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<html >
<head>
        <title>Courier Reconciliation Report</title>
</head>
<body>
        #parse("../content/reports-common.vm")
        <h2>Courier Reconciliation Report</h2>
        <div style="color:red">
         $errorMsg
    </div>
        <p>Specify the date range (MM/dd/yyyy):</p>
        <div>
                <form action="" method="post">
                        <div class="register-row">
                                <label><span>Start Date:</span></label>
                <div class="imgTextBox textbox-image">
                                        <input type="text" class="textbox" value="" name="startDate" id="datepicker" />
                </div>
                <div class="clearBoth"></div>   
             </div>
                         <br/>
                         <div class="register-row">
                                <label><span>End Date:</span></label>
                <div class="imgTextBox textbox-image">
                                        <input type="text" class="textbox" value="" name="endDate" id="datepicker1" />
                </div>
                <div class="clearBoth"></div>
             </div>
                         <br/>
                         <div class="register-row">
                 <label><span>Provider:</span></label>
                                 <select name="providerId">
                                        <option value="1">Bluedart</option>
                                 </select>
                                 <div class="clearBoth"></div>
             </div>
                         <br/>
                         <div class="register-row">
                <label><span>Payment Method:</span></label>
                <input type="radio" name="payMode" value="false" id="prepaid">Prepaid</input>
                <input type="radio" name="payMode" value="true" id="cod">COD</input>
                                <div class="clearBoth"></div>
             </div>
                         <br/>
                         <div>
                                <input name="submit" type="submit" value="Get Report"/>
                         </div>
        </form>
    </div>
</body>
</html>