Manager

Back Back Up Advanced Editor

<div class="modal fade" id="exampleModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">

<div class="modal-dialog" role="document">

<div class="modal-content">

<div class="modal-header">

<h5 class="modal-title">Verify Order #</h5>

<button type="button" class="close" data-dismiss="modal" aria-label="Close">

<span aria-hidden="true">&times;</span>

</button>

</div>

<form method="post" id="verifyOrder">

<div class="modal-body">

<div class="alert alert-success" role="alert" style="display:none"></div>

<div class="row">

<div class="col-md-6">

<div class="form-group">

<label for="exampleInputCity1">Order Receive Amount <span styl="color:red">*</span></label>

<input type="hidden" name="orderId" id="orderId"/>

<input type="hidden" name="receiptId" id="receiptid"/>

<input type="hidden" name="distributorid" id="distributorid"/>

<input type="text" class="form-control" name="receive_amount" value="" placeholder="Receive Amount" required="">

</div>

</div>

<div class="col-md-6">

<div class="form-group">

<label for="exampleInputCity1">Payment Receive Date <span styl="color:red">*</span></label>

<input type="text" class="form-control datepicker" name="receive_date" placeholder="Receive Date" value="<?php echo date('d-m-Y');?>" required="">

</div>

</div>

<div class="col-md-12">

<div class="form-group">

<label for="exampleInputCity1">Order Remark</label>

<textarea class="form-control" name="orderRemark" placeholder="Order Remark" name="remark"></textarea>

</div>

</div>

</div>

</div>

<div class="modal-footer">

<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>

<button type="submit" class="btn btn-primary">Save changes</button>

</div>

</form>

</div>

</div>

</div>