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<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
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<legend>Company</legend>
<div class="container">
<div class="row">
<div class="col-md-12">
<div class="panel-group" id="accordion">
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseOne"><span class="glyphicon glyphicon-folder-close">
</span>Details</a>
</h4>
</div>
<div id="collapseOne" class="panel-collapse collapse in">
<div class="panel-body">
<div class="col-xs-12 column">
<form class="form-horizontal">
<!-- Form Name -->
<!-- Text input-->
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span>
<input id="comp_name" name="comp_name" type="text" class="form-control" placeholder="company name">
</div>
<div class="control-group">
<label class="control-label" for="products">Products</label>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-tasks"></span></span>
<input id="products" name="products" type="text" class="form-control" placeholder="all product names">
</div>
</div>
<!-- Select Basic -->
<div class="control-group">
<label class="control-label" for="relation">Relation</label>
<span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
<select id="comprelation" name="comprelation" class="form-control">
<option value="34">Associations</option><option value="8">Bank</option><option value="36">Beware Buyer</option><option value="37">Beware Seller</option><option value="26">BMC</option><option value="7">Broker</option><option value="22">Charterd Accountant</option><option value="14">Clearing Agent</option><option value="29">Competitors</option><option value="13">Consultant</option><option value="9">Courier Agent</option><option value="39">Electrician</option><option value="23">Foreign Exchange</option><option value="6">General</option><option value="12">Hotel</option><option value="24">IMC</option><option value="28">Income Tax</option><option value="5">Indenting Agent</option><option value="48">indianfoundries.com</option><option value="38">IndianMetals.com</option><option value="41">Local Buyers</option><option value="18">New Buyer</option><option value="19">New Seller</option><option value="25">Off. Maintenance</option><option value="3">Other Buyer</option><option value="4">Other Seller</option><option value="1">Our Buyer</option><option value="2" selected="">Our Seller</option><option value="15">Personal</option><option value="40">Printer Toner</option><option value="27">Profession Tax</option><option value="16">Ship Co. Agent</option><option value="17">Ship Co/Lines</option><option value="47">stainlessindia.org</option><option value="20">Surveyors</option><option value="44">Targeted Buyers</option><option value="45">Targeted Sellers</option><option value="21">Travel Agent</option><option value="35">Travel Sites</option><option value="46">Warehouse</option><option value="30">Were Buyers</option><option value="31">Were Sellers</option>
</select>
</div>
<!-- Text input-->
<div class="control-group">
<label class="control-label" for="remark">Remark</label>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-comment"></span></span>
<input id="remarks" name="remarks" type="text" class="form-control" placeholder="remarks about the company">
</div>
</div>
<div class="control-group">
<label class="control-label" for="status">Status</label>
<span class="input-group-addon"><span class="glyphicon glyphicon-bookmark"></span></span>
<select id="comp_status" name="comp_status" class="form-control">
<option value=32>Active</option>
<option value=33>Not Active</option>
</select>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseTwo"><span class="glyphicon glyphicon-earphone">
</span>Communication</a>
</h4>
</div>
<div id="collapseTwo" class="panel-collapse collapse">
<div class="panel-body">
<div class="col-xs-12 column">
<form class="form-horizontal">
<div class="control-group">
<label class="control-label" for="relation">Type</label>
<span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
<select id="CommId" name="CommId" class="form-control">
<option value="20">BB Pin</option><option value="15">Courier</option><option value="10">eFax</option><option value="4">Email</option><option value="17">Facebook</option><option value="3">Fax</option><option value="21">GTalk</option><option value="6" selected="">Mobile</option><option value="11">MSN ID</option><option value="5">Pager</option><option value="1">Phone</option><option value="16">Post</option><option value="9">Resi. Phone</option><option value="14">Skype ID</option><option value="8">TeleFax</option><option value="2">Tlx</option><option value="19">Toll Free No.</option><option value="18">Twitter</option><option value="13">Voicemail</option><option value="7">Website</option><option value="12">Yahoo ID</option>
</select>
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-phone"></span></span>
<input id="CommValue" name="CommValue" type="text" class="form-control" placeholder="Mobile no, Phone no ,email ....">
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
<input id="commremarks" name="commremarks" type="text" class="form-control" placeholder="associated contact ....">
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span>
<select id="LocationId" name="LocationId" class="form-control">
<option value="2">Branch Office</option><option value="12">Corporate Office</option><option value="3">Factory</option><option value="9">Factory 2</option><option value="8">Factory 3</option><option value="4">Godown</option><option value="7">Main Office</option><option value="11">Marketing Office</option><option value="10">Old Address</option><option value="6">Others</option><option value="1" selected="">Regd. Office</option><option value="5">Residence</option><option value="13">Yard</option>
</select>
</div>
<div class="control-group">
<label class="control-label" for="status">Verfied</label>
<span class="input-group-addon"><span class="glyphicon glyphicon-bookmark"></span></span>
<select id="verified" name="verified" class="form-control">
<option value="0" selected="">Yes</option><option value="1">No</option>
</select>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseThree"><span class="glyphicon glyphicon-road">
</span>Address</a>
</h4>
</div>
<div id="collapseThree" class="panel-collapse collapse">
<div class="panel-body">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-th"></span></span>
