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<section class="wrapper"><div class="row"><div class="col-lg-12"><h3 class="page-header"><i class="icon_document_alt"></i>Seller</h3><ol class="breadcrumb"><li><i class="fa fa-home"></i><ahref="${rc.contextPath}/dashboard">Home</a></li><li><i class="icon_document_alt"></i>Supplier Form</li></ol></div></div><form id="new-supplier-create-form"><div class="form-row"><div class="form-group col-md-6"><label for="name">Name</label><input type="text" class="form-control" id="name" name="inputName" placeholder="Name"></div><div class="form-group col-md-6"><label for="phone">Phone</label><input type="number" class="form-control" id="phone" name="inputPhone" placeholder="Phone"></div><div class="form-group col-md-6"><label for="gst">GSTIN</label><input type="text" class="form-control" id="gst" name="inputGst" placeholder="GST"></div><div class="form-group col-md-6"><label for="panNumber">PAN</label><input type="text" class="form-control" id="panNumber" name="inputPan" placeholder="pan"></div><div class="form-group col-md-6"><label for="Fax">Fax</label><input type="text" class="form-control" id="Fax" name="inputFax" placeholder="Fax"></div><div class="form-group col-md-6"><label for="headName">Head Name</label><input type="text" class="form-control" id="headName" name="inputHeadName" placeholder="Head Name"></div><div class="form-group col-md-6"><label for="headDesig">Head Designation</label><input type="text" class="form-control" id="headDesig" name="inputHeadDesig"placeholder="Head Designation"></div><div class="form-group col-md-6"><label for="headEmail">Head Email</label><input type="email" class="form-control" id="headEmail" name="inputHeadEmail" placeholder="Head Email"></div><div class="form-group col-md-6"><label for="contactPerson">Contact Person</label><input type="text" class="form-control" id="contactPerson" name="inputContactPerson"placeholder="Contact Person"></div><div class="form-group col-md-6"><label for="contactPhone">Contact Phone</label><input type="number" class="form-control" id="contactPhone" name="inputContactPhone"placeholder="Contact Phone" ></div><div class="form-group col-md-6"><label for="contactEmail">Contact Email</label><input type="email" class="form-control" id="contactEmail" name="inputContactEmail"placeholder="Contact Email"></div><div class="form-group col-md-6"><label for="document">Document</label><input type="file" id="document" name="inputDocument"></div><div class="form-group col-md-6"><label for="contactFax">Contact Fax</label><input type="text" class="form-control" id="contactFax" name="inputContactFax"placeholder="Contact Fax"></div><div class="form-group col-md-6"><label for="registeredAddress">Registered Address</label><input type="text" class="form-control" id="registeredAddress" name="inputRegisteredAddress"placeholder="Registered Address"></div><div class="form-group col-md-6"><label for="communicationAddress">Communication Address</label><input type="text" class="form-control" id="communicationAddress" name="inputCommunicationAddress"placeholder="Communication Address"></div><div class="form-group col-md-6"><label for="terms&Conditions">Terms & Conditions</label><input type="text" class="form-control" id="terms&Conditions" name="inputTermConditions"placeholder="Terms & Conditions"></div><div class="form-group col-md-6">#if($warehouseCheckboxMap.get($wh.getId()).isWarehouse())<input type="checkbox" id="warehouseCheckbox" name="warehouseCheckbox" value="" checked><label for="warehouseCheckbox">Internal Warehouse</label><br>#else<input type="checkbox" id="warehouseCheckbox" name="warehouseCheckbox" value=""><label for="warehouseCheckbox">Internal Warehouse</label><br>#end</div><div class="form-group col-md-6"><label for="warehouse">Warehouse Name</label><select disabled class="form-control input-sm" id="warehouseId" name="warehouseId" placeholder="Warehouse Name"><option value="" disabled selected>Warehouse Name</option>#foreach($warehouseEntry in $warehouseMap.entrySet())<option value="$warehouseEntry.getKey()">$warehouseEntry.getValue()</option>#end</select></div><div class="form-group col-md-6"><label for="warehouseLocation">Warehouse Location</label><select class="chosen-select" id="warehouseLocation" name="inputWarehouseLocation"data-placeholder="Warehouse Location" multiple style="width:500px;" tabindex="4">#foreach($warehouseIdAndState in $warehouseIdAndState.entrySet())<option value="$warehouseIdAndState.getKey()">$warehouseIdAndState.getValue().getPrefix()($warehouseIdAndState.getValue().getStateName())</option>#end</select></div><div class="form-group col-md-6"><label for="state">State</label><select class="form-control input-sm" id="stateId" name="stateId" placeholder="State"><option value="" disabled selected>State</option>#foreach($stateName in $state)<option value="$stateName.getId()">$stateName.getName()</option>#end</select></div><div class="form-group col-md-6"><label for="pOValidityLimit">PO Validity Days Limit</label><input type="number" class="form-control" id="pOValidityLimit" name="inputPOValidityLimit"placeholder="PO Validity Days Limit"></div><div class="form-group col-md-6"><button type="button" class="btn btn-primary create-supplier-submit" style="margin: 20px;">Submit</button></div></div></form></section><script>$(document).ready(function () {$('.chosen-select').chosen({search_contains: true});});</script>