mirror of
https://gitlab.com/bmcgonag/get_my.git
synced 2026-03-26 15:58:50 +00:00
83 lines
No EOL
4.1 KiB
HTML
83 lines
No EOL
4.1 KiB
HTML
<template name="createServiceEntity">
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<div class="container">
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<h3>Create a Service Entity</h3>
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<div class="row">
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<div class="col s12">
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<div class="card">
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<div class="card-content">
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<span class="card-title">New Service Entity</span>
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<div class="row">
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<div class="col s12 input-field">
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<input type="text" class="entityName" id="entityName">
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<label for="entityName">Entity Name</label>
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</div>
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</div>
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<div class="row">
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<div class="col s12 input-field">
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<input type="text" class="entityAddress" id="entityAddress">
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<label for="entityAddress">Address</label>
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</div>
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</div>
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<div class="row">
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<div class="col s12 m6 l6 input-field">
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<input type="text" class="entityCity" id="entityCity" />
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<label for="entityCity">City</label>
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</div>
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<div class="col s12 m3 l3 input-field">
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<input type="text" class="entityState" id="entityState">
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<label for="entityState">State</label>
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</div>
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<div class="col s12 m3 l3 input-field">
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<input type="text" class="entityZip" id="entityZip" />
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<label for="entityZip">Postal / Zip Code</label>
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</div>
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</div>
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<div class="row">
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<div class="col s12 m6 l6 input-field">
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<input type="tel" class="entityPhone" id="entityPhone" />
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<label for="entityPhone">Primary Phone</label>
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</div>
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<div class="col s12 m6 l6 input-field">
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<input type="email" class="entityEmail" id="entityEmail" />
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<label for="entityEmail">Primary Email</label>
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</div>
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</div>
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<div class="row">
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<div class="col s12 m6 l6 input-field">
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<select name="entityType" id="entityType" class="entityType">
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<option value="" disabled selected>Choose One...</option>
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<option value="School">School</option>
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<option value="Church">Church</option>
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<option value="Daycare">Daycare</option>
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<option value="Hospital">Hospital</option>
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<option value="Elder Care">Elder Care</option>
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<option value="Group Home">Group Home</option>
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<option value="After School">After School</option>
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<option value="Sports Program">Sports Program</option>
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<option value="Private School">Private School</option>
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</select>
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<label for="entityType">Entity Type</label>
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</div>
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<div class="col s12 m4 l4 input-field">
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<input type="text" class="entityCode" id="entityCode" value="{{#if $eq useCodeGen true}}{{codeGen}}{{/if}}"/>
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<label for="entityCode">Entity Code</label>
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</div>
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<div class="col s12 m2 l2">
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<a class="waves-effect waves-light btn tooltipped generateEntityCode" data-position="bottom" data-tooltip="Generate Entity Code" id="generateEntityCode"><i class="material-icons">refresh</i></a>
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</div>
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</div>
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<div class="row">
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<div class="col s6 m6 l6">
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<a class="waves-effect waves-light btn-large orange cancelNewEntity" id="cancelNewEntity">Cancel</a>
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</div>
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<div class="col s6 m6 l6">
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<a class="waves-effect waves-light btn-large green right saveNewEntity" id="saveNewEntity">Save</a>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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{{> snackbar}}
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</div>
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</template> |