<input id="addr_detail" name="addr_detail" type="text" class="form-control" placeholder="address ....">
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-globe"></span></span>
<select id="city_id" name="city_id" class="form-control">
<option value="812">Aachen</option><option value="934">Aalst</option><option value="938">AAlwar</option><option value="905">Aberdeen</option><option value="432">Abu Dhabi</option><option value="666">Abu Road</option><option value="508">Ad Den Haag</option><option value="479">Adoni</option><option value="2">Ag Oosterhout</option><option value="354">Agra</option><option value="3">Ah Gorinchem</option><option value="4">Ahmedabad</option><option value="478">Ahmednagar</option><option value="5">Ajman</option><option value="482">Al-Salmiya</option><option value="481">Al-Shuwaikh</option><option value="866">Alaquas</option><option value="659">Aleppo</option><option value="391">Alexanderia</option><option value="357">Aligarh</option><option value="6">Alkhobar</option><option value="7">Allahabad</option><option value="393">Almhult</option><option value="100002">Alor Setar</option><option value="100004">Alor Setar</option><option value="100006">Alor Setar</option><option value="100005">Alor Setar</option><option value="100003">Alor Setar</option><option value="549">Ambernath</option><option value="8">Amman</option><option value="630">Amravati</option><option value="381">Amritsar</option><option value="628">Amstelveen</option><option value="9">Amsterdam</option><option value="879">Amstetten</option><option value="739">Anantapur</option><option value="908">Anglesey</option><option value="706">Anhui</option><option value="427">Ankara</option><option value="557">Ankleshwar</option><option value="10">Antwerp</option><option value="11">Antwerpen</option><option value="12">Anyang</option><option value="967">Anyang City</option><option value="13">Anzures</option><option value="565">Arakunnam</option><option value="14">Arcagno</option><option value="979">Armagh</option><option value="956">Arzano</option><option value="15">Ashdod</option><option value="16">Athens</option><option value="976">Atherton</option><option value="17">Atlanta</option><option value="485">Atul</option><option value="19">Auckland</option><option value="20">Aurangabad</option><option value="21">Aurora</option><option value="974">Azur</option><option value="22">Bad-Oldesole</option><option value="23">Baja California</option><option value="468">Balen</option><option value="24">Baltimore</option><option value="25">Bangalore</option><option value="27">Bangkok</option><option value="28">Barcelona</option><option value="494">Bareily</option><option value="453">Bari Brahamana</option><option value="695">Barnsley</option><option value="29">Baroda</option><option value="384">Baruch</option><option value="30">Basel</option><option value="524">Bassendean</option><option value="763">Bath</option><option value="955">Beaverton</option><option value="854">Beawar</option><option value="31">Bedford</option><option value="32">Bedford On Avon</option><option value="33">Bedfordshire</option><option value="34">Beer-Sheva</option><option value="837">Beerse</option><option value="615">Beihai</option><option value="35">Beijing</option><option value="36">Beirut</option><option value="893">Belfast</option><option value="37">Belgaum</option><option value="38">Belgrade</option><option value="497">Bellary</option><option value="39">Belo Horizonte</option><option value="40">Benoni</option><option value="41">Bensalem</option><option value="42">Bensheim</option><option value="537">Beograd</option><option value="872">Berango</option><option value="889">Berkshire</option><option value="408">Berlin</option><option value="45">Bettendorf</option><option value="774">Bex</option><option value="385">Bhadravati</option><option value="470">Bharatpur</option><option value="621">Bharuch</option><option value="535">Bhatkal</option><option value="533">Bhavnagar</option><option value="364">Bhilai</option><option value="980">Bhiwandi</option><option value="374">Bhopal</option><option value="489">Bhubaneswar</option><option value="584">Bidar</option><option value="937">Bielefeld</option><option value="46">Bijapur</option><option value="505">Bilaspur</option><option value="558">Bilbao</option><option value="506">Binanipuram</option><option value="47">Birmingham</option><option value="927">Bishnupur</option><option value="48">Blanquefort</option><option value="920">Bogota</option><option value="594">Bollaram</option><option value="910">Bolton</option><option value="49">Bolzano</option><option value="782">Bonn</option><option value="943">Boras</option><option value="617">Boston</option><option value="810">Bottrop</option><option value="51">Bramstedt</option><option value="52">Braunau-Ranshofen</option><option value="53">Bremen</option><option value="874">Brescia</option><option value="576">Brisbane</option><option value="546">British Columbia</option><option value="796">Brixlegg</option><option value="859">Bronzolo</option><option value="54">Brugge</option><option value="55">Brussels</option><option value="56">Bruxelles</option><option value="57">Bucharest</option><option value="543">Buck</option><option value="58">Budapest</option><option value="59">Buenos Aires</option><option value="966">Cagliari</option><option value="60">Cairo</option><option value="725">Calicut</option><option value="737">Cambridge</option><option value="946">Campinas,</option><option value="403">Canberra</option><option value="639">Canning Vale</option><option value="534">Cannock</option><option value="62">Canton</option><option value="518">Canton, Ohio</option><option value="842">Cape Town</option><option value="63">Caracas</option><option value="698">Cardiff</option><option value="758">Casablanca</option><option value="861">Casto</option><option value="64">Cedex</option><option value="608">Chalco</option><option value="65">Cham</option><option value="66">Chandausi</option><option value="67">Chandigarh</option><option value="475">Chandrapur</option><option value="685">Changhua</option><option value="387">Changsha</option><option value="686">Changzhou</option><option value="476">Channel Island</option><option value="622">Chantilly</option><option value="931">Chatelet</option><option value="474">Chelyabinsk</option><option value="445">Chengai</option><option value="688">Chengdu</option><option value="620">Chennai</option><option value="68">Cheshire</option><option value="895">Chesterfield</option><option