<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <link href="//maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.0.0/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <link href="https://use.fontawesome.com/releases/v5.0.11/css/all.css" rel="stylesheet"> <div class="nav-side-menu"> <div class="brand">Safe Conduct v1.0</div> <i class="fa fa-bars fa-2x toggle-btn" data-toggle="collapse" data-target="#menu-content"></i> <div class="menu-list"> <ul id="menu-content" class="menu-content collapse out"> <li> <a href="#"> <i class="fas fa-tachometer-alt fa-lg"></i> Home </a> </li> <li> <a href="#"> <i class="fas fa-inbox fa-lg"></i> Safe Conducts </a> </li> <li> <a href="#"> <i class="fas fa-user-tie fa-lg"></i> Profile </a> </li> <li> <a href="#"> <i class="fa fa-users fa-lg"></i> Users </a> </li> <li> <a href="#"> <i class="fas fa-globe fa-lg"></i> Information </a> </li> </ul> </div> </div> <div class="container"> <h2 class=""></h2> <div class="row "> <div class="col-12 col-md-8 col-lg-6 pb-5"> <!--Form with header--> <form action="#" th:action="@{/citizen-draft-sc}" th:object="${user}" method="post"> <div class="card border-primary rounded-0"> <div class="card-header p-0"> <div class="bg-info text-white text-center py-2"> <h3><i class="fa fa-envelope"></i> Need to go out?</h3> <p class="m-0">Request your SafeConduct online</p> </div> </div> <div class="card-body p-3"> <!--Body--> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text"><i class="fa fa-user text-info"></i></div> </div> <input type="text" class="form-control" id="name" name="name" placeholder="Joaquin Copete" readonly th:field="*{name}"></input> </div> </div> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text">Reason</div> </div> <!-- input type="text" class="form-control" id="reason" name="reason" placeholder="Go shopping" required th:field="*{occupation}"></input--> <div class="col-md-6 form-group"> <!-- strong>Duration:</strong --> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" th:field="*{reason}" id="option1" value="15"> <label class="form-check-label" for="option1">Basic needs shopping</label> </div> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" th:field="*{reason}" id="option2" value="30"> <label class="form-check-label" for="option2">Medical appointment</label> </div> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" th:field="*{reason}" id="option3" value="45"> <label class="form-check-label" for="option3">Go to work</label> </div> </div> </div> </div> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text">Address</div> </div> <input type="text" class="form-control" id="address1" name="address1" placeholder="BlueAppleTech office" required th:field="*{address1}"></input> </div> </div> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text">Address</div> </div> <input type="text" class="form-control" id="address2" name="address2" placeholder="C/Mahon 8" required th:field="*{address2}"></input> </div> </div> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text">City</div> </div> <input type="text" class="form-control" id="aCity" name="aCity" placeholder="Las Rozas de Madrid" required th:field="*{city}"></input> </div> </div> <div class="form-group"> <div class="input-group mb-2"> <div class="input-group-prepend"> <div class="input-group-text">Province</div> </div> <input type="text" class="form-control" id="aProvince" name="aProvince" placeholder="Madrid" required th:field="*{province}"></input> </div> </div> <div class="text-center"> <input type="submit" value="Enviar" class="btn btn-info btn-block rounded-0 py-2"></input> </div> </div> </div> </form> <!--Form with header--> </div> </div> </div>

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