<section class="content">
	<div class="user_add">		
		<form id="frm" method="post" action="" enctype="multipart/form-data">
			<div class="box">
				<div class="box-body">	
					<div class="row">					
					<div class="col-md-12">
						<div class="col-md-3 plpr">
							<div class="form-group">
								<label class="control-label">Customer Name *</label>
								<input type="text" class="form-control required" id="customer_name" name="customer_name" placeholder="Customer Name" value="" autocomplete="off" />
							</div>
						</div>
						<div class="col-md-3 plpr">	
							<div class="form-group">
								<label class="control-label">Gender *</label>
								<?php $gender_array_config=$this->config->item('gender_array_config');?>
								<select class="form-control required" id="gender" name="gender">
									<option value="">-- select gender --</option>
									<?php foreach($gender_array_config as $key => $value){ if($value['status']==0){?>
									<option value="<?php echo $key;?>"><?php echo $value['name'];?></option>
									<?php } } ?>
								</select>
							</div>
						</div>
						<div class="col-md-3 plpr">	
							<div class="form-group">
								<label class="control-label">Date of Birth *</label>
								<input type="text" class="form-control required" id="Date1" name="date_of_birth" placeholder="<?php echo date('m/d/Y');?>" value="" autocomplete="off" />
							</div>
						</div>
						<div class="col-md-3 plpr">	
							<div class="form-group">
								<label class="control-label">Mobile Number</label>
								<input type="text" class="form-control required" id="mobile_number" name="mobile_number" placeholder="Enter mobile no." value="" autocomplete="off" />
							</div>
						</div>
						<div class="col-md-3 plpr">	
							<div class="form-group">
								<label class="control-label">Email Address *</label>
								<input type="text" class="form-control email required" id="email" name="email" placeholder="Email Address" value="" autocomplete="off" />
							</div>
						</div>
						<div class="col-md-6 plpr">	
							<div class="form-group">
								<label class="control-label">Address *</label>
								<input type="text" class="form-control required" id="address" name="address" placeholder="Address" value="" autocomplete="off" />
							</div>
						</div>						
						 
					</div>
				</div>
				<div class="col-md-12 plpr">
					<h4>Login Details - </h4>
					<div class="col-md-3 plpr">
						<div class="form-group">
							<label class="control-label">Login Id *</label>
							<input type="text" class="form-control required" id="login_id" name="login_id" placeholder="" value="" autocomplete="off" />
						</div>
					</div>	
					
					<div class="col-md-3 plpr">
						<div class="form-group">
							<label class="control-label">Password *</label>
							<input type="password" class="form-control required" id="new_password" name="new_password" placeholder="Create a Password" value="" autocomplete="off" />
						</div>
					</div>
					<div class="col-md-3 plpr">	
						<div class="form-group">
							<label class="control-label">Pet Name *</label>
							<input type="text" class="form-control required" id="pet_name" name="pet_name" placeholder="Enter your pet name" value="" autocomplete="off" />
						</div>
					</div>		
				</div>
					<div class="col-md-12 plpr">
						<h4>Bank Account Details - </h4>							
							<div class="col-md-2 plpr"> 
								<div class="form-group">
									<label class="control-label">Account No. *</label>
									<input type="text" class="form-control number required" id="bank_account_no" name="bank_account_no" placeholder="Account #" value="" autocomplete="off" />
								</div>
							</div>
							<div class="col-md-2 plpr">
								<div class="form-group">
									<label class="control-label">Account Currency *</label>
									<?php $amt_currencies_array_config=$this->config->item('amt_currencies_array_config');?>
									<select class="form-control required" id="bank_account_cur" name="bank_account_cur">
										<option value="">select acct. type</option>
										<?php foreach($amt_currencies_array_config as $key => $value){ if($value['status']==0){?>
										<option value="<?php echo $key;?>"><?php echo $value['name'];?></option>
										<?php } } ?>
									</select>
								</div>
							</div>
							<div class="col-md-2 plpr">
								<div class="form-group">
									<label class="control-label">Account Category *</label>
									<?php $bank_account_types_array_config=$this->config->item('bank_account_types_array_config');?>
									<select class="form-control required" id="bank_account_category" name="bank_account_category">
										<option value="">select acct. category</option>
										<?php foreach($bank_account_types_array_config as $key => $value){ if($value['status']==0){?>
										<option value="<?php echo $key;?>"><?php echo $value['name'];?></option>
										<?php } } ?>
									</select>
								</div>
							</div>
							<div class="col-md-2 plpr">
								<div class="form-group">
									<label class="control-label">Minimum Balance *</label>
									<input type="text" class="form-control number required" id="bank_minimum_balance" name="bank_minimum_balance" placeholder="" value="" autocomplete="off" />
								</div>
							</div>
							<div class="col-md-2 plpr">
								<div class="form-group">
									<label class="control-label">COT Code *</label>
									<input type="text" class="form-control required" id="bank_transfer_code" name="bank_transfer_code" placeholder="" value="" autocomplete="off" />
								</div>
							</div>
							<div class="col-md-1 plpr">
								<div class="form-group">
									<label class="control-label">Tax Code *</label>
									<input type="text" class="form-control required" id="bank_vat_code" name="bank_vat_code" placeholder="" value="" autocomplete="off" />
								</div>
							</div>
							<div class="col-md-1 plpr">
								<div class="form-group">
									<label class="control-label">IMF Code *</label>
									<input type="text" class="form-control required" id="bank_imf_code" name="bank_imf_code" placeholder="" value="" autocomplete="off" />
								</div>
							</div>						
					</div>
					
				</div>  
				<div class="box-footer">
					<button class="btn btn-primary" type="submit">Submit Now!</button>
				</div>
			</div>
		</form>
	</div>
	
</section>