
<!-- Dashboard content -->
<div class="row">

    <?
    include 'extra/member_head.php';
    ?>

    <div class="col-lg-6"> 
        <!-- Form horizontal -->
        <div class="panel panel-flat">
            <div class="panel-body">           

                <form class="form-horizontal" action="/members/transport" method='POST'>
                    <input type="hidden" name="member_id" value="<?= $_SESSION['selected_user_row']->member_id ?>">
                    <fieldset class="content-group">
                        <legend class="text-bold">Transport Request for :  <?= $_SESSION['selected_user_row']->firstname ?> <?= $_SESSION['selected_user_row']->lastname ?>, <?= $_SESSION['selected_user_row']->street1 ?>,
                            <?= $_SESSION['selected_user_row']->street2 ?>,<?= $_SESSION['selected_user_row']->city ?>,<?= $_SESSION['selected_user_row']->state ?>,<?= $_SESSION['selected_user_row']->zipcode ?></legend>
                        <div class="form-group">
                            <label class="control-label col-lg-2">Created by</label>
                            <div class="col-lg-10">
                                <input type="text" class="form-control" readonly="readonly" value='Web Admin'>
                            </div>
                        </div>

                        <div class="form-group">
                            <label class="control-label col-lg-2">Name</label>

                            <div class="col-lg-5">
                                <input type="text" class="form-control"  name="firstname" placeholder='firstname' value='<?= $firstname ?>'>
                            </div>
                            <div class="col-lg-5">
                                <input type="text" class="form-control"  name="lastname" placeholder='lastname' value='<?= $lastname ?>'>
                            </div>
                        </div>

                        <legend class="text-bold">From</legend>
                        <div class="form-group">
                            <label class="control-label col-lg-2">Address</label>

                            <div class="col-lg-8">
                                <input type="text" class="form-control"  name="from_street" placeholder='Starting Address' value='<?= $from_street ?>'>
                            </div>
                            <div class="col-lg-2">
                                <input type="text" class="form-control"  name="from_aptno" placeholder='Apt No' value='<?= $from_aptno ?>'>
                            </div>
                        </div>
                        <div class="form-group">
                            <label class="control-label col-lg-2">Zip Code/Phone</label>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="from_zipcode" placeholder='Zip code' value='<?= $from_zipcode ?>'>
                            </div>
                            <div class="col-lg-5">
                                <input type="text" class="form-control" name="from_phone" placeholder='Phone' value='<?= $from_phone ?>'>
                            </div>
                        </div>

                        <div class="form-group">
                            <label class="control-label col-lg-2">City/State</label>
                            <div class="col-lg-6">
                                <input type="text" class="form-control" name="from_city" value='<?= $from_city ?>'>
                            </div>

                            <div class="col-lg-4">
                                <select name="from_state" class="form-control">
                                    <option value="GA">Georgia</option>                                                                 
                                </select>
                            </div>
                        </div>
                        <legend class="text-bold">Destination</legend>


                        <div class="form-group">
                            <label class="control-label col-lg-2">Destination</label>
                            <div class="col-lg-10">
                                <select name="loc_address" class="form-control" onchange="if (this.value == '0:0') {
                                            $('#new_location').show('slow');
                                        } else {
                                            $('#new_location').hide('slow');
                                        }"> 
                                    <?
                                    $dispn = "none";
                                    foreach ($destination_option as $dstt => $value) {
                                        $selt = '';
                                        if ($loc_address == $dstt) {
                                            $selt = " selected ";
                                        }
                                        if ($loc_address == "0:0") {
                                            $dispn = "block";
                                        }
                                        echo "<option value='" . $dstt . "' " . $selt . ">" . $value . "</option>";
                                    }
                                    ?>                                    
                                </select>
                            </div>
                        </div>                                               

                        <div id='new_location' style='background-color: #f5f7de; display:<?= $dispn ?>;'>
                            <div class="form-group">
                                <label class="control-label col-lg-2">Address</label>

                                <div class="col-lg-8">
                                    <input type="text" class="form-control"  name="to_street" placeholder='Ending Address' value='<?= $to_street ?>'>
                                </div>
                                <div class="col-lg-2">
                                    <input type="text" class="form-control"  name="to_aptno" placeholder='Apt No' value='<?= $to_aptno ?>'>
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="control-label col-lg-2">Zip Code/Phone</label>
                                <div class="col-lg-5">
                                    <input type="text" class="form-control" name="to_zipcode" placeholder='Zip code' value='<?= $to_zipcode ?>'>
                                </div>
                                <div class="col-lg-5">
                                    <input type="text" class="form-control" name="to_phone" placeholder='Phone' value='<?= $to_phone ?>'>
                                </div>
                            </div>

                            <div class="form-group">
                                <label class="control-label col-lg-2">City/State</label>
                                <div class="col-lg-6">
                                    <input type="text" class="form-control" name="to_city" value='<?= $to_city ?>'>
                                </div>

                                <div class="col-lg-4">
                                    <select name="to_state" class="form-control">
                                        <option value="GA">Georgia</option>                                                                 
                                    </select>
                                </div>
                            </div>

                            <div class="form-group">
                                <label class="control-label col-lg-2">Location Type</label>
                                <div class="col-lg-10">
                                    <select name="loc_type" class="form-control">
                                        <?
                                        foreach ($location_types as $i => $value) {
                                            ?>
                                            <option value="<?= $value ?>"><?= $value ?></option>
    <?
}
?>
                                    </select>
                                </div>
                            </div>  
                        </div>

                        <div class="form-group">
                            <label class="control-label col-lg-2">Date/Time</label>
                            <div class="col-lg-10">

                                <div class="content-group">
                                    <div class="input-group">
                                        <span class="input-group-btn">
                                            <button type="button" class="btn btn-default btn-icon" id="ButtonCreationDemoButton"><i class="icon-calendar3"></i></button>
                                        </span>
                                        <input type="text" class="form-control" id="ButtonCreationDemoInput" placeholder="Select a date" name="transport_date" value='2017-10-01 08:30:30'>
                                    </div>
                                    <span class="help-block">Format must be YYYY-MM-DD HH:MM:SS</span>
                                </div>
                            </div>
                        </div>             

                    </fieldset>
                    <div class="text-right">
                        <button type="submit" class="btn btn-primary">Submit <i class="icon-arrow-right14 position-right"></i></button>
                    </div>
                </form>
            </div>
        </div>
        <!-- /form horizontal -->
    </div>

    <div class="col-lg-6">
     <?
     include 'extra/member_recent.php';
     ?>
    </div>
</div>
<!-- /dashboard content -->

