mscZone.order.tpl

{var $pls = $_modx->getPlaceholders()}

<form id="msOrder" class="form-horizontal ms2_form msczone-order" method="post">

    {var $tmp = ['city','country']}
    {foreach $tmp as $field}
		<input type="hidden" id="{$field}" name="{$field}" value="{$form[$field]}">
    {/foreach}
	<input type="hidden" name="msczone_process_blocks" value="{$pls.msczone_processBlocks | htmlentities}">
	<input type="hidden" name="msczone_settlement" value="{$order.msczone_settlement}">

	<div class="row">
		<div class="col-md-12" id="deliveries">
			<h4>{'msczone_deliveries'|lexicon} {'!mscZone.Settlement' | snippet}</h4>
			<div class="form-group">
				<label class="col-md-4 control-label">
					<span class="required-star">*</span> {'ms2_frontend_delivery_select' | lexicon}
				</label>
				<div class="col-sm-12">

					<div class="btn-group msczone-buttons-group" data-toggle="buttons">
                        {foreach $deliveries as $delivery index=$index}
                            {var $checked = !$order.delivery && $index == 0 || $delivery.id == $order.delivery}

							<label class="delivery btn btn-primary {$checked ? 'active' : ''} input-parent">
								<input type="radio" name="delivery" value="{$delivery.id}" id="delivery_{$delivery.id}"
									   data-payments="{$delivery.payments | json_encode}"
									   data-properties="{$delivery.properties | json_encode | htmlentities}"
										{$checked ? 'checked' : ''}>
								{if $delivery.logo?}
									<img src="{$delivery.logo}" alt="{$delivery.name}" title="{$delivery.name}"/>
								{else}
									{$delivery.name}
								{/if}
							</label>
						{/foreach}
					</div>
				</div>
			</div>

			{*
			<div class="msczone-hidden" name="msczone_error" style="display: none;">
				<div class="msczone msczone-error">
				</div>
			</div>
			*}

		</div>
	</div>

	<div class="row">
		<div class="col-md-3">
			<h4>{'msczone_credentials' | lexicon}</h4>
			{foreach ['email','receiver','phone'] as $field}
				<div class="form-group input-parent">
					<div class="col-sm-12">
						<label class="control-label" for="{$field}">
							<span class="required-star">*</span> {('ms2_frontend_' ~ $field) | lexicon}
						</label>
						<input type="text" id="{$field}" placeholder="{('ms2_frontend_' ~ $field) | lexicon}"
							   name="{$field}" value="{$form[$field]}"
							   class="form-control{($field in list $errors) ? ' error' : ''}">
					</div>
				</div>
			{/foreach}
			<div class="form-group input-parent">
				<div class="col-sm-12">
					<label class="control-label" for="comment">
						<span class="required-star">*</span> {'ms2_frontend_comment' | lexicon}</label>
                    <textarea name="comment" id="comment" placeholder="{'ms2_frontend_comment' | lexicon}"
							  class="form-control{('comment' in list $errors) ? ' error' : ''}">{$form.comment}</textarea>
				</div>
			</div>
		</div>

		<div class="col-md-3" name="delivery_address">
			<h4>{'msczone_address' | lexicon}</h4>

			{set $field = 'city'}
			<div class="form-group input-parent">
				<div class="col-sm-12">
					<label class="control-label" for="{$field~'name'}">
						<span class="required-star">*</span> {('ms2_frontend_' ~ $field) | lexicon}
					</label>
					<input type="text" id="{$field~'name'}" placeholder="{('ms2_frontend_' ~ $field) | lexicon}"
						   name="{$field~'name'}" value="{$form[$field]}"
						   class="form-control{($field in list $errors) ? ' error' : ''} msczone"
						   data-msczone-mode="settlement.field"
						   data-windowload>
				</div>
			</div>

			{foreach ['index','region','street'] as $field}
				<div class="form-group input-parent">
					<div class="col-sm-12">
						<label class="control-label" for="{$field}">
							<span class="required-star">*</span> {('ms2_frontend_' ~ $field) | lexicon}
						</label>
						<input type="text" id="{$field}" placeholder="{('ms2_frontend_' ~ $field) | lexicon}"
							   name="{$field}" value="{$form[$field]}"
							   class="form-control{($field in list $errors) ? ' error' : ''}">
					</div>
				</div>
			{/foreach}
			<div class="form-group input-parent">
				<div class="col-md-12">
					<label class="control-label" for="street">
						<span class="required-star">*</span> {'ms2_frontend_building' | lexicon}</label>
					<div class="form-group row">
						{foreach ['building','room'] as $field}
							<div class="col-md-6 col-sm-6 col-xs-6">
								<input type="text" id="{$field}" placeholder="{('ms2_frontend_' ~ $field) | lexicon}"
									   name="{$field}" value="{$form[$field]}"
									   class="form-control{($field in list $errors) ? ' error' : ''}">
							</div>
						{/foreach}
					</div>
				</div>
			</div>
		</div>

		<div class="col-md-3 col-sm-3 col-xs-3 msczone-hidden" name="msczone_delivery_info" style="display: none;">
			<h4>{'msczone_info' | lexicon}</h4>
			<div class="msczone msczone-delivery-info">
			</div>
		</div>

		<div class="col-md-3 col-sm-6 col-xs-6 pull-right">
			<div id="payments">
				<h4>{'msczone_payments' | lexicon}</h4>
				<div class="form-group">
					<label class="col-md-12 control-label"><span class="required-star">*</span>
						{'ms2_frontend_payment_select' | lexicon}</label>
					<div class="col-sm-12">
                        {foreach $payments as $payment index=$index}
                            {var $checked = !$order.payment && $index == 0 || $payment.id == $order.payment}

							<div class="radio input-parent">
								<label class="payment">
									<input type="radio" name="payment" value="{$payment.id}" id="payment_{$payment.id}"
                                            {$checked ? 'checked' : ''}>
									{if $payment.logo?}
										<img src="{$payment.logo}" alt="{$payment.name}" title="{$payment.name}"/>
									{else}
										{$payment.name}
									{/if}
									{if $payment.description?}
										<p class="small">
											{$payment.description}
										</p>
									{/if}
								</label>
							</div>
						{/foreach}
					</div>
				</div>
			</div>

			<div>
				<h3 class="msczone-mg-0">
					<span id="ms2_order_cost">{$order.cost ?: 0}</span> {'ms2_frontend_currency' | lexicon}
				</h3>
				<p>
					<small>{'msczone_order_cost' | lexicon}</small>
				</p>
				<button type="submit" name="ms2_action" value="order/submit"
						class="btn btn-default btn-primary ms2_link">
					{'msczone_order_submit' | lexicon}
				</button>
			</div>

		</div>
	</div>

	<hr>
	<div>
		<button type="button" name="ms2_action" value="order/clean" class="btn btn-default ms2_link">
			<i class="glyphicon glyphicon-remove"></i> {'ms2_frontend_order_cancel' | lexicon}
		</button>
	</div>

</form>

add cityname https://gist.github.com/vgrish/91ef93e9dcf1c588fb876b61a9189c8b#file-msczone-order-tpl-L79-L91