<div class="modal-header">
    <button type="button" class="close" data-dismiss="modal" aria-hidden="true">&times;</button>
    <h3>{$_L['Add New Contact']}</h3>
</div>
<div class="modal-body">

    <form class="form-horizontal" id="rform">

        <div class="form-group"><label class="col-lg-2 control-label" for="account">{$_L['Full Name']}</label>

            <div class="col-lg-10"><input type="text" id="account" name="account" class="form-control" >

            </div>
        </div>

        <div class="form-group"><label class="col-lg-2 control-label" for="company">{$_L['Company Name']}</label>

            <div class="col-lg-10"><input type="text" id="company" name="company" class="form-control">

            </div>
        </div>
        
        <div class="form-group"><label class="col-lg-2 control-label" for="email">{$_L['Email']}</label>

            <div class="col-lg-10"><input type="text" id="email" name="email" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="phone">{$_L['Phone']}</label>

            <div class="col-lg-10"><input type="text" id="phone" name="phone" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="m_address">{$_L['Address']}</label>

            <div class="col-lg-10"><input type="text" id="m_address" name="m_address" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="city">{$_L['City']}</label>

            <div class="col-lg-10"><input type="text" id="city" name="city" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="state">{$_L['State Region']}</label>

            <div class="col-lg-10"><input type="text" id="state" name="state" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="zip">{$_L['ZIP Postal Code']} </label>

            <div class="col-lg-10"><input type="text" id="zip" name="zip" class="form-control" >

            </div>
        </div>
        <div class="form-group"><label class="col-lg-2 control-label" for="country">{$_L['Country']}</label>

            <div class="col-lg-10">

                <select name="country" class="country" id="country" class="form-control">
                    <option value="">{$_L['Select Country']}</option>
                    {$countries}
                </select>

            </div>
        </div>


    </form>

</div>
<div class="modal-footer">

    <button type="button" data-dismiss="modal" class="btn btn-danger">{$_L['Cancel']}</button>
    <button class="btn btn-primary contact_submit" type="submit" id="contact_submit"><i class="fa fa-check"></i> {$_L['Add Contact']}</button>
</div>