<div class="col-12 col-md-8"> <div class="row"> <div class=col-sm> <div id="pnl_message" class="alert alert-danger"> <button id="view.login.message.button" type="button" class="btn-close" aria-label="Close"></button> <span id="view.login.message.label"></span> </div> </div> </div> <h4 class="custom-h4 mt-3">Company</h4> <hr class="custom-hr"> <div class="row"> <div class="col-auto"> <label for="wdbe_first_name" class="form-label mt-2">Company Name:</label> <input id="edtcompanyname" type="text" class="form-control" style="width: 300px;"/> </div> <div class="col-auto"> <label for="wdbe_first_name" class="form-label mt-2">Account Company Name:</label> <input id="edtaccountcompanyname"type="text" class="form-control" style="width: 150px"/> </div> <div class="col-auto"> <label for="wdbe_first_name" class="form-label mt-2">In Quickbooks?:</label> <input id="edtinquickbooks"type="text" class="form-control" style="width: 150px"/> </div> </div> <h4 class="custom-h4 mt-3">Staff Fields</h4> <hr class="custom-hr"> <div class="row"> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Order Date:</label> <input class="form-control input-sm" id="dtporderdate" type="date"> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Proof Date:</label> <input class="form-control input-sm" id="dtpproofdate" type="date"> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Ship Date:</label> <input class="form-control input-sm" id="dtpshipdate" type="date"> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Ship Via:</label> <input id="edtshipvia" type="text" class="form-control"/> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Quantity:</label> <input id="edtquantity" class="form-control input-sm" style="width: 100px"/> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Price:</label> <input id="edtprice" class="form-control input-sm" style="width: 100px" type="number" min="0"/> </div> <div> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Invoice To:</label> <input id="edtinvoiceto" class="form-control input-sm"/> </div> <div> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Ship To:</label> <select id="wcbshipto" class='form-select'></select> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">PO Number:</label> <input id="edtponumber" class="form-control input-sm" width='50%'/> </div> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Job Name:</label> <input id="edtjobname" class="form-control input-sm" width='50%'/> </div> <div class="col-auto"> <label style="font-weight: 700; font-size: 15px;" class="form-label mt-2">QuickBooks Item:</label> <select id="wcbqbitem" class='form-select'></select> </div> </div> <h4 class="custom-h4 mt-3">General</h4> <hr class="custom-hr"> <div class="row"> <div class="col-auto"> <label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label">Special Instructions</label> <textarea id="edtspecialinstructions" class="form-control" style=" width: 500px; height: 150px;"></textarea> </div> </div> <div class="row"> <div class="col-auto"> <button id="btnconfirm" class="btn btn-primary btn-sm float-end my-2">Confirm</button> </div> <div class="col-auto"> <button id="btncancel" class="btn btn-primary btn-sm float-end my-2">Cancel</button> </div> </div> </div>