<div class="modaLoader"></div>
<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 :</label>
            <select class="form-control" name="groupe">{include file='paniers_groupes/paniers_groupes_select_list.tpl'}</select>
        </div>
        <div class="form-group">
            <label>féquence :</label>
            <select class="form-control" name="frequence">
                <option value="hebdo">hedbomadaire</option>
                <option value="quinz">quinzaine</option>
            </select>
        </div>
        <div class="form-group">
            <label>type de panier :</label>
            <select class="form-control" name="panier_type">{include file='paniers/paniers_select_list.tpl'}</select>
        </div>
        <div class="form-group">
            <label>nb. de panier :</label>
            <div class="input-group"> 
                <input type="number" class="form-control" name="nb_paniers" placeholder="nb. de panier">
                <span class="input-group-addon">panier(s)</span>
            </div>
        </div>
        <div class="form-group"> 
            <label>valeur :</label>
            <div class="input-group"> 
                <input type="number" class="form-control" name="prix_total" placeholder="prix total" leng="en">
                <span class="input-group-addon">€</span>
                <span class="input-group-btn"><button class="btn btn-default btnCalcTotal"><i class="glyphicon glyphicon-th"></i></button></span>
            </div>
        </div>
    </div>
</div>