{% extends app.request.get('project_setting').instance_theme_path~":"~app.request.get('project_setting').instance_theme~":themeBase.html.twig" %}
{% block seo_meta_title %}
Company Store Inquiry
{% endblock seo_meta_title %}
{% block main_content %}
<div class="container">
  <div class="innerpage">
    {% block breadcrumb %}
    <!--BREADCRUMB-->
    <div class="breadcrumb">
      <ul>
        <li><a href="{{ url('office_brain_page_homepage_view') }}">{{ 'home'| trans({},"app") }}</a><i class="fa fa-angle-right fa-fw"> </i></li>
        <li><strong>{{ "subshop_inquiry.breadcrumb" | trans }}</strong></li>
      </ul>
    </div>
    <!--END BREADCRUMB-->
    {% endblock breadcrumb %}
    <h1 class="main-title"><i class="fa fa-hospital-o"></i> {{ "subshop_inquiry.form_title" | trans }}</h1>
    <div class="row">
      <!-- SUBMIT FORM -->
      <div class="ob-personal-info-mian-block">
        {{ form_start(form, {'action' : path('office_brain_subshopbundle_subshopinquiry_processinquiry'), 'attr' : { 'novalidate' : ''}}) }}
        <!--Block1 --->
        <div class="col-sm-12 col-md-6 col-lg-6 col-xs-12">
          <div class="ob-personal-info-block">
            <div class="sub-form-box">
              <h2>{{ "subshop_inquiry.form.personal_information" | trans  }}</h2>
              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.firstName) }} <span class="red">*</span>
                    {{ form_widget(form.firstName, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.first_name" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.firstName) }}
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.lastName) }} <span class="red">*</span>
                    {{ form_widget(form.lastName, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.last_name" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.lastName) }}
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-12 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.companyName) }} <span class="red">*</span>
                    {{ form_widget(form.companyName, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.company_name" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.companyName) }}
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="ob-personal-info-block">
            <div class="sub-form-box">
              <h2>{{ "subshop_inquiry.form.company_information" | trans }}</h2>

              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.industryType) }}
                    <span class="checkout-select-wrapper">
                    {{ form_widget(form.industryType, {'attr' : {'class' : 'custom-select', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    </span>
                    {{ form_errors(form.industryType) }}
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.annualBudget) }}
                    <span class="checkout-select-wrapper">
                    {{ form_widget(form.annualBudget, {'attr' : {'class' : 'custom-select', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    </span>
                    <div class="error-message">
                      {{ form_errors(form.annualBudget) }}
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.employeeLength) }}
                    {{ form_widget(form.employeeLength, {'attr' : {'class' : 'custom-select', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    <div class="error-message">
                      {{ form_errors(form.employeeLength) }}
                    </div>
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.productRange) }}
                    {{ form_widget(form.productRange, {'attr' : {'class' : 'custom-select', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    <div class="error-message">
                      {{ form_errors(form.productRange) }}
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-12 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.shopType) }} <span class="red">*</span>
                    {{ form_widget(form.shopType, {'attr' : {'class' : 'custom-select', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    <div class="error-message">
                      {{ form_errors(form.shopType) }}
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
        <div class="col-sm-12 col-md-6 col-lg-6 col-xs-12">
          <div class="ob-contact-info-block">
            <div class="sub-form-box">
              <h2>{{ "subshop_inquiry.form.contact_information" | trans }}</h2>
              <div class="row">
                <div class="col-sm-12 col-xs-12 col-lg-12 col-md-12">
                  <div class="form-group">
                    {{ form_label(form.addressLine1) }} <span class="red">*</span>
                    {{ form_widget(form.addressLine1, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.addressline1" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.addressLine1) }}
                  </div>
                </div>
                <div class="col-sm-12 col-xs-12 col-lg-12 col-md-12">
                  <div class="form-group">
                    {{ form_label(form.addressLine2) }}
                    {{ form_widget(form.addressLine2, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.addressline2" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.addressLine2) }}
