
<div class="panel panel-flat">
    <fieldset class="content-group">
        <legend id="driver_name" class="text-bold"><?= $form_title ?></legend>
        <input type="hidden" id="driver_id" name="driver_id" value="0">

        <!-- Basic text input -->
        <div class="form-group">
            <label class="control-label col-lg-3">Description <span class="text-danger">*</span></label>
            <div class="col-lg-9">
                <input type="text" id="email" name="description" class="form-control" required="required" placeholder="Description">
            </div>
        </div>
        <!-- /basic text input -->

        <!-- Basic text input -->
        <div class="form-group">
            <label class="control-label col-lg-3">Licence Number <span class="text-danger">*</span></label>
            <div class="col-lg-3">
                <input type="text" id="lic_number" name="lic_number" class="form-control" required="required" placeholder="Licence Number">
            </div>

            <label class="control-label col-lg-3">Licence State</label>
            <div class="col-lg-3">
                <?= $lic_states_combo ?>
            </div>

        </div>
        <!-- /basic text input -->



        <!-- Multiple select -->
        <div class="form-group">
            <label class="control-label col-lg-3">Expr Month  <span class="text-danger">*</span></label>
            <div class="col-lg-3">
                <select id="expr_month" name="expr_month" class="form-control"  required="required">										
                    <? for ($i = 1; $i <= 12; $i++) { ?><option value="<?= $i ?>"><?= $i ?></option><? } ?>					
                </select>
            </div>

            <label class="control-label col-lg-3">Expr Year  <span class="text-danger">*</span></label>
            <div class="col-lg-3">
                <select id="expr_year" name="expr_year" class="form-control"  required="required">										
                    <? for ($i = date("Y") + 20; $i >= date("Y"); $i--) { ?><option value="<?= $i ?>"><?= $i ?></option><? } ?>												
                </select>
            </div>
        </div>
        <!-- /multiple select -->



        


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


</div>

<script type="text/javascript">
<!--
    function saveDevice(locID, device_id) {

        $('#accs' + locID).prop('disabled', true);
        $.ajax({
            url: "/transp/adddevices?proc=NCOMPLETE&locID=" + locID + "&device_id=" + device_id
        }).done(function (data) {
            $('#device_form').html(data);
            $('#accs' + locID).prop('disabled', false);
        });
        return false;

    }

// -->
</script>
<!--
vi:ts=2