submitordernew.html 4.4 KB

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  1. <form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
  2. <div class="form-group">
  3. <label class="control-label col-xs-12 col-sm-2">手机号:</label>
  4. <div class="col-xs-12 col-sm-8">
  5. <input id="c-mobile" data-rule="required" class="form-control" name="user_mobile" type="text" value="">
  6. </div>
  7. </div>
  8. <div class="form-group">
  9. <label class="control-label col-xs-12 col-sm-2">联系人:</label>
  10. <div class="col-xs-12 col-sm-8">
  11. <input id="c-name" data-rule="required" class="form-control" name="user_name" type="text" value="">
  12. </div>
  13. </div>
  14. <div class="form-group">
  15. <label class="control-label col-xs-12 col-sm-2">车牌号:</label>
  16. <div class="col-xs-12 col-sm-8">
  17. <input id="c-car_number" data-rule="required" class="form-control" name="user_car_number" type="text" value="">
  18. </div>
  19. </div>
  20. <div class="form-group">
  21. <label class="control-label col-xs-12 col-sm-2">地址:</label>
  22. <div class="col-xs-12 col-sm-8">
  23. <input id="c-address" class="form-control" name="user_address" type="text" value="">
  24. </div>
  25. </div>
  26. <div class="form-group">
  27. <label class="control-label col-xs-12 col-sm-2">{:__('Servicetype_id')}:</label>
  28. <div class="col-xs-12 col-sm-8">
  29. <input id="c-servicetype_id" data-rule="required" name="servicetype_id" data-source="servicetype/index" data-field="title" class="form-control selectpage" type="text" value="">
  30. </div>
  31. </div>
  32. <div class="form-group">
  33. <label class="control-label col-xs-12 col-sm-2">服务时间:</label>
  34. <div class="col-xs-12 col-sm-8">
  35. <input id="c-server_time" class="form-control datetimepicker" name="server_time" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" type="text" value="{:date('Y-m-d H:i:s')}">
  36. </div>
  37. </div>
  38. <div class="form-group">
  39. <label class="control-label col-xs-12 col-sm-2">服务内容:</label>
  40. <div class="col-xs-12 col-sm-8">
  41. <input id="c-server_info" class="form-control" name="server_info" type="text" value="">
  42. </div>
  43. </div>
  44. <div class="form-group">
  45. <label class="control-label col-xs-12 col-sm-2">服务图片:</label>
  46. <div class="col-xs-12 col-sm-8">
  47. <div class="input-group">
  48. <input id="c-server_images" class="form-control" size="50" name="server_images" type="text">
  49. <div class="input-group-addon no-border no-padding">
  50. <span><button type="button" id="faupload-server_images" class="btn btn-danger faupload" data-input-id="c-server_images" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="true" data-preview-id="p-server_images"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
  51. <span><button type="button" id="fachoose-server_images" class="btn btn-primary fachoose" data-input-id="c-server_images" data-mimetype="image/*" data-multiple="true"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
  52. </div>
  53. <span class="msg-box n-right" for="c-server_images"></span>
  54. </div>
  55. <ul class="row list-inline faupload-preview" id="p-server_images"></ul>
  56. </div>
  57. </div>
  58. <div class="form-group">
  59. <label class="control-label col-xs-12 col-sm-2">收款金额:</label>
  60. <div class="col-xs-12 col-sm-8">
  61. <input id="c-pay_fee" class="form-control" step="0.01" name="pay_fee" type="number" value="0.00">
  62. </div>
  63. </div>
  64. <div class="form-group">
  65. <label class="control-label col-xs-12 col-sm-2">操作店员:</label>
  66. <div class="col-xs-12 col-sm-8">
  67. <input id="c-staff_id" data-rule="required" disabled data-source="company_staff/index" data-field="truename" class="form-control selectpage" type="text" value="{$staff_id|htmlentities}">
  68. </div>
  69. </div>
  70. <div class="form-group layer-footer">
  71. <label class="control-label col-xs-12 col-sm-2"></label>
  72. <div class="col-xs-12 col-sm-8">
  73. <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
  74. <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
  75. </div>
  76. </div>
  77. </form>