value="552">Chheharta</option><option value="734">Chiba</option><option value="69">Chicago</option><option value="372">Chickmagalur</option><option value="70">Chikmangalore</option><option value="568">Chitradurga</option><option value="606">Chittagong</option><option value="360">Chittorgarh</option><option value="989">Chongqing</option><option value="947">Chowtuppal</option><option value="71">Christ Church</option><option value="856">Cieszyn</option><option value="598">Cincinnati</option><option value="380">Cochin</option><option value="73">Coimbatore</option><option value="663">Coimbatore</option><option value="74">Colemborg</option><option value="75">Colombo</option><option value="76">Compton</option><option value="77">Concordville</option><option value="823">Connecticut</option><option value="78">Copenhagen</option><option value="894">Cork</option><option value="79">Cramerview</option><option value="80">Creil</option><option value="81">Cuauhtemoc</option><option value="761">Cuidad</option><option value="82">Cuttack</option><option value="601">Dadra</option><option value="687">Dalian</option><option value="83">Dallas</option><option value="456">Daman</option><option value="689">Damascus</option><option value="84">Dammam</option><option value="85">Damme</option><option value="86">Dar-es-salaam</option><option value="925">Deerlijk</option><option value="87">Dehradun</option><option value="708">Delaware</option><option value="88">Delhi</option><option value="816">Denizli</option><option value="462">Derby</option><option value="89">Derbyshire</option><option value="900">Devon</option><option value="605">Dhaka</option><option value="451">Dhanbad</option><option value="447">Dhanot</option><option value="792">Dinslaken</option><option value="692">Djibouti</option><option value="90">Doha</option><option value="868">Dolo</option><option value="778">Donauworth</option><option value="818">Donbas</option><option value="775">Dordrecht</option><option value="786">Dortmund</option><option value="911">Downpatrick</option><option value="91">Dubai</option><option value="92">Dublin</option><option value="100000">Dudley</option><option value="100001">Dudley</option><option value="392">Duesseldorf</option><option value="93">Duisburg</option><option value="909">Dumfries</option><option value="97">Duncriag</option><option value="98">Durban</option><option value="1">Durgapur</option><option value="99">Dusseldorf</option><option value="579">East Sussex</option><option value="912">Edinburgh</option><option value="826">Eindhoven</option><option value="616">Ekaterinburg</option><option value="100">Elmhurst</option><option value="944">Enkoping</option><option value="785">Enschede</option><option value="101">Enugu</option><option value="802">Eppingen</option><option value="873">Erandio</option><option value="880">Erfurt</option><option value="693">Erode</option><option value="824">Escobedo</option><option value="941">Espoo</option><option value="102">Essen</option><option value="540">Essex</option><option value="806">Essingen</option><option value="748">Fahaheel</option><option value="399">Faridabad</option><option value="747">Farwaniya</option><option value="773">Fehrbellin</option><option value="103">Feldkirch</option><option value="794">Feldmeilen</option><option value="491">Firozabad</option><option value="929">Flemalle</option><option value="798">Flensburg</option><option value="529">Florida</option><option value="850">Fort Wayne</option><option value="105">Frankfurt</option><option value="452">Fribourg</option><option value="106">Fridolfing</option><option value="436">Fujairah</option><option value="717">Fujian</option><option value="541">Funabashi City</option><option value="517">Fuzhou</option><option value="780">Gaggenau</option><option value="107">Galena Park</option><option value="544">Gandhidham</option><option value="378">Gandhinagar</option><option value="680">Gansu</option><option value="990">Gauteng</option><option value="108">Geertruidenberg</option><option value="397">Geneva</option><option value="935">Genk</option><option value="109">Gennevilliers</option><option value="110">Genoa</option><option value="582">Gent</option><option value="877">Genval-Lac</option><option value="111">Gerhardshoffen</option><option value="112">Ghaziabad</option><option value="463">Ghazipur</option><option value="586">Gijon</option><option value="933">Gistel</option><option value="627">Givatayum</option><option value="714">Giza</option><option value="899">Glamorgan</option><option value="839">Glasgow</option><option value="886">Gloucester</option><option value="377">Goa</option><option value="726">Gobindgarh</option><option value="711">Goochland</option><option value="113">Gothenburg</option><option value="791">Gottenheim</option><option value="843">Grampian</option><option value="871">Granada</option><option value="819">Gravendeel</option><option value="114">Grazerplatz</option><option value="499">Great Neck</option><option value="610">Guangdong</option><option value="611">Guangxi</option><option value="589">Guayaquil</option><option value="903">Guernsey</option><option value="978">Guizhou</option><option value="115">Gujarat</option><option value="116">Gujranwala</option><option value="678">Gundlav</option><option value="563">Gurgaon</option><option value="555">Guwahati</option><option value="502">Gwalior</option><option value="117">Gwent</option><option value="965">Gyeongsangnsm-Do</option><option value="804">Hagen</option><option value="633">Haicheng</option><option value="919">Haifa</option><option value="632">Haiphong</option><option value="669">Haldia</option><option value="352">Halol</option><option value="118">Hamburg</option><option value="119">Hamilton</option><option value="121">Hamilton,Scotland</option><option value="963">Hamina</option><option value="120">Hampshire</option><option value="677">Hangzhou</option><option value="800">Hannover</option><option value="631">Hanoi</option><option value="122">Harare</option><option value="803">Harderwijk</option><option value="890">Hartlepool</option><option value="133">Haryana</option><option value="729">Hawally</option><option value="779">Heeze</option><option value="460">Helsingborg</option><option value="124">Helsinki</option><option value="125">Hemiksem</option><option value="126">Hendrick-ido-ambacht</option><option value="971">Herts</option><option value="836">Hertz</option><option value="591">Hilton Head Island</option><option