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Rev 22642 Rev 22643
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	</div>
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	</div>
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</div>
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</div>
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#end
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#end
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<div id="customer-details" style="background:white;background-color:white;padding:10px;">
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<div id="customer-details" style="background:white;background-color:white;padding:10px;">
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	<h4 class="modelHeaderCustom" style="text-align:center;">Customer Information</h4>
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	<h4 class="modelHeaderCustom" style="font-size:22px;">Customer Information</h4>
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	<div>
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	<div>
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		<div class = "row">
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		<div class = "row">
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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="First Name" id="firstName" name="firstName" type="text" value="" class="form-control input-sm">
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			   	<input placeholder="First Name" id="firstName" name="firstName" type="text" value="" class="form-control input-sm">
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			</div>
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			</div>