<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 for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">QuickBooks Item:</label>
<input id="edtquickbooksitem" 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">Art Due:</label>
<input class="form-control input-sm" id="dtpartdue" type="date">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Plate Due:</label>
<input class="form-control input-sm" id="dtpplatedue" type="date">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Mount Due:</label>
<input class="form-control input-sm" id="dtpmountdue" type="date">
</div>
</div>
<h4 class="custom-h4 mt-3">Supplied by Customer</h4>
<hr class="custom-hr">
<div class="row">
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Color Copy:</label>
<input type="checkbox" id="cbcolorcopy">
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Plates:</label>
<input type="checkbox" id="cbplates">
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Sample Carton:</label>
<input type="checkbox" id="cbsampleCarton">
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Email:</label>
<input type="checkbox" id="edtemail"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">FTP:</label>
<input type="checkbox" id="cbftp"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Other:</label>
<input class="form-control input-sm" id="edtother" style="width: 150px"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Existing Cutting Die:</label>
<input type="checkbox" id="edtexistingcuttingdie"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Ref Art Print Card:</label>
<input type="checkbox" id="edtrefartprintcard"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;">Ref Art A PDF:</label>
<input type="checkbox" id="edtrefartapdf"/>
</div>
</div>
<h4 class="custom-h4 mt-3">Layout</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">RSC L:</label>
<input id="edtrscl" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">RSC W:</label>
<input id="edtrscw" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">RSC D:</label>
<input id="edtrscd" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Die Cut No:</label>
<input class="form-control input-sm" id="edtdiecutno" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Across No:</label>
<input class="form-control input-sm" id="edtacrossno" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Around No:</label>
<input class="form-control input-sm" id="edtaroundno" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">CAD File:</label>
<input id="edtcadfile" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Excalibur Die:</label>
<input type="checkbox" id="cbexcaliburdie">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">RSC Style:</label>
<input id="edtrscstyle" class="form-control input-sm" style="width: 150px"/>
</div>
</div>
<h4 class="custom-h4 mt-3">Mounting</h4>
<hr class="custom-hr">
<div class="row">
<div class="col-auto">
<label for="wdbe_first_name" class="form-label mt-2">Loose:</label>
<input type="checkbox" id="cbloose">
<input id="edtloose" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Sticky Bak:</label>
<input type="checkbox" id="cbstickybak">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Full Mount:</label>
<input type="checkbox" id="cbfullmount">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Strip Mount:</label>
<input type="checkbox" id="cbstripmount">
<input id="edtstripmount" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Standard Setup:</label>
<input id="edtstandardsetup" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Custom Backing:</label>
<input id="edtcustombacking" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Custom Adhesive:</label>
<input id="edtcustomadhesive" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Cylinder Size:</label>
<input id="edtcylindersize" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Machine Indent:</label>
<input id="edtmachineindent" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Cross Hairs:</label>
<input id="edtcrosshairs" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Clemson:</label>
<input id="edtclemson" class="form-control input-sm" style="width: 150px"/>
</div>
</div>
<h4 class="custom-h4 mt-3">Colors</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">Colors:</label>
<button id="btnaddcolor" class="btn btn-primary btn-sm float-end">+</button>
<div id="additionalFields" class="row mt-3"></div>
</div>
</div>
<h4 class="custom-h4 mt-3">Proofing</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">Fax:</label>
<input id="edtfax" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Fax Attn:</label>
<input id="edtfaxattn" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Email:</label>
<input id="edtproofemail" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Email Attn:</label>
<input id="edtemailattn" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Ship To:</label>
<input id="edtproofshipto" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Full Size Panel:</label>
<input type="checkbox" id="cbfullsizepanel">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Print Card:</label>
<input type="checkbox" id="cbprintcard">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Wide Format:</label>
<input type="checkbox" id="cbwideformat">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">PDF File:</label>
<input type="checkbox" id="cbpdffile">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Other:</label>
<input id="edtproofother" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Art Approved As Is:</label>
<input type="checkbox" id="cbartapprovedasis">
</div>
<div class="col-auto">
<label for="wdbe_first_name" style="font-weight: 700; font-size: 15px;" class="form-label mt-2">Approved Date:</label>
<input class="form-control input-sm" id="dtpapproveddate" type="date">
</div>
</div>
<h4 class="custom-h4 mt-3">Plates</h4>
<hr class="custom-hr">
<div class="row">
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;" id="lblthickness">Thickness:</label>
<input id="edtThickness" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;" id="lblplatematerial">Plate Material:</label>
<input id="edtplatematerial" class="form-control input-sm" style="width: 150px"/>
</div>
<div class="col-auto">
<label class='pe-2' style="font-weight: 700; font-size: 15px;" id="lbljobnumber">Job Number:</label>
<input id="edtjobnumber" class="form-control input-sm" style="width: 150px"/>
</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">Confirm</button>
</div>
</div>
</div>
<script>
</script>