value="457">Hindupur</option><option value="454">Hissar</option><option value="581">Ho Chi Minh City</option><option value="783">Hockenheim</option><option value="954">Holon</option><option value="127">Homewood</option><option value="409" >Hongkong</option><option value="511">Hosur</option><option value="128">Houston</option><option value="130">Howrah</option><option value="514">Hubli</option><option value="690">Huludao</option><option value="131">Hunan</option><option value="132">Hyderabad</option><option value="134">Idrija</option><option value="590">Ijssel</option><option value="135">Ijsselstein</option><option value="825">Illionis</option><option value="602">Indianapolis</option><option value="136">Indore</option><option value="137">Ingbert</option><option value="728">Ingur</option><option value="727">Ingur</option><option value="138">Iquique</option><option value="551">Irvine</option><option value="139">Irving</option><option value="417">Islamabad</option><option value="140">Islanoo</option><option value="141">Istanbul</option><option value="142">Itssel</option><option value="959">Izmir</option><option value="550">Jabalpur</option><option value="143">Jacobstrabe</option><option value="144">Jagadhri</option><option value="145">Jaipur</option><option value="495">Jajpur</option><option value="146">Jakarta</option><option value="984">Jalandar</option><option value="441">Jalgoan</option><option value="498">Jalpaiguri</option><option value="492">Jammu</option><option value="147">Jamnagar</option><option value="148">Jamshedpur</option><option value="720">Jebel Ali</option><option value="149">Jeddah</option><option value="150">Jeruselam</option><option value="369">Jhansi</option><option value="707">Jharkhand</option><option value="855">Jiangsu</option><option value="400">Jodhpur</option><option value="822">Joetsu</option><option value="151">Johannesburg</option><option value="152">Johar Bahru</option><option value="548">Jorhat</option><option value="509">Junagadh</option><option value="702">Kadiyam</option><option value="668">Kakinada</option><option value="539">Kalavoor</option><option value="587">Kaliningrad</option><option value="683">Kalol</option><option value="950">Kalyaneshwari</option><option value="153">Kanpur</option><option value="154">Kaohsiung</option><option value="155">Karachi</option><option value="593">Karakoy-Istanbul</option><option value="853">Karlsruhe</option><option value="382">Karnal</option><option value="562">Karwar</option><option value="547">Kashipur</option><option value="960">Kathua</option><option value="595">Kayseri</option><option value="156">Kent</option><option value="556">Kentucky</option><option value="821">Kenwick</option><option value="158">Kerteminde</option><option value="751">Khajuraho</option><option value="446">Kharagpur</option><option value="159">Khartoum</option><option value="160">Khatmandu</option><option value="634">Khopoli</option><option value="741">Khormouj</option><option value="636">Kiev</option><option value="161">Kingston</option><option value="430">Kinhasa</option><option value="991">Kitwe</option><option value="469">Klagenfurt</option><option value="762">Klinhurst</option><option value="162">Koblenz</option><option value="439">Kocaeli</option><option value="466">Kochi</option><option value="735">Koga</option><option value="163">Kolhapur</option><option value="61">Kolkatta</option><option value="977">Kollam</option><option value="164">Konstanz</option><option value="527">Koraput</option><option value="442">Korba</option><option value="353">Kota</option><option value="368">Kotte</option><option value="528">Kottyam</option><option value="165">Kowloon</option><option value="793">Krefeld</option><option value="166">Krefeld</option><option value="167">Kruishoutem</option><option value="168">Kuala Lampur</option><option value="461">Kumbakonam</option><option value="849">Kushtia</option><option value="413">Kuwait City</option><option value="942">Kvistgaard</option><option value="730">Kyungki-do</option><option value="731">Kyungnam</option><option value="921">Labuan</option><option value="169">Lagos</option><option value="170">Lahore</option><option value="738">Lampang</option><option value="896">Lanarkshire</option><option value="171">Lancashire</option><option value="172">Lancaster</option><option value="531">Lancaster, MA</option><option value="801">Langenhagen</option><option value="681">Lanzhou</option><option value="173">Lausanne</option><option value="174">Leeds</option><option value="906">Leicester</option><option value="973">Leon</option><option value="932">Leper</option><option value="597">Levate</option><option value="176">Liancourt</option><option value="721">Lianyungang</option><option value="846">Liaoning</option><option value="356">Lichenstein</option><option value="177">Lichtervelde</option><option value="930">Liege</option><option value="178">Lima</option><option value="596">Limassol</option><option value="767">Limay</option><option value="904">Limerick</option><option value="350">Limoges</option><option value="744">Lincolnshire</option><option value="179">Lingfield</option><option value="573">Linz</option><option value="419">Lisbon</option><option value="180">Liverpool</option><option value="181">Livorno</option><option value="712">Lo Creusot</option><option value="765">Lokeren</option><option value="569">Lonavla</option><option value="182">London</option><option value="183">Long Beach</option><option value="184">Los Angeles</option><option value="840">Louveciennes</option><option value="186">Lubumbashi</option><option value="187">Lucerne</option><option value="188">Lucknow</option><option value="483">Ludhiana</option><option value="815">Lugones</option><option value="189">Lunen</option><option value="975">Luoyang</option><option value="190">Lusaka</option><option value="191">Lutry</option><option value="414">Luxembourg City</option><option value="768">Lyon</option><option value="820">Maalot</option><option value="838">Maastricht</option><option value="467">Macclesfield</option><option value="701">Madhapar</option><option value="192">Madras</option><option value="193">Madrid</option><option value="194">Madurai</option><option value="667">Madurantakam</option><option value="363">Mahad</option><option value="515">Mahuva</option><option value="195">Malerkotla</option><option value="559">Malmo</option><option value="196">Malonne</option><option value="752">Manali</option><option