<form class="form-horizontal az-form" id="form" name="form" method="POST">
	<input type="hidden" name="idcustomer" id="nidcustomer">
	<input type="hidden" id="idcsoutlet" name="idcsoutlet">
	<div class="form-group">
		<label class="control-label col-md-4"><?php echo azlang('Customer Code');?> <red>*</red></label>
		<div class="col-md-5">
			<input type="text" class="form-control" id="customer_code" name="customer_code" readonly placeholder="Otomatis" />
		</div>
	</div>	
	<div class="form-group">
		<label class="control-label col-md-4"><?php echo azlang('Customer Name');?> <red>*</red></label>
		<div class="col-md-5">
			<input type="text" class="form-control" id="customer_name" name="customer_name"/>
		</div>
	</div>	
	<div class="form-group hide">
		<label class="control-label col-md-4">Kategori Pelanggan <red>*</red></label>
		<div class="col-md-5">
			<select class="form-control" name="idcustomer_category" id="idcustomer_category">
				<?php 
					foreach ($customer_category->result() as $key => $value) {
						echo "<option value='".$value->idcustomer_category."'>".$value->customer_category_name."</option>";
					}
				?>
			</select>
		</div>
	</div>	
	<div class="form-group">
		<label class="control-label col-md-4"><?php echo azlang('Email');?></label>
		<div class="col-md-5">
			<input type="text" class="form-control" id="email" name="email"/>
		</div>
	</div>
	<div class="form-group">
		<label class="control-label col-md-4">Alamat</label>
		<div class="col-md-5">
			<input type="text" class="form-control" id="address" name="address"/>
		</div>
	</div>
	<div class="form-group">
		<label class="control-label col-md-4"><?php echo azlang('Phone');?></label>
		<div class="col-md-5">
			<input type="text" class="form-control" id="phone" name="phone" data-role="tagsinput"/>
		</div>
	</div>	
	<div class="form-group">
		<label class="control-label col-md-4">Tanggal Lahir</label>
		<div class="col-md-5">
			<?php echo $birthday;?>
		</div>
	</div>	
</form>