{% extends "template.html.twig" %}


{% block body %}
    {{ parent() }}

    <h1>  Add new Retailers</h1>
    <div class="wrap">

        <form action="" method="post">
            <input name="latitude_id" type="hidden" value="{{ data.latitude_id }}"/>
            <input name="data" type="hidden" value="{{ data.date }}"/>
            <input name="lat" type="hidden" value="{{ data.latitude }}"/>
            <input name="long" type="hidden" value="{{ data.longitude }}"/>
                
                <div class="col-md-6">
                    <h4> Retailers's Name* / </h4>

                    <div class="form-group">
                        <label for="exampleInputEmail1">Site's Name</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="name" value="{{ data.name }}">
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Address 1</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="address1" value="{{ data.address1 }}">
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Address 2</label>
                        <input type="text"  disabled class="form-control" id="exampleInputEmail1" name="address2" value="{{ data.address2 }}">
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Address 3</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="address3" value="{{ data.address3 }}">
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Post Code</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="postcode" value="{{ data.postcode }}">
                    </div>
                    <h4> Country / State / County</h4>

                    <div class="form-group">
                        <label for="exampleInputEmail1">State</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="state" value="{{ data.state }}">
                    </div>  
                    <div class="form-group">
                        <label for="exampleInputEmail1">County</label>
                        <input type="text" disabled class="form-control" id="exampleInputEmail1" name="county" value="{{ data.county }}">
                    </div>  
                    <div class="form-group">
                        <label for="exampleInputEmail1">Country</label>
                        <input disabled type="text" class="form-control" id="exampleInputEmail1" name="country" value="{{ data.country }}">
                    </div>
                    
                      <button class="btn btn-danger"> <i class="fa fa-trash"></i> Delete Site </button>
            
                </div>    
             

        </form>
    </div>
{% endblock %}{# empty Twig template #}