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<div class="row">
<div class="form-group col-md-6">
<label class="form-label" for="firstname">[L]First Name[/L]</label>
<input class="form-control" type="text" name="fname" placeholder="Joe" id="firstname" value="[evalue fname]"/>
</div>
<div class="form-group col-md-6">
<label class="form-label" for="lastname">[L]Last Name[/L]</label>
<input class="form-control" type="text" name="lname" placeholder="Biden" id="lastname" value="[evalue lname]"/>
</div>
<div class="form-group col-md-6">
<label class="form-label" for="emailaddress_shipping">[L]Email Address[/L]</label>
<input class="form-control" type="text" name="email" placeholder="joe.black@gmail.com" id="emailaddress_shipping" value="[evalue email]"/>
</div>
<div class="form-group col-md-6">
<label class="form-label" for="street_shipping">[L]Street[/L]</label>
<input class="form-control" type="text" name="address1" placeholder="123 Main St." id="street_shipping" value="[evalue address1]"/>
</div>
<div class="form-group col-md-6">
<label class="form-label" for="city_shipping">[L]City[/L]</label>
<select name="city" id="city_shipping" class="form-control" onchange="this.form.submit()">
<option value="-- [L]Please select[/L] --">-- [L]Please select[/L] --</option>[perl tables="products shipping"]
my $options = '';
for my $zone_group (@{$Tag->query({sql => "SELECT zone_group FROM cpa GROUP BY zone_group ORDER BY zone_group"})}) {
$options .= qq(
<optgroup label="$zone_group->[0]">);
for my $zone (@{$Tag->query({sql => "SELECT zone FROM cpa WHERE zone_group='$zone_group->[0]'"})}) {
$options .= qq(
<option value="$zone->[0]") . ($zone->[0] eq $Tag->value({keep => 1, filter => encode_entities, name => city}) ? ' selected' : '') . ">$zone->[0]</option>";
}
$options .= q(
</optgroup>);
}
return $options;
[/perl]
</select>
</div>
<div class="form-group col-md-6">
<label class="form-label" for="zip_shipping">[L]ZIP[/L]</label>
<input class="form-control" type="text" name="zip" placeholder="Postal code" id="zip_shipping" value="[evalue zip]"/>
</div>
<!--div class="form-group col-md-6">
<label class="form-label" for="state_shipping">[L]State[/L]</label>
<input class="form-control" type="text" name="state" placeholder="State" id="state_shipping" value="[evalue state]"/>
</div-->
<input type="hidden" name="country" value="__SHIP_DEFAULT_COUNTRY__"/>
<div class="form-group col-md-6">
<label class="form-label" for="phonenumber_shipping">[L]Phone Number[/L]</label>
<input class="form-control" type="text" name="phone_day" placeholder="Phone Number" id="phonenumber_shipping" value="[evalue phone_day]"/>
</div>
</div>
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