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.country) }} <span class="red">*</span>
                    {{ form_widget(form.country, {'attr' : {'class' : 'custom-select js-country', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.country) }}
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.state) }} <span class="red">*</span>
                    {{ form_widget(form.state, {'attr' : {'class' : 'custom-select js-state', 'data-original-title' : '', 'title' : '', 'data-placement' : 'top', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.state) }}
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group inp-parts">
                    {{ form_label(form.city) }} <span class="red">*</span>
                    {{ form_widget(form.city, {'attr' : {'class' : 'custom-select js-city', 'data-original-title' : "subshop_inquiry.form.city" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.city) }}
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.zipCode) }} <span class="red">*</span>
                    {{ form_widget(form.zipCode, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.zip_code" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.zipCode) }}
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.phone) }} <span class="red">*</span>
                    {{ form_widget(form.phone, {'attr' : {'class' : 'input js-phone', 'data-original-title' : "subshop_inquiry.form.phone" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.phone) }}
                  </div>
                </div>
                <div class="col-sm-6 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.fax) }}
                    {{ form_widget(form.fax, {'attr' : {'class' : 'input js-phone', 'data-original-title' : "subshop_inquiry.form.fax" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.fax) }}
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-12 col-xs-12">
                  <div class="form-group">
                    {{ form_label(form.email) }} <span class="red">*</span>
                    {{ form_widget(form.email, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.email" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.email) }}
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
        <div class="clearfix"></div>
        <div class="col-sm-12 col-md-12 col-lg-12 col-xs-12">
          <div class="ob-membership-info subshop">
            <div class="sub-form-box">
              <div class="row">
                <div class="col-lg-6 col-xs-12">
                	<div class="form-group">
                		{{ form_label(form.hasShop) }}
	                  	<div class="radio ob-subshop-storeprogram form-group">
	                    	{{ form_widget(form.hasShop, {'attr' : {'class' : 'js-radiobtn'}}) }}
	                  	</div>
                	</div>
                </div>
                <div class="col-lg-6 col-xs-12">
                  <div id="js-store-program" class="oculto" >
                  <div class="form-group">
                    {{ form_label(form.shopLink) }} <span class="red">*</span></label>
                    {{ form_widget(form.shopLink, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.shop_link" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                    {{ form_errors(form.shopLink) }}
                  </div>
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-lg-6 col-xs-12">
                <div class="form-group">
                  {{ form_label(form.anticipateShopRollOut) }}
                  {{ form_widget(form.anticipateShopRollOut, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.anticipate_shop_rollout" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                </div>
              </div>
              <div class="col-lg-6 col-xs-12">
                <div class="form-group">
                  {{ form_label(form.comments) }}
                  {{ form_widget(form.comments, {'attr' : {'class' : 'input', 'data-original-title' : "subshop_inquiry.form.comments" | trans, 'title' : '', 'data-placement' : 'bottom', 'data-toggle' : 'tooltip', 'tabindex' : '1'}}) }}
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="col-sm-12 col-md-12 col-lg-12 col-xs-12">
        <span class="required-field">{{ "subshop.form.required" | trans }}</span>
      </div>
      <div class="clearfix"></div>
      <div class="col-sm-12 col-md-12 col-lg-12 col-xs-12">
        <div class="btn-box-main ob-btn-reg-block">
          {{ form_rest(form, {'attr' :{'class' :'hidden'}})  }}
          <input type="submit" tabindex="17" value="{{ "subshop.form.submit" | trans }}" class="btn btn-default">
          <input type="reset" tabindex="18" value="{{ "subshop.form.reset" | trans }}" class="btn btn-default">
        </div>
      </div>
      <!-- SUBMIT FORM -->
      {{ form_end(form) }}
    </div>
  </div>
</div>
</div>
{% endblock main_content %}

{% block footer_js  %}
	{{ parent() }}
	{% javascripts '@OfficeBrainSubShopBundle/Resources/public/js/inquiry.js' %}
    	  <script src="{{ asset_url }}" type='text/javascript'></script>
    {% endjavascripts %}
{% endblock footer_js %}