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<section class="wrapper">
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<div class="row">
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<div class="col-lg-12">
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<h3 class="page-header"><i class="icon_document_alt"></i> WOD Request Panel</h3>
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<ol class="breadcrumb">
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<li><i class="fa fa-home"></i><a href="${rc.contextPath}/dashboard">Home</a></li>
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<li>WOD Request Panel</li>
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</ol>
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</div>
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</div>
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<div class="row" style="margin-bottom:15px;">
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<div class="col-md-3">
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<label>Select Partner</label>
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<select id="partnerSelect" class="form-control">
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<option value="">-- Select Partner --</option>
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#foreach($entry in $retailers.entrySet())
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<option value="$entry.key">$entry.value.getBusinessName() ($entry.value.getCode())</option>
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#end
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</select>
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</div>
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<div class="col-md-2">
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<label>Select Brand</label>
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<select id="brandSelect" class="form-control" disabled>
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<option value="">-- Select Brand --</option>
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#foreach($brand in $brands)
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<option value="$brand">$brand</option>
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#end
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</select>
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</div>
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<div class="col-md-2">
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<label>Select State/Region</label>
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<select id="stateSelect" class="form-control" disabled>
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<option value="">-- Select State --</option>
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</select>
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</div>
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<div class="col-md-2">
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<label>Working with Distributor?</label>
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<select id="distributorSelect" class="form-control" disabled>
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<option value="">-- Select --</option>
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<option value="yes">Yes - Working with Distributor</option>
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<option value="no">No - Non Distributor / New Partner</option>
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</select>
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</div>
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<div class="col-md-3" style="margin-top:25px;">
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<button id="loadFormBtn" class="btn btn-primary" disabled>Load Form</button>
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<a href="javascript:void(0);" class="btn btn-default wod-request-list">Past Requests</a>
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</div>
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</div>
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<div id="dynamicFormContainer" style="display:none;">
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<div class="panel panel-default">
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<div class="panel-heading">
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<h4 id="formTitle" style="margin:0;">WOD Request Form</h4>
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</div>
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<div class="panel-body">
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<input type="hidden" id="templateId">
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<input type="hidden" id="fofoId">
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<input type="hidden" id="distributorType">
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<div id="formFieldsContainer" class="row"></div>
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<hr>
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<div class="row">
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<div class="col-md-12">
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<button type="button" class="btn btn-success btn-lg" id="submitBtn">
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<i class="fa fa-paper-plane"></i> Submit WOD Request
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</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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</section>
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