reseller_edit_address.htm

<div class='page-header'>
	<h1><tmpl_var name="list_head_txt"></h1>
</div>
<p><tmpl_var name="list_desc_txt"></p>


        <legend>Address</legend>
            <div class="form-group">
                <label for="company_name" class="col-sm-3 control-label">{tmpl_var name='company_name_txt'}</label>
                <div class="col-sm-9"><input type="text" name="company_name" id="company_name" value="{tmpl_var name='company_name'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="gender" class="col-sm-3 control-label">{tmpl_var name='gender_txt'}</label>
                <div class="col-sm-9"><select name="gender" id="gender" class="form-control">
                    {tmpl_var name='gender'}
                </select></div>
            </div>
			<div class="form-group">
                <label for="contact_firstname" class="col-sm-3 control-label">{tmpl_var name='contact_firstname_txt'}</label>
                <div class="col-sm-9"><input type="text" name="contact_firstname" id="contact_firstname" value="{tmpl_var name='contact_firstname'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="contact_name" class="col-sm-3 control-label">{tmpl_var name='contact_name_txt'}*</label>
                <div class="col-sm-9"><input type="text" name="contact_name" id="contact_name" value="{tmpl_var name='contact_name'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="customer_no" class="col-sm-3 control-label">{tmpl_var name='customer_no_txt'}</label>
                <div class="col-sm-9"><input type="text" name="customer_no" id="customer_no" value="{tmpl_var name='customer_no'}" class="form-control" /></div><input name="customer_no_org" id="customer_no_org" value="{tmpl_var name='customer_no'}" type="hidden" />
            </div>
            <div class="form-group">
                <label for="username" class="col-sm-3 control-label">{tmpl_var name='username_txt'}*</label>
                <div class="col-sm-9"><input type="text" name="username" id="username" value="{tmpl_var name='username'}" class="form-control" /></div></div>
			<div class="form-group">
                <label for="password" class="col-sm-3 control-label">{tmpl_var name='password_txt'}</label>
                <div class="col-sm-9">
				<div class="input-group">
					<input type="password" name="password" id="password" value="{tmpl_var name='password'}" class="form-control" autocomplete="off" onkeyup="pass_check(this.value);checkPassMatch('password','repeat_password');" />
					<span class="input-group-btn">
						<button class="btn btn-default" type="button" onclick="generatePassword('password','repeat_password');">{tmpl_var name='generate_password_txt'}</button>
					</span>
				</div>
				</div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">{tmpl_var name='password_strength_txt'}</label>
                <div id="passBar"></div>
                <p class="formHint"><span id="passText">&nbsp;</span></p>
            </div>
            <div class="form-group">
                <label for="repeat_password" class="col-sm-3 control-label">{tmpl_var name='repeat_password_txt'}</label>
                <div class="col-sm-9"><input type="password" name="repeat_password" id="repeat_password" value="" class="form-control" autocomplete="off" onkeyup="checkPassMatch('password','repeat_password');" /></div></div>
            <div id="confirmpasswordError" style="display:none;" class="confirmpassworderror">{tmpl_var name='password_mismatch_txt'}</div>
            <div id="confirmpasswordOK" style="display:none;" class="confirmpasswordok">{tmpl_var name='password_match_txt'}</div>
            <div class="form-group">
                <label for="language" class="col-sm-3 control-label">{tmpl_var name='language_txt'}</label>
                <div class="col-sm-9"><select name="language" id="language" class="form-control flags">
                    {tmpl_var name='language'}
                </select></div>
            </div>
            <div class="form-group">
                <label for="usertheme" class="col-sm-3 control-label">{tmpl_var name='usertheme_txt'}</label>
                <div class="col-sm-9"><select name="usertheme" id="usertheme" class="form-control">
                    {tmpl_var name='usertheme'}
                </select></div>
            </div>
            <div class="form-group">
                <label for="street" class="col-sm-3 control-label">{tmpl_var name='street_txt'}</label>
                <div class="col-sm-9"><input type="text" name="street" id="street" value="{tmpl_var name='street'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="zip" class="col-sm-3 control-label">{tmpl_var name='zip_txt'}</label>
                <div class="col-sm-9"><input type="text" name="zip" id="zip" value="{tmpl_var name='zip'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="city" class="col-sm-3 control-label">{tmpl_var name='city_txt'}</label>
                <div class="col-sm-9"><input type="text" name="city" id="city" value="{tmpl_var name='city'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="state" class="col-sm-3 control-label">{tmpl_var name='state_txt'}</label>
                <div class="col-sm-9"><input type="text" name="state" id="state" value="{tmpl_var name='state'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="country" class="col-sm-3 control-label">{tmpl_var name='country_txt'}</label>
                <div class="col-sm-9"><select name="country" id="country" class="form-control flags">
                    {tmpl_var name='country'}
                </select></div>
            </div>
            <div class="form-group">
                <label for="telephone" class="col-sm-3 control-label">{tmpl_var name='telephone_txt'}</label>
