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-xs-12 col-sm-2">{:__('Ret_code')}:</label>
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<div class="col-xs-12 col-sm-8">
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<input id="c-ret_code" class="form-control" name="row[ret_code]" type="text">
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</div>
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</div>
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<div class="form-group">
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<label class="control-label col-xs-12 col-sm-2">{:__('Ret_msg')}:</label>
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<div class="col-xs-12 col-sm-8">
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<input id="c-ret_msg" class="form-control" name="row[ret_msg]" type="text">
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</div>
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</div>
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<div class="form-group layer-footer">
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<label class="control-label col-xs-12 col-sm-2"></label>
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<div class="col-xs-12 col-sm-8">
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<button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
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</div>
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</div>
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</form>
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