 <div class="row" id="supform" style="display: none;">
	<div class="spinner" id="grid-loader" style="display:none">
	  <div class="rect1"></div>
	  <div class="rect2"></div>
	  <div class="rect3"></div>
	</div>
	
	<div class="col-md-12">
			
		
			<form action="" id="customer_form" class="form-horizontal" enctype="multipart/form-data" method="post" accept-charset="utf-8" novalidate="novalidate">

			<div class="panel panel-piluku">
				<div class="panel-heading">
		                <h3 class="panel-title">
		                    <i class="ion-edit"></i> 
		                    Supplier Information							<small>(Fields in red are required)</small>
		                    <i class="ion-close" id="closesupform" style="float: right; background: #dc1919; color: white; padding: 4px; border-radius: 3px;"></i>
		                </h3>
		        </div>

			<div class="panel-body">
					<?php
                    if (isset($_POST['submitf'])) {
                    ?>
                    <div class="alert alert-<?php echo ($success) ? "success" : "danger"; ?>"> 
                            <?php echo ($success) ? $success : $danger; ?>                          
                    </div>
                 <?php } ?>

				<div class="row">
	<div class="col-md-12">
		<div class="form-group">
			<label for="date" class="col-sm-3 col-md-3 col-lg-2 control-label required">Date :</label>			<div class="col-sm-9 col-md-9 col-lg-10">
			<input type="text" name="date" value="" autofocus class="form-control datepicker" id="date2">
			</div>
		</div>

		<div class="form-group">
			<label for="first_name" class="required col-sm-3 col-md-3 col-lg-2 control-label ">Supplier Name :</label>			<div class="col-sm-9 col-md-9 col-lg-10">
				<input type="text" name="fullname"  value="" class="form-control" id="fullname2" list="listSuppliers">
				<datalist id="listSuppliers">
						<?php
							$listItems = $db->query("SELECT * FROM supplier_setup");
							while($listrow = $listItems->fetchArray()){
						?>
							<option value="<?php echo $listrow['supplier_name']; ?>"><?php echo $listrow['supplier_name']; ?></option>
						<?php } ?>
				</datalist>
			</div>
		</div>

		<div class="form-group">
			<label for="email" class="col-sm-3 col-md-3 col-lg-2 control-label not_required">Email  :</label>			<div class="col-sm-9 col-md-9 col-lg-10">
			<input type="text" name="email" value="" class="form-control" id="email2">
			</div>
		</div>
		<div class="form-group">	
			<label for="phone_number" class="col-sm-3 col-md-3 col-lg-2 control-label ">Phone Number  :</label>			<div class="col-sm-9 col-md-9 col-lg-10">
			<input type="text" name="phone_number" value="" class="form-control" id="phone_number2">
			</div>
		</div>
		

<div class="form-group">	
<label for="address_1" class="col-sm-3 col-md-3 col-lg-2 control-label ">Address :</label>	<div class="col-sm-9 col-md-9 col-lg-10">
	<input type="text" name="address" value="" class="form-control" id="address2">
	</div>
</div>

			<div class="form-group">	
<label for="city" class="col-sm-3 col-md-3 col-lg-2 control-label ">City :</label>	<div class="col-sm-9 col-md-9 col-lg-10">
	<input type="text" name="city" value="" class="form-control " id="city2">
	</div>
</div>

			<div class="form-group">	
<label for="ntn" class="col-sm-3 col-md-3 col-lg-2 control-label ">NTN :</label>	<div class="col-sm-9 col-md-9 col-lg-10">
	<input type="text" name="ntn" value="" class="form-control " id="ntn2">
	</div>
</div>

			<div class="form-group">	
<label for="gst" class="col-sm-3 col-md-3 col-lg-2 control-label ">GST :</label>	<div class="col-sm-9 col-md-9 col-lg-10">
	<input type="text" name="gst" value="" class="form-control " id="gst2">
	</div>
</div>

	<div class="form-group">	
<label for="comments" class="col-sm-3 col-md-3 col-lg-2 control-label ">Comments :</label>	<div class="col-sm-9 col-md-9 col-lg-10">
	<textarea name="comments" cols="17" rows="5" id="comments2" class="form-control text-area"></textarea>
	</div>
</div>
 
	</div><!-- /col-md-12 -->
</div><!-- /row -->				
								<div class="form-group">	
					<label for="balance" class="col-sm-3 col-md-3 col-lg-2 control-label ">Opening Balance  :</label>					<div class="col-sm-9 col-md-9 col-lg-10">
						<input type="text" name="balance" value="0.00" id="balance2" class="form-control balance2">
						</div>
					</div>
	
				
				<div class="form-group">	
					<label for="company_name" class="col-sm-3 col-md-3 col-lg-2 control-label ">Company Name :</label>					<div class="col-sm-9 col-md-9 col-lg-10">
						<input type="text" name="company_name" value="" id="company_name2" class="company_names form-control">
						</div>
					</div>

					<div class="form-group">	
						<label for="account_number" class="col-sm-3 col-md-3 col-lg-2 control-label ">Account # :</label>						<div class="col-sm-9 col-md-9 col-lg-10">
							<input type="text" name="account_number" value="" id="account_number2" class="company_names form-control">
							</div>
						</div>

						<div class="form-actions pull-right">
														
							<input type="submit" name="submitf" value="Submit" id="supsubmit" class=" submit_button btn btn-primary">
						</div>
					</div>
				</div>
										</form>
			</div>
		</div><!-- /row -->