<div class="modal fade bs-modal-lg" id="form-pay" tabindex="-1" role="dialog" aria-hidden="true">
	<div class="modal-dialog modal-lg">
		<div class="modal-content">

			<div class="modal-header">
				<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
				<h4 class="modal-title">Payment</h4>
			</div>
			<div id="_div_paymentPopup" style="display:none;" class="alert alert-block alert-danger fade in">
				<h4 class="alert-heading">Warning!</h4>
				<p id="_msg_paymentPopup"></p>
			</div>

			<form class="form-horizontal" role="form" action="<?php echo e(route('purchase-payment.store_payment')); ?>" method="post">
				<?php echo csrf_field(); ?>
				<div class="row">
					<br>
					<div class="col-md-12">
						<input type="hidden" name="purchase_id" id="purchase_id">
						<div class="col-md-5 col-md-offset-1">
							<div class="form-group">
								<label class="col-md-5 required control-label">Supplier</label>
								<div class="col-md-7">
									<div class="input-group">
										<input type="text" name="supplier" class="form-control" id="supplier" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 required control-label">Total Amount</label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="total_amount" class="form-control" id="total_amount" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 required control-label">Payment</label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="payment" class="form-control allownumericwithdecimal" id="payment" readonly>
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 control-label">Reference </label>
								<div class="col-md-7">
									<input type="text" name="reference" class="form-control form-control" id="reference">
								</div>
							</div>
							
							<div class="form-group" id="deposit-schedule-payment-method-from">
								
							</div>
						</div>
						<div class="col-md-5">
							<div class="form-group">
								<label class="col-md-5 required control-label">Tel.</label>
								<div class="col-md-7">
									<div class="input-group">
										<input type="text" name="phone" class="form-control" id="phone" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 required control-label">Date </label>
								<div class="col-md-7">
									<input type="text" name="date_pay" class="form-control form-control date_picker" value="<?php echo e(date('d-m-Y')); ?>" id="date">
								</div>
							</div>
							<div class="form-group" id="bank-list-condition">
								<label class="required col-md-5 control-label">Method</label>
								<div class="col-md-7">
									<?php echo Form::select('bank_id',['11001'=>'Cash On Hand','11002'=>'Cash In Bank','11013'=>'Cheque'], null, ['id' => 'bank-list', 'class' => 'form-control payment-schedule-type-payment select2','required']); ?>

								</div>
							</div>
							<div class="form-group" id="deposit-schedule-payment-method-to">
                            </div>
							<div class="form-group">
								<label class="col-md-5  control-label">Remark </label>
								<div class="col-md-7">
									<textarea class="form-control  " rows="3" name="remark" placeholder="" id="remark" value=""></textarea>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="modal-footer">
					<button type="button" class="button_danger" data-dismiss="modal">Close</button>
					<button type="submit" class="button_success">Payment</button>
				</div>
			</form>
		</div>
		<!-- /.modal-content -->
	</div>
	<!-- /.modal-dialog -->
</div>