value="197">Manama</option><option value="607">Manchester</option><option value="566">Mandya</option><option value="198">Mangalore</option><option value="199">Manila</option><option value="808">Mannheim</option><option value="201">Marco Evangelista</option><option value="507">Mariamalainagar</option><option value="202">Marshall Town</option><option value="203">Mathura</option><option value="599">Medan</option><option value="383">Meerut</option><option value="521">Mehsana</option><option value="204">Melbourne</option><option value="205">Menen</option><option value="473">Merignac</option><option value="670">Merseyside</option><option value="371">Mettur Dam</option><option value="415">Mexico City</option><option value="206">Miami</option><option value="828">Michigan</option><option value="207">Middleburg</option><option value="208">Middlesex</option><option value="697">Midlands</option><option value="209">Milano</option><option value="832">Milwaukee</option><option value="724">Minas Gerais</option><option value="691">Minsk</option><option value="210">Mirzapur</option><option value="764">Moerdijk</option><option value="211">Mogadishu</option><option value="212">Mombasa</option><option value="213">Monore</option><option value="625">Monrovia</option><option value="214">Montengro</option><option value="860">Montesilvano</option><option value="362">Montreal</option><option value="787">Montreux</option><option value="614">Moonak</option><option value="215">Moradabad</option><option value="420">Moscow</option><option value="216">Mosta</option><option value="949">Mulheim an der Ruhr</option><option value="50">Mumbai</option><option value="807">Munich</option><option value="218">Murray Hill</option><option value="219">Muscat</option><option value="438">Muzaffarnagar</option><option value="220">Mysore</option><option value="221">N. Humberside</option><option value="928">Naarden</option><option value="223">Nagpur</option><option value="412">Nairobi</option><option value="545">Nalco Nagar</option><option value="858">Nallore</option><option value="709">Nanchang</option><option value="629">Nanchang</option><option value="759">Nanded</option><option value="471">Nanjing</option><option value="224">Nanterre</option><option value="358">Nashik</option><option value="577">Nassau</option><option value="660">Navi Mumbai</option><option value="592">Netanya</option><option value="225">Neuilly-sur-siene</option><option value="226">Neuss</option><option value="986">New</option><option value="398">New Delhi</option><option value="227">New Jersey</option><option value="228">New South Wales</option><option value="229">New York</option><option value="230">Newark</option><option value="914">Newtownabbey</option><option value="743">Newzealand</option><option value="618">Nhava Sheva</option><option value="231">Nicosia</option><option value="516">Niederanven</option><option value="232">Nieuwegein</option><option value="817">Ningbo</option><option value="852">Noida</option><option value="902">Norfolk</option><option value="742">North Harrow</option><option value="233">Northfield</option><option value="234">Novato</option><option value="968">Nuevo Leon</option><option value="235">Nuremberg</option><option value="236">Oberusel</option><option value="784">Ochtrup</option><option value="781">Odense</option><option value="626">Ohio</option><option value="237">Okhlahoma</option><option value="238">Okland Yard</option><option value="239">Olifantafontein</option><option value="240">Omaha</option><option value="664">Oman</option><option value="241">Ontario</option><option value="878">Oostkapelle</option><option value="753">Ooty</option><option value="750">Ooty</option><option value="242">Orissa</option><option value="857">Orvieto</option><option value="243">Osaka</option><option value="244">Oslo</option><option value="898">Ossett</option><option value="916">Paisley</option><option value="373">Pampady</option><option value="500">Panaji</option><option value="658">Pannala</option><option value="245">Papendrecht</option><option value="964">Paranaque</option><option value="247">Paris</option><option value="530">Parwanoo</option><option value="248">Pas De Calais</option><option value="361">Patna</option><option value="776">Peine</option><option value="250">Penang</option><option value="252">Penns Park</option><option value="253">Perak</option><option value="254">Perth</option><option value="249">Phathumthani</option><option value="255">Philadelphia</option><option value="256">Phuntsholing</option><option value="936">Ping Tung Hsien</option><option value="554">Piracicaaba</option><option value="257">Pireeus</option><option value="662">Pithampur-Dhar</option><option value="258">Pittsburg</option><option value="390">Plano,Texas</option><option value="260">Plaris</option><option value="789">Plochingen</option><option value="609">Polanco</option><option value="261">Pondicherry</option><option value="863">Pontirolo Nuovo</option><option value="262">Poona</option><option value="870">Porrino</option><option value="696">Port Blair</option><option value="263">Port Louis</option><option value="264">Portland</option><option value="988">Potchefstroom</option><option value="907">Powys</option><option value="405">Prague</option><option value="459">Prai</option><option value="671">Punjab</option><option value="265">Pusan</option><option value="574">Puttur</option><option value="523">Pyongyang</option><option value="684">Qinghai</option><option value="981">Qinqdao</option><option value="952">Quatre Bornes</option><option value="266">Quebec</option><option value="267">Queensland</option><option value="613">Rabat</option><option value="700">Raigad</option><option value="268">Raipur</option><option value="913">Rajasthan</option><option value="367">Rajkot</option><option value="564">Ramanathapuram</option><option value="269">Ranchi</option><option value="443">Ranipur</option><option value="270">Ratnagiri</option><option value="522">Ravivalasa</option><option value="957">Rayong</option><option value="448">Regensdorf</option><option value="444">Rehla</option><option value="624">Reinheim</option><option value="892">Renfrew</option><option value="450">Renukoot</option><option value="271">Reutlingen</option><option value="477">Rewa</option><option value="355">Rewari</option><option value="410">Reykjavik</option><option value="713">Richards Bay</option><option value="272">Ridderkerk</option><option value="273">Ridgefield</option><option