<div class="modal fade" tabindex="-1" id="client_add_modal" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
  <div class="modal-dialog " role="document" style="max-width: 800px">
    <div class="modal-content">
      <div class="modal-header" style="background-color: #36a3f7;border-radius: 4px">
        <h5 class="modal-title" id="exampleModalLabel" style="color: #ffffff" >
          Create New Client
        </h5>
        <button type="button" class="close" data-dismiss="modal" aria-label="Close">
          <span aria-hidden="true">
            &times;
          </span>
        </button>
      </div>
      <form autocomplete="off"  id="form_client_add" data-form-type="client_add" data-modal-id="client_add_modal" method="post" action="<?php echo base_url().'clients/create'?>" enctype="multipart/form-data" class="m-form m-form--fit m-form--state m-form--label-align-right " >
        <div class="modal-body">
          <div class="m-form__content">
            <div class="m-alert m-alert--icon alert alert-warning m--hide" role="alert" id="form_client_add_msg">
              <div class="m-alert__icon">
                <i class="la la-warning"></i>
              </div>
              <div class="m-alert__text">
                Oh snap! Change a few things up and try submitting again.
              </div>
              <div class="m-alert__close">
                <button type="button" class="close" data-close="alert" aria-label="Close"></button>
              </div>
            </div>
          </div>
          <div class="row">
            <div class="col-lg-12">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Client Name
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-user"></i>
                    </span>
                  </div>
                  <input required type="text" name="name"  class="form-control form_client_add_fields m-input" placeholder="Client Name" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Contact Person
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-user"></i>
                    </span>
                  </div>
                  <input  type="text" name="contact_person"  class="form_client_add_fields form-control m-input" placeholder="Contact Person" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Phone
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-phone"></i>
                    </span>
                  </div>
                  <input required type="text" name="phone"  class="form_client_add_fields form-control m-input" placeholder="Phone No" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Whatsapp No
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-whatsapp"></i>
                    </span>
                  </div>
                  <input type="text" name="whatsapp_no"  class="form_client_add_fields form-control m-input" placeholder="Whatsapp No" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Email
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-envelope"></i>
                    </span>
                  </div>
                  <input type="text" name="email"  class="form_client_add_fields form-control m-input" placeholder="Email ID" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Company Name
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-edit"></i>
                    </span>
                  </div>
                  <input type="text" name="company_name"  class="form_client_add_fields form-control m-input" placeholder="Company Name" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Group Name
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-edit"></i>
                    </span>
                  </div>
                  <input  type="text" name="group_name"  class="form_client_add_fields form-control m-input" placeholder="Group Name" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>

            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  PO Box
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-edit"></i>
                    </span>
                  </div>
                  <input type="text" name="po_box"  class="form_client_add_fields form-control m-input" placeholder="PO Box" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-6">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Address
                </label>
                <textarea placeholder="Address"  name="address" class="form-control form_client_add_fields m-input  m-input--air m-input--pill" ></textarea>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-4">
              <div class="form-group m-form__group">
                <label for="user_name">
                  Civil Id No
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <!-- <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-user"></i>
                    </span>
                  </div> -->
                  <input type="text" name="civil_id"  class="form_client_add_fields form-control m-input" placeholder="Civil ID No" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-4">
              <div class="form-group m-form__group">
                <label for="user_name">
                  <?php echo $this->config->item('Tax_tax_name') ?>/TRN No
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <!-- <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-edit"></i>
                    </span>
                  </div> -->
                  <input type="text" name="tax_no"  class="form_client_add_fields form-control m-input" placeholder="<?php echo $this->config->item('Tax_tax_name') ?>/TRN No" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-4">
              <div class="form-group m-form__group">
                <label for="user_name">
                  <?php echo $this->config->item('Tax_tax_name') ?> Date
                </label>
                <div class="input-group m-input-group m-input-group--pill m-input-group--air">
                  <!-- <div class="input-group-prepend">
                    <span class="input-group-text" id="basic-addon1">
                      <i class="la la-edit"></i>
                    </span>
                  </div> -->
                  <input type="text"  data-date-format="dd-mm-yyyy" name="tax_date" id="tax_date_add"  class="form_client_add_fields form-control m-input" placeholder="<?php echo $this->config->item('Tax_tax_name') ?> Date" aria-describedby="basic-addon1">
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
            <div class="col-lg-4">
              <div class="form-group m-form__group"  >
                <label for="user_name">
                  State Code
                </label>
                <div class="m-select2 m-select2--air m-select2--pill">
                  <select required id="state_id_add"  name="state_id"  style="width: 100%" class="form-control m-input"  aria-describedby="basic-addon1" >
                    <option selected disabled>Select State</option>
                    <option value="0">N/A</option>
                    <?php
                    foreach($tax_state_codes as $row):
                      ?>
                      <option value="<?php echo $row->state_id?>"><?php echo $row->state_name." - ".$row->state_code?></option>
                      <?php
                    endforeach;
                    ?>
                  </select>
                </div>
                <span class="m-form__help"></span>
              </div>
            </div>
          </div>
        </div>
        <div class="modal-footer">
          <button type="button" class="btn btn-secondary" data-dismiss="modal">
            Close
          </button>
          <button type="submit" class="btn btn-primary form_submit_btn">
            Submit
          </button>
        </div>
      </form>
    </div>
  </div>
</div>
