<div class="modaLoader"></div>
<button class="hide"></button>
<div class="row">
    <div class="col-md-12">
        <div class="form-group">
            <label>nom :</label>
            <input type="text" class="form-control" name="nom" placeholder="nom">
        </div>
        <div class="form-group">
            <label>groupe de contrats :</label>
            <div class="input-group">
                <select class="form-control" name="groupe">{include file='paniers_groupes/paniers_groupes_select_list.tpl'}</select>
                <span class="input-group-btn hide">
                    <button class="btn btn-default btnSecondAction">
                        <i class="glyphicon glyphicon-remove"></i>
                    </button>
                </span>
                <span class="input-group-btn">
                    <button class="btn btn-default btnAction add">
                        <i class="glyphicon glyphicon-plus"></i>
                    </button>
                </span>
            </div>
        </div>
        <div class="form-group">
            <label>valeur :</label>
            <div class="input-group">
                <input type="text" class="form-control" name="valeur" placeholder="valeur">
                <span class="input-group-addon">€</span>
            </div>
        </div>
    </div>
</div>