<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action=""> <input type="hidden" name="row[brand_id]" value="{$row.brand_id|htmlentities}"/> <div class="form-group"> <label class="control-label col-xs-12 col-sm-2">{:__('Coach_id')}:</label> <div class="col-xs-12 col-sm-8"> <input id="c-coach_id" min="0" disabled data-rule="required" data-source="xilufitness/coach/index" data-field="coach_name" class="form-control selectpage" name="row[coach_id]" type="text" value="{$row.coach_id|htmlentities}"> </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" disabled class="form-control" name="row[order_no]" type="text" value="{$row.order_no|htmlentities}"> </div> </div> <div class="form-group"> <label class="control-label col-xs-12 col-sm-2">{:__('Withdraw_price')}:</label> <div class="col-xs-12 col-sm-8"> <input id="c-withdraw_price" min="0" class="form-control" step="0.01" name="row[withdraw_price]" type="number" value="{$row.withdraw_price|htmlentities}"> </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"> {:Form::radios("row[withdraw_status]",$statusList,$row.withdraw_status)} </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>