{include file="sections/header.tpl"}

		<div class="row">
			<div class="col-sm-12 col-md-12">
				<div class="panel panel-primary panel-hovered panel-stacked mb30">
					<div class="panel-heading">{$_L['Add_Contact']}</div>
						<div class="panel-body">

						<form class="form-horizontal" method="post" role="form" action="{$_url}customers/add-post" >
							<div class="form-group">
								<label class="col-md-2 control-label">{$_L['Username']}</label>
								<div class="col-md-6">
									<input type="text" class="form-control" id="username" name="username" required placeholder="Phone number">
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-2 control-label">{$_L['Full_Name']}</label>
								<div class="col-md-6">
									<input type="text" required class="form-control" id="fullname" name="fullname">
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-2 control-label">{$_L['Password']}</label>
								<div class="col-md-6">
									<input type="password" class="form-control" required id="password" name="password">
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-2 control-label">{$_L['Confirm_Password']}</label>
								<div class="col-md-6">
									<input type="password" class="form-control" required id="cpassword" name="cpassword">
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-2 control-label">{$_L['Address']}</label>
								<div class="col-md-6">
									<textarea name="address" id="address"  class="form-control"></textarea>
								</div>
							</div>

							<div class="form-group">
								<div class="col-lg-offset-2 col-lg-10">
									<button class="btn btn-primary waves-effect waves-light" type="submit">{$_L['Save']}</button>
									Or <a href="{$_url}customers/list">{$_L['Cancel']}</a>
								</div>
							</div>
						</form>
						</div>
					</div>
				</div>
			</div>
		</div>


{include file="sections/footer.tpl"}
