 <div class="content-wrapper">
    <div class="container-fluid">
		<form action="#" method="post" method="post" enctype="multipart/form-data">
			   <input type="hidden" name="id" value="<?= @$id; ?>">
		<div class="row">
          
 			<div class="col-lg-12">
			   <div class="card">
			     <div class="card-body">
				   <div class="card-title"><?= $pagetitle; ?></div>
				   <?php echo ($this->session->flashdata('form_error'));?>
				   <?php echo ($this->session->flashdata('image_error'));?>
				</div>
               </div> 
             </div>  
			<div class="col-lg-6">			 
				<div class="card">
            	<div class="card-body">
					<div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Merchant*</label>
					  <div class="col-sm-9">
						<select name="merchantId" id="getmerchant" class="form-control">
                        	<option value="0">Select Merchant</option>                        	
                        </select>
					  </div>
					</div>
                    
                    <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">List Id*</label>
					  <div class="col-sm-9">
						<select name="listId" id="getcontactlist" class="form-control">
                        	<option value="0">Select Merchant List</option>                        	
                        </select>
					  </div>
					</div>
                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">First Name*</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="first_name" id="input-21" placeholder="Enter First Name" <?php if(@$first_name !=''){echo "value='".@$first_name."'";}?>>
					  </div>
					</div>
                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Last Name</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="last_name" id="input-21" placeholder="Enter Last Name" <?php if(@$last_name !=''){echo "value='".@$last_name."'";}?>>
					  </div>
					</div>
                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Contact*</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="contact" id="input-21" placeholder="Enter Contact" <?php if(@$contact !=''){echo "value='".@$contact."'";}?>>
					  </div>
					</div>
                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Email</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="email" id="input-21" placeholder="Enter Email" <?php if(@$email !=''){echo "value='".@$email."'";}?>>
					  </div>
					</div>
                    
                    <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Source</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="source" id="input-21" placeholder="Enter Source (Google,Social Media,Others)" <?php if(@$source !=''){echo "value='".@$source."'";}?>>
					  </div>
					</div>
                   
				 </div>
			 </div>
             </div>
             
             <div class="col-lg-6">			 
				<div class="card">
            	<div class="card-body">

                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Country</label>
					  <div class="col-sm-9">
						<select name="country" id="getcountry" class="form-control">
                        	<option value="0">Select Country</option>                        	
                        </select>
					  </div>
					</div>
                    
                     <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">State</label>
					  <div class="col-sm-9">
						<select name="state" id="getstate" class="form-control">
                        	<option value="0">Select State</option>                        	
                        </select>
					  </div>
					</div>
                    
                    <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">City</label>
					  <div class="col-sm-9">
						<select name="city" id="getcity" class="form-control">
                        	<option value="0">Select City</option>                        	
                        </select>
					  </div>
					</div>
                    
                     
                    
                    <div class="form-group row">
					  <label for="input-21" class="col-sm-3 col-form-label">Postcode</label>
					  <div class="col-sm-9">
						<input type="text" class="form-control" name="postcode" id="input-21" placeholder="Enter Postcode" <?php if(@$postcode !=''){echo "value='".@$postcode."'";}?>>
					  </div>
					</div>
					<div class="form-group row">
					  <label for="input-24" class="col-sm-3 col-form-label">Whatsapp</label>
					  <div class="col-sm-3">
						<input type="checkbox" name="notify_whatsapp" class="" id="activestatuswhatsapp" value="1" <?php if(@$notify_whatsapp==1){echo "checked";}?>> <label for="activestatuswhatapp"> Active</label>
					  </div>
                      
                      <label for="input-24" class="col-sm-2 col-form-label">SMS</label>
					  <div class="col-sm-4">
						<input type="checkbox" name="notify_sms" class="" id="activestatussms" value="1" <?php if(@$notify_sms==1){echo "checked";}?>> <label for="activestatussms"> Active</label>
                        
					</div>
				
					</div>
                   
                    
					 <div class="form-group row">
					  <label class="col-sm-2 col-form-label"></label>
					  <div class="col-sm-10">
						<button type="submit" name="submit" class="btn btn-primary px-5"><i class="icon-lock"></i> Update</button>
					  </div>
					</div>
				 </div>
			 </div> 
             </div>
	</form> 
              <div class="col-md-12">			 
				<div class="card">
            		<div class="card-body">
                    	 <div class="form-group row">
                          <label for="input-21" class="col-sm-4 col-form-label">Bulk Contact Upload (.csv or.xlsx) <br/> <a href="<?= base_url('uploads/contactsample.csv');?>" download="<?= base_url('uploads/contactsample.csv');?>">Download Sample Sheet</a></label>
                          <div class="col-sm-8">
                            <input type="file" class="form-control" name="storename" id="input-21" placeholder="Enter Postcode" <?php if(@$storename !=''){echo "value='".@$storename."'";}?>>
                          </div>
                        </div>
                        
                        <div class="form-group row text-center">
                          <div class="col-sm-12">
                            <button type="submit" name="submit" class="btn btn-primary px-5"><i class="icon-lock"></i> Upload</button>
                          </div>
                        </div>
                    
                </div>
             </div>     
		</div>
     
	</div><!--End Row-->
     
	
	