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: / var / www / html / projects / wavoo / nirvakam / view / template / savings /
Filename : pay.twig
back
{{ header }}{{ column_left }}
<div id="content">
  <div class="page-header">
    <div class="container-fluid">
      <div class="pull-right">
        <button type="submit" form="form-user" data-toggle="tooltip" title="{{ button_save }}" class="btn btn-primary"><i class="fa fa-save"></i></button>
        <a href="{{ cancel }}" data-toggle="tooltip" title="{{ button_cancel }}" class="btn btn-default"><i class="fa fa-reply"></i></a></div>
      <h1>New Payment</h1> 
      <ul class="breadcrumb">
        {% for breadcrumb in breadcrumbs %}
        <li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
        {% endfor %}
      </ul>
    </div>
  </div>
  <div class="container-fluid">
    {% if error_warning %}
    <div class="alert alert-danger alert-dismissible"><i class="fa fa-exclamation-circle"></i> {{ error_warning }}
      <button type="button" class="close" data-dismiss="alert">&times;</button>
    </div>
    {% endif %}

    {% if success %}
    <div class="alert alert-success alert-dismissible"><i class="fa fa-check-circle"></i> {{ success }}
      <button type="button" class="close" data-dismiss="alert">&times;</button>
    </div>
    {% endif %}

    <div class="panel panel-default">
      <div class="panel-heading">
        <h3 class="panel-title"><i class="fa fa-pencil"></i> {{ text_form }}</h3>
      </div>
      <div class="panel-body">
        <form action="{{ action }}" method="post" enctype="multipart/form-data" id="form-user" class="form-horizontal">
          
          
          <div class="form-group required">
            <label class="col-sm-3 control-label" for="input-username">Date</label>
            <div class="col-sm-9">
              <input type="date" name="date" required placeholder="" value="{{ date }}" id="input-date" class="form-control" autocomplete="off" />

              {% if error_date %}
              <div class="text-danger">{{ error_date }}</div>
              {% endif %}
            </div>
          </div>


          <div class="form-group">
                <label class="col-sm-3 control-label">Payment Mode</label>
                <div class="col-sm-9">
                  <label class="radio-inline">                       <input type="radio" name="payment_mode" value="1" checked="checked">
                      Cash
                     </label> <label class="radio-inline">                       <input type="radio" name="payment_mode" value="2">
                      DD
                     </label>
                </div>
              </div>

         
          <div class="form-group">
            <label class="col-sm-3 control-label" for="input-username">Transaction Details</label>
            <div class="col-sm-9">
              <input type="text" name="transaction_details" required placeholder="" value="{{ transaction_details }}" id="input-transaction_details" class="form-control" autocomplete="off" />

            </div>
          </div>
         
          <div class="form-group required">
            <label class="col-sm-3 control-label" for="input-username">Amount to Pay</label>
            <div class="col-sm-9">
              <input type="text" readonly name="amount" required placeholder="" value="{{ amount }}" id="input-amount" class="form-control" autocomplete="off" />

            </div>
          </div>
         
         
          
        </form>
      </div>
    </div>
  </div>
</div>


 <script type="text/javascript"><!--

$('button[type=\'submit\']').on('click', function(e) {
e.preventDefault();
});

//--></script>
{{ footer }}