{% extends 'OfficeBrainCustomBundleThemeBundle:'~ app.request.get('project_setting').instance_theme ~':themeBase.html.twig' %}

{% block main_content %}

    <div class="container-fluid main">
        <div class="content-info-page">
            <div class="innerpage row account-innerpage">
                {% block page_title_block %}{% endblock page_title_block %}
                <div class="col-sm-12 col-md-12 col-lg-12 col-xs-12">
                    <div class="ob-account-right">
                        {% use 'OfficeBrainCustomBundleThemeBundle:IdmeTheme:BaseUIElements/breadCrumb.html.twig' %}
                        {% block bread_crumb %} {{ parent() }} {% endblock bread_crumb %}
                    </div>
                </div>
                {% if ecatalogueOrderAccessField.status ==1 %}
                
                <div class="container">
                    <div class="ob-order-catalog">
                        <form action="{{ path("office_brain_ecataloguebundle_ecatalogue_frontend_ecatalogueordersave") }}" method="post" >
                            <div class="row js-shipping-catalog-id">
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <span>How many catalogs would you like? </span>
                                </div>
                                <div class="col-lg-1 col-sm-1 col-md-1 col-xs-12">
                                    <div class="register-input">
                                        {% block no_of_catalogue_block %}{% endblock no_of_catalogue_block %}
                                    </div>
                                </div>
                                <div class="col-lg-5 col-sm-5 col-md-5 col-xs-12 text-right">
                                    <span>How many sales flyers would you like?</span>
                                </div>
                                <div class="col-lg-1 col-sm-1 col-md-1 col-xs-12">
                                    <div class="register-input">
                                        {% block no_of_flyers_block %}{% endblock no_of_flyers_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <span>Additional Information :</span>
                                </div>
                                <div class="col-lg-9 col-sm-9 col-md-9 col-xs-12">
                                    <div class="form-group">
                                        {% block additional_info_block %}{% endblock additional_info_block %}
                                    </div>
                                </div>
                                
                                {% block shipping_block %}{% endblock shipping_block %}
                            </div>
                            <div class="ship-to-other">
                                <div class="col-lg-12 col-sm-12 col-md-12 col-xs-12">
                                    <h2 class="catalog-title">Personal Information</h2>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="FirstName">First Name<span class="mandatory-field">*</span></label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="First name" value="">#}
                                        {% block first_name_block %}{% endblock first_name_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="LastName">Last Name<span class="mandatory-field">*</span></label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Mobile number" value="">#}
                                        {% block last_name_block %}{% endblock last_name_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="LastName">Company Name</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Company Name" value="">#}
                                        {% block company_name_block %}{% endblock company_name_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="Email Address">Email Address</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Email Address" value="">#}
                                        {% block email_block %}{% endblock email_block %}
                                    </div>
                                </div>
                                <div class="col-lg-12 col-sm-12 col-md-12 col-xs-12">
                                    <h2 class="catalog-title">Contact Information</h2>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="PhoneName">Phone Number</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="PhoneName" value="">#}
                                        {% block phone_block %}{% endblock phone_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="FaxName">Fax Number</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="FaxName" value="">#}
                                        {% block fax_block %}{% endblock fax_block %}
                                    </div>
                                </div>
                                <div class="col-lg-6 col-sm-6 col-md-6 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="Address">Address</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Address" value="">#}
                                        {% block street1_block %}{% endblock street1_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="Country" class="checkout_label">Country</label>
                                        <div class="register-input">
                                            {% block country_block %}{% endblock country_block %}
                                        </div>
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="Country" class="checkout_label">State</label>
                                        <div class="register-input">
                                            {% block state_block %}{% endblock state_block %}
                                        </div>
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="City">City</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="City" value="">#}
                                        {% block city_block %}{% endblock city_block %}
                                    </div>
                                </div>
                                <div class="col-lg-3 col-sm-3 col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label class="checkout-label" for="Zip Code">Zip Code</label>
                                        {# 	                                <input type="text" class="input" tabindex="1" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Zip Code" value="">#}
                                        {% block zip_code_block %}{% endblock zip_code_block %}
                                    </div>
                                </div>
                            </div>
                            <div class="col-xs-12">
                                <div class="btn-box-main">
                                    <input type="submit" class="btn btn-default" value="Submit" tabindex="17">
                                    <input type="button" class="btn btn-default" value="Cancel" tabindex="18">
                                </div>
                            </div>
                            {{ form_rest(form_ecatalogOrder, {'display': 'hidden'}) }}
                        </form>
                    </div>
                </div>
                {% endif %}
                
            </div>
        </div>
    </div>
{% endblock main_content %}