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<div className="container"> | |
<h2>Purchase Order Item form</h2> | |
<div className="row"> | |
<div className="col-md-6"> | |
<div className="form-group"> | |
<label>Title:</label> | |
<input type="text" className="form-control" placeholder="Enter Title" name="Title" /> | |
</div> | |
</div> | |
<div className="col-md-6"> | |
<div className="form-group"> | |
<label >Full Name:</label> | |
<input type="text" className="form-control" placeholder="Enter Full Name" name="fullName" /> | |
</div> | |
</div> | |
</div> | |
<div className="row"> | |
<div className="col-md-9"> | |
<div className="form-group"> | |
<label >Street Address:</label> | |
<input type="text" className="form-control" placeholder="123 Main Street" name="street" /> | |
</div> | |
</div> | |
<div className="col-md-3"> | |
<div className="form-group"> | |
<label >Appartment/Room #:</label> | |
<input type="text" className="form-control" placeholder="Appartment #" name="Appartment" /> | |
</div> | |
</div> | |
</div> | |
<div className="row"> | |
<div className="col-md-4"> | |
<div className="form-group"> | |
<label >City:</label> | |
<input type="text" className="form-control" placeholder="Enter City" name="city" /> | |
</div> | |
</div> | |
<div className="col-md-4"> | |
<div className="form-group"> | |
<label >State:</label> | |
<select className="form-control" name="state"> | |
<option value="">Select State --</option> | |
</select> | |
</div> | |
</div> | |
<div className="col-md-4"> | |
<div className="form-group"> | |
<label>Zip Code:</label> | |
<input type="text" className="form-control" placeholder="Zip Code" name="zip" /> | |
</div> | |
</div> | |
</div> | |
<div className="row"> | |
<div className="col-md-12"> | |
<div className="checkbox"> | |
<label><input type="checkbox" name="remember" checked /> Is Billing Address Same</label> | |
</div> | |
</div> | |
<div className="col-md-12 hidden"> | |
<div className="form-group"> | |
<label >Billing Address:</label> | |
<textarea className="form-control" rows={3} name="billing" placeholder="Billing Address"></textarea> | |
</div> | |
</div> | |
<div className="col-sm-12"> | |
<button type="submit" className="btn btn-primary float-right">Submit</button> | |
<button type="submit" className="btn btn-secondary float-right">Cancel</button> | |
</div> | |
</div> | |
</div> |
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