<commit_before>{% extends 'NumaDOASiteBundle::listing-layout.html.twig' %}
{% form_theme form with ['bootstrap_3_horizontal_layout.html.twig', _self] %}
{% block form_label_class -%}
    col-sm-3
{%- endblock form_label_class %}
{% block form_group_class -%}
    col-sm-9
{%- endblock form_group_class %}

{% block content %}
    <script src='https://www.google.com/recaptcha/api.js'></script>
    {{ displayComponent('text',"HTML")|raw }}

    {{ displayComponent('page_content',"HTML")|raw }}

    <p>
        * Indicates required field
    </p>
    {{ form_errors(form) }}
    {{ form_start(form) }}

    <h4>Applicant Information</h4>
    <p></p>
    {{ form_row(form.cust_name) }}
    {{ form_row(form.cust_last_name) }}
    {{ form_row(form.preferred_contact) }}
    {{ form_row(form.email) }}
    {{ form_row(form.day_phone) }}
    {{ form_row(form.cell_phone) }}
    {{ form_row(form.address) }}
    {{ form_row(form.city) }}
    {{ form_row(form.state) }}
    {{ form_row(form.zip_code) }}
    {{ form_row(form.ssn_sin_nr) }}
    {{ form_row(form.birth_date) }}
    {{ form_row(form.residence_type) }}
    {{ form_row(form.monthly_payment) }}
    {{ form_row(form.at_residence) }}
    <div>
        <div class="col-md-6">
            {{ form_row(form.landlord_name) }}
        </div>
        <div class="col-md-6">
            {{ form_row(form.landlord_phone) }}
        </div>
    </div>

    <h4>Employment Information</h4>
    {{ form_row(form.employer_name) }}
    {{ form_row(form.employer_occupation) }}
    {{ form_row(form.employer_monthly_income) }}
    {{ form_row(form.employer_on_job) }}
    {{ form_row(form.employer_business_phone) }}
    {{ form_row(form.employer_address) }}
    {{ form_row(form.employer_city) }}
    {{ form_row(form.employer_state) }}
    {{ form_row(form.employer_zip) }}
    {{ form_row(form.supervisors_name) }}

    <p>
        If You Are Not The Owner Of The Vehicle, Previde Owner Details
    </p>

    {{ form_row(form.other_name) }}
    {{ form_row(form.other_address) }}
    {{ form_row(form.other_city) }}
    {{ form_row(form.other_state) }}
    {{ form_row(form.other_zip) }}
    <div>
        <div class="col-md-6">
            {{ form_row(form.other_home_phone) }}
        </div>
        <div class="col-md-6">
            {{ form_row(form.other_work_phone) }}
        </div>
    </div>

    <h4>Vehicle Information</h4>
    <div class="row">
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.make, {'attr': {'placeholder': 'Make'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.model, {'attr': {'placeholder': 'Model'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.year, {'attr': {'placeholder': 'Year'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.vehicle_type, {'attr': {'placeholder': 'Vehicle Type'} }) }}
        </div>
    </div>
    <div class="row">
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.plate, {'attr': {'placeholder': 'Plate #'} }) }}
        </div>
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.vin, {'attr': {'placeholder': 'VIN #'} }) }}
        </div>
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.mileage, {'attr': {'placeholder': 'Mileage'} }) }}
        </div>
    </div>
    {{ form_row(form.financed_by) }}
    {{ form_row(form.message_text) }}
    {{ form_end(form) }}

{% endblock %}
<commit_msg>DC deleted<commit_after>{% extends 'NumaDOASiteBundle::listing-layout.html.twig' %}
{% form_theme form with ['bootstrap_3_horizontal_layout.html.twig', _self] %}
{% block form_label_class -%}
    col-sm-3
{%- endblock form_label_class %}
{% block form_group_class -%}
    col-sm-9
{%- endblock form_group_class %}

{% block content %}
    <script src='https://www.google.com/recaptcha/api.js'></script>

    <p>
        * Indicates required field
    </p>
    {{ form_errors(form) }}
    {{ form_start(form) }}

    <h4>Applicant Information</h4>
    <p></p>
    {{ form_row(form.cust_name) }}
    {{ form_row(form.cust_last_name) }}
    {{ form_row(form.preferred_contact) }}
    {{ form_row(form.email) }}
    {{ form_row(form.day_phone) }}
    {{ form_row(form.cell_phone) }}
    {{ form_row(form.address) }}
    {{ form_row(form.city) }}
    {{ form_row(form.state) }}
    {{ form_row(form.zip_code) }}
    {{ form_row(form.ssn_sin_nr) }}
    {{ form_row(form.birth_date) }}
    {{ form_row(form.residence_type) }}
    {{ form_row(form.monthly_payment) }}
    {{ form_row(form.at_residence) }}
    <div>
        <div class="col-md-6">
            {{ form_row(form.landlord_name) }}
        </div>
        <div class="col-md-6">
            {{ form_row(form.landlord_phone) }}
        </div>
    </div>

    <h4>Employment Information</h4>
    {{ form_row(form.employer_name) }}
    {{ form_row(form.employer_occupation) }}
    {{ form_row(form.employer_monthly_income) }}
    {{ form_row(form.employer_on_job) }}
    {{ form_row(form.employer_business_phone) }}
    {{ form_row(form.employer_address) }}
    {{ form_row(form.employer_city) }}
    {{ form_row(form.employer_state) }}
    {{ form_row(form.employer_zip) }}
    {{ form_row(form.supervisors_name) }}

    <p>
        If You Are Not The Owner Of The Vehicle, Previde Owner Details
    </p>

    {{ form_row(form.other_name) }}
    {{ form_row(form.other_address) }}
    {{ form_row(form.other_city) }}
    {{ form_row(form.other_state) }}
    {{ form_row(form.other_zip) }}
    <div>
        <div class="col-md-6">
            {{ form_row(form.other_home_phone) }}
        </div>
        <div class="col-md-6">
            {{ form_row(form.other_work_phone) }}
        </div>
    </div>

    <h4>Vehicle Information</h4>
    <div class="row">
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.make, {'attr': {'placeholder': 'Make'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.model, {'attr': {'placeholder': 'Model'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.year, {'attr': {'placeholder': 'Year'} }) }}
        </div>
        <div class="col-md-3 inputGroup">
            {{ form_widget(form.vehicle_type, {'attr': {'placeholder': 'Vehicle Type'} }) }}
        </div>
    </div>
    <div class="row">
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.plate, {'attr': {'placeholder': 'Plate #'} }) }}
        </div>
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.vin, {'attr': {'placeholder': 'VIN #'} }) }}
        </div>
        <div class="col-md-4 inputGroup">
            {{ form_widget(form.mileage, {'attr': {'placeholder': 'Mileage'} }) }}
        </div>
    </div>
    {{ form_row(form.financed_by) }}
    {{ form_row(form.message_text) }}
    {{ form_end(form) }}

{% endblock %}

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