value="777">Riga</option><option value="875">Rijkevorsel</option><option value="274">Rio De Janerio</option><option value="275">Rishon Le Zion</option><option value="421">Riyadh</option><option value="881">Rockensussra</option><option value="746">Romania</option><option value="411">Rome</option><option value="809">Rommerskirchen</option><option value="612">Roorkee</option><option value="276">Rosenheim</option><option value="386">Rotherham</option><option value="756">Rotherham</option><option value="757">Rotherham</option><option value="862">Rotkreuz</option><option value="277">Rotterdam</option><option value="278">Rourkela</option><option value="867">Rubano</option><option value="876">Rumst</option><option value="279">Ruwi</option><option value="280">Safat</option><option value="504">Sahibabad</option><option value="281">Sailsbury</option><option value="635">Sakura</option><option value="396">Salem</option><option value="282">Salo</option><option value="283">Salt Lake City</option><option value="766">Samutprakarn</option><option value="284">Samutsakom</option><option value="834">San Diego</option><option value="286">San Jose</option><option value="710">San Luis Potosi</option><option value="288">Sandton</option><option value="455">Sangli</option><option value="619">Sangrur</option><option value="351">Sanming</option><option value="435">Sanna</option><option value="831">Santa Ana</option><option value="961">Santa Domingo</option><option value="865">Santander</option><option value="289">Santigo</option><option value="290">Sao Joao Del Rei</option><option value="291">Sao Paulo</option><option value="510">Satara</option><option value="571">Satna</option><option value="987">São João da Boa</option><option value="553">Scarborough</option><option value="811">Scheemda</option><option value="805">Schkopau</option><option value="814">Schwarzenbach</option><option value="829">Seattle</option><option value="379">Secunderabad</option><option value="292">Selangor</option><option value="293">Seoul</option><option value="830">Sevilla</option><option value="294">Sevojno</option><option value="603">Shaanxi</option><option value="296">Shandong</option><option value="600">Shanghai</option><option value="297">Sharjah</option><option value="298">Shatin</option><option value="745">Shaukiwan</option><option value="389">Sheffield</option><option value="732">Shenyang</option><option value="299">Shenzhen</option><option value="845">Shi jia zhuang</option><option value="526">Shikohabad</option><option value="512">Shillong</option><option value="300">Shimoga</option><option value="560">Shiroli</option><option value="923">Shoham</option><option value="472">Shoumen</option><option value="679">Shreeramnagar</option><option value="718">Sichuan</option><option value="665">Silvassa</option><option value="736">Sincan</option><option value="422">Singapore</option><option value="464">Singhania</option><option value="513">Sinnar</option><option value="948">Sirohi</option><option value="458">Sirsa</option><option value="301">Sivakasi</option><option value="926">Skien</option><option value="939">Skive</option><option value="302">Skokie</option><option value="303">Sofia</option><option value="883">Solihull</option><option value="945">Sollentuna</option><option value="486">Sonepat</option><option value="304">Spazzini</option><option value="797">Sprockhoevel</option><option value="749">Srinagar</option><option value="305">St. Louis</option><option value="306">St. Petersburg</option><option value="885">Staffs</option><option value="308">Stamford</option><option value="884">Stirlingshire</option><option value="307">Stockholm</option><option value="915">Stockton</option><option value="772">Stolberg</option><option value="771">Straubing</option><option value="795">Stuttgart</option><option value="496">Suffolk</option><option value="310">Surabaya</option><option value="375">Surat</option><option value="311">Surrey</option><option value="891">Sussex</option><option value="488">Suvigliana</option><option value="313">Svelgen</option><option value="314">Sydney</option><option value="315">Taby</option><option value="316">Taipei</option><option value="672">Taiyuan</option><option value="674">Taizhou</option><option value="490">Taloja</option><option value="733">Tamworth</option><option value="567">Tanuku</option><option value="918">Tasmania</option><option value="317">Tehran</option><option value="318">Tel-Aviv</option><option value="970">Texas</option><option value="401">Thane</option><option value="740">Thanyaburi,</option><option value="985">Thessaloniki</option><option value="404">Thimpu</option><option value="673">Tianjin</option><option value="319">Tienen</option><option value="940">Tilst</option><option value="754">Tirana</option><option value="755">Tirana</option><option value="320">Tirol</option><option value="536">Tiruchirapalli</option><option value="848">Tirunelveli</option><option value="561">Tirupati</option><option value="321">Titova Uzice</option><option value="623">Tohana</option><option value="322">Tokyo</option><option value="323">Toledo</option><option value="570">Torarniska</option><option value="388">Torino</option><option value="847">Toronto</option><option value="769">Toulouse</option><option value="324">Trabuco Canyan</option><option value="325">Treibach</option><option value="922">Trezzo</option><option value="493">Trichy</option><option value="326">Tullinge</option><option value="437">Tumkur</option><option value="395">Turin</option><option value="328">Udaipur</option><option value="538">Udupi</option><option value="329">Ujjain</option><option value="703">Ukraine</option><option value="992">Ulsan</option><option value="578">Umergoan</option><option value="705">Unhui</option><option value="433">Valetta</option><option value="501">Valsad</option><option value="332">Vancouver</option><option value="484">Vancouver WA</option><option value="333">Vapi</option><option value="370">Varanasi</option><option value="953">Varna</option><option value="661">Vashi</option><option value="827">Veenendaal</option><option value="788">Velbert</option><option value="503">Vellore</option><option value="869">Venezia</option><option value="583">Veraval</option><option value="851">Verviers</option><option value="334">Victoria</option><option value="799">Vienenburg</option><option value="335">Vienna</option><option value="480">Vijaywada</option><option value="336">Vilnius</option><option value="969">Virginia</option><option