<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    <input type="hidden" name="row[brand_id]" value="1"/>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Coach_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-coach_id" min="0" data-rule="required" data-source="coach/index" class="form-control selectpage" name="row[coach_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_no" class="form-control" name="row[order_no]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Withdraw_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-withdraw_price" min="0" class="form-control" step="0.01" name="row[withdraw_price]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Withdraw_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-withdraw_status" min="0" class="form-control" name="row[withdraw_status]" type="number" value="0">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>