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Rev 34317 Rev 36452
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                    </div>
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                    </div>
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                    <div class="col-lg-2 form-group">
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                    <div class="col-lg-2 form-group">
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                        <input placeholder="Amount" id="schemeAmount" name="schemeAmount" type="number"
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                        <input placeholder="Amount" id="schemeAmount" name="schemeAmount" type="number"
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                               class="form-control input-sm">
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                               class="form-control input-sm">
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                    </div>
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                    </div>
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                    <div class="col-lg-2 form-group">
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                        <input placeholder="Reference" id="schemeReference" name="schemeReference" type="text" value=""
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                               class="form-control input-sm">
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                    </div>
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                </div>
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                </div>
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                <div class="row form-group">
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                <div class="row form-group">
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                    <label class="checkbox-inline"><input id="cashbackScheme" type="checkbox" value="" disabled>Cashback
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                    <label class="checkbox-inline"><input id="cashbackScheme" type="checkbox" value="" disabled>Cashback
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                        Scheme</label>
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                        Scheme</label>
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                </div>
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                </div>