value="465">Virudhunagar</option><option value="365">Vishakapatanam</option><option value="338">W. Midlands</option><option value="339">Waldhofen</option><option value="340">Wanchai</option><option value="588">Wardha</option><option value="951">Warrington</option><option value="418">Warsaw</option><option value="449">Warwickshire</option><option value="341">Washington</option><option value="637">Waterloo</option><option value="901">Watford</option><option value="585">Wellington</option><option value="542">Welshpool</option><option value="342">Wenonah</option><option value="790">Werdohl</option><option value="888">West Lothian</option><option value="841">West Midlands</option><option value="917">Western Australia</option><option value="344">White Plains</option><option value="844">Wijk Bij Duurstede</option><option value="924">Willebroek</option><option value="345">Willston Park</option><option value="897">Wiltshire</option><option value="835">Wisconsin</option><option value="699">Wolverhampton</option><option value="575">Woollahra</option><option value="638">Worcester</option><option value="346">Worcestershire</option><option value="813">Wuppertal</option><option value="715">Xiamen</option><option value="347">Xian</option><option value="719">Xichang</option><option value="972">Xingtai</option><option value="682">Xinyi</option><option value="572">Yamunanagar</option><option value="487">Yanam</option><option value="520">Yavatmal</option><option value="770">Ybbs</option><option value="760">Yingkow City</option><option value="348">Yokohama</option><option value="694">Yorkshire</option><option value="675">Yuhuan</option><option value="716">Yunnan</option><option value="580">Zaporozhye</option><option value="864">Zaragoza</option><option value="440">Zarka</option><option value="349">Zeno Naviglio</option><option value="525">Zevenaar</option><option value="676">Zhejiang</option><option value="958">Zhengzhou</option><option value="704">Zug</option><option value="723">Zurich</option>
</select>
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-plane"></span></span>
<select id="country_id" name="country_id" class="form-control">
<option value="112">Albania</option><option value="2">Argentina</option><option value="3">Australia</option><option value="4">Austria</option><option value="91">Bahamas</option><option value="5">Bahrain</option><option value="97">Bangladesh</option><option value="6">Belgium</option><option value="7">Bhutan</option><option value="8">Brazil</option><option value="9">Bulgaria</option><option value="10">Canada</option><option value="11">Ceylon</option><option value="12">Chile</option><option value="13">China</option><option value="90">CIS</option><option value="85">Colombia</option><option value="14">Cyprus</option><option value="15">Czechoslovakia</option><option value="16">Denmark</option><option value="114">Dominican Republic</option><option value="107">East Africa</option><option value="94">Ecqador</option><option value="18">Egypt</option><option value="87">Europe</option><option value="19">Finland</option><option value="20">France</option><option value="21">Germany</option><option value="22">Greece</option><option value="113">Guatenmala</option><option value="23">Holland</option><option value="24" >Hongkong</option><option value="25">Hungary</option><option value="26">Iceland</option><option value="27">India</option><option value="28">Indonesia</option><option value="29">Iran</option><option value="30">Ireland</option><option value="31">Israel</option><option value="32">Italy</option><option value="33">Jamaica</option><option value="34">Japan</option><option value="35">Jordan</option><option value="36">Kenya</option><option value="106">Korea</option><option value="38">Kuwait</option><option value="109">Latvia</option><option value="39">Lebanon</option><option value="110">Lianyungang</option><option value="100">Liberia</option><option value="115">Libya</option><option value="40">Lithuania</option><option value="41">Luxembourg</option><option value="42">Malaysia</option><option value="43">Malta</option><option value="44">Mauritius</option><option value="45">Mexico</option><option value="98">Morocco</option><option value="46">Nepal</option><option value="47">New Zealand</option><option value="48">Nigeria</option><option value="37">North Korea</option><option value="49">Norway</option><option value="50">Oman</option><option value="51">Pakistan</option><option value="111">Pathumthani</option><option value="52">Peru</option><option value="53">Philippines</option><option value="54">Poland</option><option value="55">Portugal</option><option value="56">Qatar</option><option value="57">Rumania</option><option value="58">Russia</option><option value="59">Saudi Arabia</option><option value="61">Singapore</option><option value="62">Somalia</option><option value="63">South Africa</option><option value="108">South Andaman</option><option value="64">South Korea</option><option value="65">Spain</option><option value="66">Sri Lanka</option><option value="67">Sudan</option><option value="68">Sweden</option><option value="69">Switzerland</option><option value="105">Syria</option><option value="70">Taiwan</option><option value="71">Tanzania</option><option value="72">Thailand</option><option value="86">The Netherlands</option><option value="73">Turkey</option><option value="83">U.A.E</option><option value="75">UK</option><option value="92">Ukraine</option><option value="76">USA</option><option value="77">Venezuela</option><option value="93">Vietnam</option><option value="99">West Africa</option><option value="78">Yemen</option><option value="79">Yugoslavia</option><option value="80">Zaire</option><option value="81">Zambia</option><option value="82">Zimbabwe</option>
</select>
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-record"></span></span>
<input id="zip" name="zip" type="text" class="form-control" placeholder="zip code ....">
</div>
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span>
<select id="LocationId" name="LocationId" class="form-control">
<option value="2">Branch Office</option><option value="12">Corporate Office</option><option value="3">Factory</option><option value="9">Factory 2</option><option value="8">Factory 3</option><option value="4">Godown</option><option value="7">Main Office</option><option value="11">Marketing Office</option><option value="10">Old Address</option><option value="6">Others</option><option value="1" selected="">Regd. Office</option><option value="5">Residence</option><option value="13">Yard</option>
