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


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


    <h1>  Add new Site</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.data }}"/>
            <input name="latitude" type="hidden" value="{{ data.latitude }}"/>
            <input name="longitude" 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" class="form-control" id="exampleInputEmail1" name="name" value="{{ data.name }}">
                </div>
                <div class="form-group">
                    <label for="exampleInputEmail1">Address 1</label>
                    <input type="text" class="form-control" id="exampleInputEmail1" name="address1" value="{{ data.address1 }}">
                </div>
                <div class="form-group">
                    <label for="exampleInputEmail1">Address 2</label>
                    <input type="text" class="form-control" id="exampleInputEmail1" name="address2" value="{{ data.address2 }}">
                </div>
                <div class="form-group">
                    <label for="exampleInputEmail1">Address 3</label>
                    <input type="text" class="form-control" id="exampleInputEmail1" name="address3" value="{{ data.address3 }}">
                </div>
                <div class="form-group">
                    <label for="exampleInputEmail1">Post Code</label>
                    <input type="text" 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" class="form-control" id="exampleInputEmail1" name="state" value="{{ data.state }}">
                </div>  
                <div class="form-group">
                    <label for="exampleInputEmail1">County</label>
                    <input type="text" class="form-control" id="exampleInputEmail1" name="county" value="{{ data.county }}">
                </div>  
                <div class="form-group">
                    <label for="exampleInputEmail1">Country</label>
                    <input type="text" class="form-control" id="exampleInputEmail1" name="country" value="{{ data.country }}">
                </div>

                <button class="btn btn-success"> <i class="fa fa-floppy-o"></i> Edit Retailer </button>

            </div>    

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