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Mini Shell

Mini Shell

Direktori : /home1/dimen328/libertysa.com.br/admin/modules/dados/
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Current File : //home1/dimen328/libertysa.com.br/admin/modules/dados/EditForm.php

<script src="modules/dados/EditFormJS.js"></script>
<input type="hidden" id="idEdit" name="idEdit" value="<?=$_POST['idEdit']?>" />
<form>
	<!--div class="row">
		<div class="col-sm-3 col-xs-6 ">
			<label>Logotipo</label>
			<div id="logotipo" name="logotipo" class="upload fs-upload-element fs-upload"></div>
		</div>
	</div-->
	<div class="row">
		<div class="col-lg-6">
			<div class="form-group has-feedback">	
				<label for="txtrazao_social" >Razão Social</label>
				<input type="text" id="txtrazao_social" name="txtrazao_social" class="form-control "placeholder="Nome Empresa">
			</div>
		</div>
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txt_unidade" >Unidade</label>
				<input type="text" id="txtunidade" name="txtunidade" class="form-control "placeholder="Unidade">
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-lg-2">
			<div class="form-group has-feedback">	
				<label for="txtcep" >CEP</label>
				<input type="text" id="txtcep" name="txtcep" class="form-control requiredField" placeholder="CEP"/>
				<span style="display:none" id="spanLoad"class="glyphicon glyphicon-refresh glyphicon-refresh-animate" ></span>
			</div>
		</div>
		<div class="col-lg-6">
			<div class="form-group has-feedback">	
				<label for="txtendereco" >Endereço</label>
				<input type="text" id="txtendereco" name="txtendereco" class="form-control" placeholder="Endereço"/>
				
			</div>
		</div>
		<div class="col-lg-2">
			<div class="form-group has-feedback">	
				<label for="txtnumero" >Número</label>
				<input type="text" id="txtnumero" name="txtnumero" class="form-control"placeholder="Número" />
			</div>
		</div>
		<div class="col-lg-2">
			<div class="form-group has-feedback">	
				<label for="cmbestado" >Estado</label>
				<select id="cmbestado" name="cmbestado" class="form-control">
					<option> -- Selecione -- </option>
					<option value="AC">Acre</option>
					<option value="AL">Alagoas</option>
					<option value="AP">Amapá</option>
					<option value="AM">Amazonas</option>
					<option value="BA">Bahia</option>
					<option value="CE">Ceará</option>
					<option value="DF">Distrito Federal</option>
					<option value="ES">Espirito Santo</option>
					<option value="GO">Goiás</option>
					<option value="MA">Maranhão</option>
					<option value="MT">Mato Grosso</option>
					<option value="MS">Mato Grosso do Sul</option>
					<option value="MG">Minas Gerais</option>
					<option value="PA">Pará</option>
					<option value="PB">Paraiba</option>
					<option value="PR">Paraná</option>
					<option value="PE">Pernambuco</option>
					<option value="PI">Piauí</option>
					<option value="RJ">Rio de Janeiro</option>
					<option value="RN">Rio Grande do Norte</option>
					<option value="RS">Rio Grande do Sul</option>
					<option value="RO">Rondônia</option>
					<option value="RR">Roraima</option>
					<option value="SC">Santa Catarina</option>
					<option value="SP">São Paulo</option>
					<option value="SE">Sergipe</option>
					<option value="TO">Tocantis</option>
				</select>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txtbairro" >Bairro</label>
				<input type="text" id="txtbairro" name="txtbairro" class="form-control" placeholder="Bairro"/>
			</div>
		</div>
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txtcidade" >Cidade</label>
				<input type="text" id="txtcidade" name="txtcidade" class="form-control" placeholder="Cidade"/>
			</div>
		</div>
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txtcomplemento" >Complemento</label>
				<input type="text" id="txtcomplemento" name="txtcomplemento" class="form-control" placeholder="Complemento"/>
			</div>
		</div>
	</div>
	<!--div class="row">
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txttelefone" >Telefone</label>
				<input type="text" id="txttelefone" name="txttelefone" class="form-control requiredField" placeholder="Telefone"/>
			</div>
		</div>
		<div class="col-lg-4">
			<div class="form-group has-feedback">	
				<label for="txtcelular" >Celular</label>
				<input type="text" id="txtcelular" name="txtcelular" class="form-control" placeholder="Celular"/>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-lg-6">
			<div class="form-group has-feedback">	
				<label for="txtemail" >E-mail</label>
				<input type="email" id="txtemail" name="txtemail" class="form-control requiredField" placeholder="E-mail"/>
			</div>
		</div>
	</div-->
	<div class="row">
		<div class="col-lg-12">
			<div class="pull-right">
				<div class="form-inline">
					<label for="cmbstatus" >Status</label>
					<select id="cmbstatus" name="cmbstatus" class="form-control formStatus">
						<option value="1">Ativo</option>
						<option value="2">Inativo</option>
					</select>
					
					<button type="button" id="btnatualizar" name="btnatualizar" class="btn btn-info">Enviar</button>
				</div>
			</div>
		</div>
	</div>
</form>

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