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<div class="row"><div class="col-md-12"><div class="form-group"><p style="font-size: 12px;"><b>$mobileInsurancePlan.getPlanName() - ($mobileInsurancePlan.getProviderName())</b> $mobileInsurancePlan.getDuration() - ($mobileInsurancePlan.getPremium()) <buttonclass="btn btn-sm btn-success pull-right order-payment-status" data-orderid="$fofoOrder.getId()"style="font-size: 11px;margin-top:-5px;">Payment Status</button></p></div></div><hr style="margin:8px 0;"><div class="col-md-4"><div class="form-group"><label>Ram</label><input type="text" class="form-control ram" placeholder="ram"></div></div><div class="col-md-4"><div class="form-group"><label>Memory</label><input type="text" class="form-control memory" placeholder="memory"></div></div><div class="col-md-4"><div class="form-group"><label>MFG Date</label><input type="date" class="form-control wmfgDate" placeholder="MFG"></div></div><div class="col-md-3"><div class="form-group"><label>Serial Number</label><input type="text" class="form-control serial-number serial-number-input" placeholder="Serial Number"></div></div><div class="col-md-3"><div class="form-group"><label>Customer Email</label>#if ($customer.getEmailId())<input type="email" class="form-control customerEmail" placeholder="Email"value="$customer.getEmailId()">#else<input type="email" class="form-control customerEmail" placeholder="Email">#end</div></div><div class="col-md-3"><div class="form-group"><label>Customer Dob</label>#if ($customer.getDob())<input type="date" class="form-control dob" placeholder="DOB" value="$customer.getDob()">#else<input type="date" class="form-control dob" placeholder="DOB">#end</div></div><div class="col-md-3"><div class="form-group"><label>Gender</label>#if ($customer.getGender())<select class="form-control gender"><option value="$customer.getGender()">$customer.getGender()</option></select>#else<select class="form-control gender"><option value="">Select Option</option><option value="Male">Male</option><option value="Female">Female</option></select>#end</div></div><input type="hidden" class="order-item-id" value="$fofoOrderItem.getId()"><input type="hidden" class="order-id" value="$fofoOrder.getId()"><input type="hidden" class="insurance-id" value="$mobileInsurancePlan.getProductId()"><input type="hidden" class="insurance-dp" value="$mobileInsurancePlan.getDp()"><input type="hidden" class="insurance-premium" value="$mobileInsurancePlan.getPremium()"><input type="hidden" class="insurance-amount" value="$mobileInsurancePlan.getPremium()"><input type="hidden" class="insurance-description" value="$mobileInsurancePlan.getProductDescription()"><input type="hidden" class="insurance-plan-name" value="$mobileInsurancePlan.getPlanName()"><input type="hidden" class="customer-mobile-number" value="$customer.getMobileNumber()"><input type="hidden" class="customer-first-name" value="$customer.getFirstName()"><input type="hidden" class="customer-email-id" value="$customer.getEmailId()"><input type="hidden" class="customer-serial-number" value="$serialNumber"><div class="clearfix"></div><hr style="margin:8px 0;"><div class="col-md-12 well" style="padding: 10px; max-height: 200px;overflow-y: auto;margin-bottom: 0;"><button type="button" class="btn btn-sm btn-primary add-new-address-btn pull-right"style="font-size: 10px;margin-bottom: 10px;" data-customerid="$customer.getId()"data-orderid="$fofoOrder.getId()">Add New Address</button><table class="table table-striped table-bordered address-table" style="width: 100%"><thead><tr><th>Name</th><th>Address Lines</th><th>City</th><th>State</th><th>Pin</th><th>Mobile</th><th>Action</th></tr></thead><tbody>#foreach($address in $customerAddress)<tr><td>$address.getName()</td><td>$address.getLine1() $address.getLine2()</td><td>$address.getCity()</td><td>$address.getState()</td><td>$address.getPinCode()</td><td>$address.getPhoneNumber()</td><td><a href="javascript:void(0)" class="select-customer-address" data-addressid="$address.getId()"data-orderid="$fofoOrder.getId()">Select Address</a></td></tr>#end</tbody></table></div><div class="clearfix"></div><hr style="margin:8px 0;"><div class="col-md-12"><div class="form-group"><button type="button" class="btn btn-info btn-sm create-insurance-mk pull-right mr-lr-5"style="display: none;">Create Insurance</button><button type="button" class="btn btn-success btn-sm payment-link-mk pull-right mr-lr-5">Send Payment Link</button></div></div></div>