{% extends "OfficeBrainCustomBundleThemeBundle:IdmeTheme:themeBase.html.twig" %}

{% block main_content %}
<div class="container main">
    <div class="content-info-page">
        <div class="innerpage">
	        <div class="ob-upload-artwork-block">
	        	{% use 'OfficeBrainCustomBundleThemeBundle:IdmeTheme:BaseUIElements/breadCrumb.html.twig' %}
				{% block bread_crumb %} {{ parent() }} {% endblock bread_crumb %}
				<div class="invoice-request">
		        	{% block page_title_block %}
		      			<h1 class="main-title"><i class="fa fa-question-circle"></i> {{ 'cms.front.invoice_request.heading' | trans }}</h1>
		      		{% endblock page_title_block %}
		      		<div class="row">
						<div class="col-sm-12 col-md-12 col-lg-12 col-xs-12">
							<div class="ob-contact-main-block">
								{{ form_start(form, {'action' : path('office_brain_custombundle_cmsbundle_invoice_request_process_add'), 'attr' : { 'novalidate' : ''}}) }}
								<div class="ob-order-form-block">
									<div class="sub-form-box">
										<div class="row">
											<div class="col-md-6 col-lg-6 col-sm-12 col-xs-12">
												<div class="form-group">
													{{ form_widget(form.senderName,{'attr': { 'placeholder': "*"~"cms.front.invoice_request.sender_name.label"|trans }}) }}
													{{ form_errors(form.senderName) }}
												</div>
											</div>
											<div class="col-md-6 col-lg-6 col-sm-12 col-xs-12 padding-left-0">
												<div class="form-group">
													{{ form_widget(form.poNumber,{'attr': { 'placeholder': "*"~"cms.front.invoice_request.po_number.label"|trans }}) }}
													{{ form_errors(form.poNumber) }}
												</div>
											</div>
											<div class="clearfix"></div>
											<div class="col-md-12 col-lg-12 col-sm-12 col-xs-12">
                                                <div class="form-group">
                                                    {{ form_widget(form.companyName,{'attr': { 'placeholder': "*"~"cms.front.invoice_request.company_name.label"|trans }}) }}
                                                    {{ form_errors(form.companyName) }}
                                                </div>
                                            </div>
											<div class="clearfix"></div>
											<div class="col-md-12 col-lg-12 col-sm-12 col-xs-12">
												<div class="form-group">
													<label>{{ "cms.front.invoice_request.fax.label"|trans }}</label>
													{{ form_widget(form.fax,{'attr': { 'placeholder': "*"~"cms.front.invoice_request.fax.placeholder"|trans, 'class':'js-phone','autocomplete':'off' }}) }}
													{{ form_errors(form.fax) }}
													<span>{{ "cms.front.invoice_request.or"|trans }}</span>
												</div>
											</div>
											<div class="clearfix"></div>
											<div class="col-md-12 col-lg-12 col-sm-12 col-xs-12">
												<div class="form-group">
													<label>{{ "cms.front.invoice_request.email.label"|trans }}</label>
													{{ form_widget(form.email,{'attr': { 'placeholder': "*"~"cms.front.invoice_request.email.placeholder"|trans }}) }}
													{{ form_errors(form.email) }}
												</div>
											</div>
										</div>
									</div>
								</div>
								<div class="btn-box-main">
									{{ form_rest(form, {'attr' :{'class' :'hidden'}}) }}
									<input type="submit" value="Submit" class="btn btn-default">
	                				<input type="reset" value="Reset" class="btn btn-default js-reset-btn">
								</div>
								{{ form_end(form) }}
							</div>
						</div>
					</div>
				</div>
			</div>  	
        </div>
    </div>
</div>
<script>
	$(document).ready(function(){
		/*$('.js-phone').on('change', function(){
			var reg = '^[0-9]{3}-[0-9]{3}-[0-9]{4}$';
			var val = $(this).val();
			if(val.match(reg)) {
				return true;
			} else {
				$(this).val('');
				return false;
			}
		});*/
	});
</script>
{% endblock main_content %}