</select>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</div>
</div>
</div>
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseFour"><span class="glyphicon glyphicon-usd">
</span>Bank</a>
</h4>
</div>
<div id="collapseFour" class="panel-collapse collapse">
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span>
<input id="bank_name" name="bank_name" type="text" class="form-control" placeholder="bank name.....">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-tasks"></span></span>
<input id="bank_address" name="bank_address" type="text" class="form-control" placeholder="bank address....">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-barcode"></span></span>
<input id="bank_acno" name="bank_acno" type="text" class="form-control" placeholder="account no....">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-barcode"></span></span>
<input id="swiftcode" name="swiftcode" type="text" class="form-control" placeholder="swift code...">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-tasks"></span></span>
<input id="corr_bank_desc" name="corr_bank_desc" type="text" class="form-control" placeholder="corresponding bank address...">
</div>
</div>
<div class="control-group">
<label class="control-label" for="status">Draft from</label>
<span class="input-group-addon"><span class="glyphicon .glyphicon-bookmark"></span></span>
<select id="Draftfrom" name="Draftfrom" class="form-control">
<option value="0" selected="">Yes</option><option value="1">No</option>
</select>
</div>
<div class="control-group">
<label class="control-label" for="status">Preferred</label>
<span class="input-group-addon"><span class="glyphicon glyphicon-bookmark"></span></span>
<select id="preferred_bank" name="preferred_bank" class="form-control">
<option value="0" selected="">Yes</option><option value="1">No</option>
</select>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</div>
</div>
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseFive"><span class="glyphicon glyphicon-th-large">
</span>Product</a>
</h4>
</div>
<div id="collapseFive" class="panel-collapse collapse">
<div class="input-group input-group-lg">
<div class="col-xs-12 column">
<form class="form-horizontal">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-th-list"></span></span>
<select id="prod_spec_id" name="prod_spec_id" class="form-control">
<option value="">All Spec </option><option value="82">HG Zn</option><option value="269">Remelted Zn SLBS</option><option value="246">SHG Zn</option><option value="812">ZA4-1</option><option value="863">Zinc Oxide 74%</option><option value="862">Zinc Oxide 97.5-98.5%</option><option value="556" selected="">Zn Alloys</option><option value="820">Zn Ing 98.7%</option><option value="302">Zn Ing 99%</option><option value="819">Zn Ing 99.5%</option><option value="818">Zn Ing 99.95%</option><option value="857">Zn Ing 99.987%</option><option value="817">Zn Ing 99.99%</option><option value="858">Zn Oxide 99.5%</option>
</select>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-shopping-cart"></span></span>
<input id="qtypermonth" name="qtypermonth" type="text" class="form-control" placeholder="qty per month.....">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-list-alt"></span></span>
<input id="preferred_description" name="preferred_description" type="text" class="form-control" placeholder="preferred description.....">
</div>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</form>
</div>
</div>
</div>
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapseSix"><span class="glyphicon glyphicon-user">
</span>Person</a>
</h4>
</div>
<div id="collapseSix" class="panel-collapse collapse">
<div class="input-group input-group-lg">
<div class="col-xs-12 column">
<form class="form-horizontal">
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-shopping-cart"></span></span>
<input id="person_firstname" name="person_firstname" type="text" class="form-control" placeholder="firstname.....">
</div>
</div>
<div class="control-group">
<div class="input-group input-group-lg">
<span class="input-group-addon"><span class="glyphicon glyphicon-list-alt"></span></span>
<input id="person_midname" name="person_midname" type="text" class="form-control" placeholder="middlename.....">
</div>
</div>
<!-- Button -->
<div class="control-group">
<label class="control-label" for="submit"></label>
<div class="controls">
<a href="#" class="btn btn-block btn-sm btn-primary"><span class="glyphicon glyphicon-save"></span> Save</a>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
//$(document).ready(function() {
// The maximum number of options
var MAX_OPTIONS = 5;
$('#surveyForm')
.bootstrapValidator({
feedbackIcons: {
valid: 'glyphicon glyphicon-ok',
invalid: 'glyphicon glyphicon-remove',
validating: 'glyphicon glyphicon-refresh'
},
fields: {
question: {
validators: {
notEmpty: {
message: 'The question required and cannot be empty'
}
}
},
'option[]': {
validators: {
notEmpty: {
message: 'The option required and cannot be empty'
},
stringLength: {
max: 100,
message: 'The option must be less than 100 characters long'
}
}
}
}
})
// Add button click handler
.on('click', '.addButton', function() {
var $template = $('#optionTemplate'),
$clone = $template
.clone()
.removeClass('hide')
.removeAttr('id')
.insertBefore($template),
$option = $clone.find('[name="option[]"]');
// Add new field
$('#surveyForm').bootstrapValidator('addField', $option);
})
// Remove button click handler
.on('click', '.removeButton', function() {
var $row = $(this).parents('.form-group'),
$option = $row.find('[name="option[]"]');
// Remove element containing the option
$row.remove();
// Remove field
$('#surveyForm').bootstrapValidator('removeField', $option);
})
// Called after adding new field
.on('added.field.bv', function(e, data) {
// data.field --> The field name
// data.element --> The new field element
// data.options --> The new field options
if (data.field === 'option[]') {
if ($('#surveyForm').find(':visible[name="option[]"]').length >= MAX_OPTIONS) {
$('#surveyForm').find('.addButton').attr('disabled', 'disabled');
}
}
})
// Called after removing the field
.on('removed.field.bv', function(e, data) {
if (data.field === 'option[]') {
if ($('#surveyForm').find(':visible[name="option[]"]').length < MAX_OPTIONS) {
$('#surveyForm').find('.addButton').removeAttr('disabled');
}
}
// });
});
