{{ header }}
<header class="background-white bottom-margin-large">
  <div class="container-fluid">
    <div class="row no-space-xs">
      <div class="col-xs-12">
        <div class="content-box vertical-padding-large flex between-xs middle-xs">
          <div>
            <span class="text-x-large text-dark">{{ heading_title }}</span>
            <div class="adm-breadcrumb">
              {% for breadcrumb in breadcrumbs %}
                <i class="fas fa-angle-right text-x-small text-gray horizontal-padding-small"></i>
                <a href="{{ breadcrumb.href }}" class="text-x-small text-gray text-decoration-none">{{ breadcrumb.text }}</a>
              {% endfor %}
            </div>
          </div>
          <div class="flex flex-row middle-xs">
            <a href="{{ cancel }}" class="btn-default btn-medium btn-outline right-margin-small">
              <span>{{ button_cancel }}</span>
            </a>
            <button class="btn-default btn-medium btn-primary js-submit-main-form">
              <span>{{ button_save }}</span>
            </button>
          </div>
          {% if error_warning %}<div class="warning full-width top-margin-medium">{{ error_warning }}</div>{% endif %}
        </div>
      </div>
    </div>
  </div>
</header>
<div class="container-fluid">
  <form action="{{ action }}" method="post" class="row js-main-form">
    <div class="col-xs-12 col-md-6">
      <div class="content-box background-white padding-large shadow-small">
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_descricao }}</span>
          <input type="text" name="dlog_descricao" value="{{ dlog_descricao }}" class="field-entry" >
          {% if error_dlog_descricao %}
            <span class="error">{{ error_dlog_descricao }}</span>
          {% endif %}
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_codigo }}</span>
          <input type="text" name="dlog_codigo" value="{{ dlog_codigo }}" class="field-entry numeric" maxlength="11">
          {% if error_dlog_codigo %}
            <span class="error">{{ error_dlog_codigo }}</span>
          {% endif %}
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_login }}</span>
          <input type="text" name="dlog_login" value="{{ dlog_login }}" class="field-entry cnpj">
          {% if error_dlog_login %}
            <span class="error">{{ error_dlog_login }}</span>
          {% endif %}
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_token }}</span>
          <input type="text" name="dlog_token" value="{{ dlog_token }}" class="field-entry" maxlength="35">
          {% if error_dlog_token %}
            <span class="error">{{ error_dlog_token }}</span>
          {% endif %}
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_cep_origem }}</span>
          <input type="text" name="dlog_cep_origem" value="{{ dlog_cep_origem }}" class="field-entry numeric mask-cep" >
          {% if error_dlog_cep_origem %}
            <span class="error">{{ error_dlog_cep_origem }}</span>
          {% endif %}
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_valor_extra }}</span>
          <input type="text" name="dlog_valor_extra" value="{{ dlog_valor_extra }}" class="field-entry mask-money" >
        </label>
        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_prazo_extra }}</span>
          <input type="text" name="dlog_prazo_extra" value="{{ dlog_prazo_extra }}" class="field-entry numeric" >
        </label>

        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_simular_caixa }}</span>
          <select class="field-entry field-entry-medium js-sort-by-option" name="dlog_simular_caixa">
            {% for hab_dlog_simular_caixa in dlog_simular_caixa_list %}
            <option value="{{ hab_dlog_simular_caixa.key }}" {{ hab_dlog_simular_caixa.selected }}>{{ hab_dlog_simular_caixa.value }}</option>
            {% endfor %}
          </select>
        </label>

        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_modal_service }}</span>
          <select class="field-entry field-entry-medium js-sort-by-option" name="dlog_modal_service">
            {% for dlog_modal_service in dlog_modal_service_list %}
            <option value="{{ dlog_modal_service.key }}" {{ dlog_modal_service.selected }}>{{ dlog_modal_service.value }}</option>
            {% endfor %}
          </select>
        </label>

        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_icms }}</span>
          <select class="field-entry field-entry-medium js-sort-by-option" name="dlog_icms">
            {% for dlog_icms in dlog_icms_list %}
            <option value="{{ dlog_icms.key }}" {{ dlog_icms.selected }}>{{ dlog_icms.value }}</option>
            {% endfor %}
          </select>
        </label>


        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_sort_order }}</span>
          <input type="text" name="dlog_sort_order" value="{{ dlog_sort_order }}" class="field-entry numeric">
        </label>

        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_geo_zone_id }}</span>
          <select class="field-entry field-entry-medium js-sort-by-option" name="dlog_geo_zone_id">
            <option value="0">{{text_all_zones}}</option>
            {% for geo_zone in dlog_geo_zones %}
                {% if geo_zone.geo_zone_id == dlog_geo_zone_id %}
                <option value="{{geo_zone.geo_zone_id}}" selected="selected">{{geo_zone.name}}</option>
                {% else %}
                <option value="{{geo_zone.geo_zone_id}}">{{geo_zone.name}}</option>
                {% endif %}
            {% endfor %}
          </select>
        </label>

        <label class="field field-medium bottom-margin-medium">
          <span class="field-label">{{ entry_dlog_status }}</span>
          <select class="field-entry field-entry-medium js-sort-by-option" name="dlog_status">
            {% for dlog_status in status_dlog_list %}
            <option value="{{ dlog_status.key }}" {{ dlog_status.selected }}>{{ dlog_status.value }}</option>
            {% endfor %}
          </select>
        </label>


      </div>
    </div>
  </form>
</div>
{{ form }}
{{ footer }}