                <div class="col-sm-9"><input type="text" name="telephone" id="telephone" value="{tmpl_var name='telephone'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="mobile" class="col-sm-3 control-label">{tmpl_var name='mobile_txt'}</label>
                <div class="col-sm-9"><input type="text" name="mobile" id="mobile" value="{tmpl_var name='mobile'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="fax" class="col-sm-3 control-label">{tmpl_var name='fax_txt'}</label>
                <div class="col-sm-9"><input type="text" name="fax" id="fax" value="{tmpl_var name='fax'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="email" class="col-sm-3 control-label">{tmpl_var name='email_txt'}*</label>
                <div class="col-sm-9"><input type="text" name="email" id="email" value="{tmpl_var name='email'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="internet" class="col-sm-3 control-label">{tmpl_var name='internet_txt'}</label>
                <div class="col-sm-9"><input type="text" name="internet" id="internet" value="{tmpl_var name='internet'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="icq" class="col-sm-3 control-label">{tmpl_var name='icq_txt'}</label>
                <div class="col-sm-9"><input type="text" name="icq" id="icq" value="{tmpl_var name='icq'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="vat_id" class="col-sm-3 control-label">{tmpl_var name='vat_id_txt'}</label>
                <div class="col-sm-9"><input type="text" name="vat_id" id="vat_id" value="{tmpl_var name='vat_id'}" class="form-control" /></div></div>
			<div class="form-group">
                <label for="company_id" class="col-sm-3 control-label">{tmpl_var name='company_id_txt'}</label>
                <div class="col-sm-9"><input type="text" name="company_id" id="company_id" value="{tmpl_var name='company_id'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_account_owner" class="col-sm-3 control-label">{tmpl_var name='bank_account_owner_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_account_owner" id="bank_account_owner" value="{tmpl_var name='bank_account_owner'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_account_number" class="col-sm-3 control-label">{tmpl_var name='bank_account_number_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_account_number" id="bank_account_number" value="{tmpl_var name='bank_account_number'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_code" class="col-sm-3 control-label">{tmpl_var name='bank_code_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_code" id="bank_code" value="{tmpl_var name='bank_code'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_name" class="col-sm-3 control-label">{tmpl_var name='bank_name_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_name" id="bank_name" value="{tmpl_var name='bank_name'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_account_iban" class="col-sm-3 control-label">{tmpl_var name='bank_account_iban_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_account_iban" id="bank_account_iban" value="{tmpl_var name='bank_account_iban'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="bank_account_swift" class="col-sm-3 control-label">{tmpl_var name='bank_account_swift_txt'}</label>
                <div class="col-sm-9"><input type="text" name="bank_account_swift" id="bank_account_swift" value="{tmpl_var name='bank_account_swift'}" class="form-control" /></div></div>
			<div class="form-group">
                <label for="paypal_email" class="col-sm-3 control-label">{tmpl_var name='paypal_email_txt'}</label>
                <div class="col-sm-9"><input type="text" name="paypal_email" id="paypal_email" value="{tmpl_var name='paypal_email'}" class="form-control" /></div></div>
			<div class="form-group">
                <label for="added_date" class="col-sm-3 control-label">{tmpl_var name='added_date_txt'}</label>
                <div class="col-sm-9"><input type="text" name="added_date" id="added_date" value="{tmpl_var name='added_date'}" class="form-control" /></div></div>
			<div class="form-group">
                <label for="added_by" class="col-sm-3 control-label">{tmpl_var name='added_by_txt'}</label>
                <div class="col-sm-9"><input type="text" name="added_by" id="added_by" value="{tmpl_var name='added_by'}" class="form-control" /></div></div>
            <div class="form-group">
                <label for="notes" class="col-sm-3 control-label">{tmpl_var name='notes_txt'}</label>
                <div class="col-sm-9"><textarea class="form-control" name="notes" id="notes" rows='10' cols='30'>{tmpl_var name='notes'}</textarea></div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">{tmpl_var name='locked_txt'}</label>
                <div class="col-sm-9">
                    {tmpl_var name='locked'}
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">{tmpl_var name='canceled_txt'}</label>
                <div class="col-sm-9">
                    {tmpl_var name='canceled'}
                </div>
            </div>
            {tmpl_var name='required_fields_txt'}
        

        <input type="hidden" name="id" value="{tmpl_var name='id'}">

        <div class="clear"><div class="right">
            <button class="btn btn-default formbutton-success" type="button" value="{tmpl_var name='btn_save_txt'}" data-submit-form="pageForm" data-form-action="client/reseller_edit.php">{tmpl_var name='btn_save_txt'}</button>
            <button class="btn btn-default formbutton-default" type="button" value="{tmpl_var name='btn_cancel_txt'}" data-load-content="client/reseller_list.php">{tmpl_var name='btn_cancel_txt'}</button>
        </div></div>