{{ html()->form('POST', 'javascript:;')->class('form-horizontal topup-form')->id('pay_topup_form')->open() }} {{ html()->hidden('mode')->class('col-md-2 form-control-label')->id('mode') }}

{{ html()->label(__('topup::labels.backend.topup.table.project'))->class('col-md-2 form-control-label')->for('project') }}

{{ html()->label(__('topup::labels.backend.topup.table.mobile'))->class('col-md-2 form-control-label')->for('pay_mobile') }}

{{--

{{ html()->text('pay_mobile') ->class('form-control') ->placeholder(__('topup::labels.backend.topup.table.mobile')) ->attribute('maxlength', 191) ->required() }}

--}}

{{ html()->label(__('topup::labels.backend.topup.table.amount'))->class('col-md-2 form-control-label')->for('pay_amount') }}

{{ html()->text('pay_amount') ->class('form-control') ->placeholder(__('topup::labels.backend.topup.table.amount')) ->attribute('maxlength', 191) ->required() }}

{{ html()->label(__('topup::labels.backend.topup.table.payment_expired_date_time'))->class('col-md-2 form-control-label')->for('payment_expired_date_time') }}

{{ html()->text('payment_expired_date_time') ->class('form-control payment_expired_date_time') ->placeholder(__('topup::labels.backend.topup.payment_date_time')) ->attribute('maxlength', 191) ->readonly(true) ->required() }}

{{ html()->label(__('topup::labels.backend.topup.table.item_name'))->class('col-md-2 form-control-label')->for('item_name') }}

{{ html()->text('item_name') ->class('form-control') ->placeholder(__('topup::labels.backend.topup.table.item_name')) ->attribute('maxlength', 191) ->required() }}

{{ html()->label(__('topup::labels.backend.topup.table.order_no'))->class('col-md-2 form-control-label')->for('order_no') }}

{{ html()->text('order_no') ->class('form-control') ->placeholder(__('topup::labels.backend.topup.table.order_no')) ->attribute('maxlength', 191) ->required() }}

{{ html()->label(__('topup::labels.backend.topup.table.remark'))->class('col-md-2 form-control-label')->for('description') }}

{{ html()->textarea('description') ->class('form-control') ->placeholder(__('topup::labels.backend.topup.table.remark')) }}

{{ form_cancel('javascript:;', __('buttons.general.cancel'))->class('pay_cancel') }}