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form.htm
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form.htm
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- The above 3 meta tags *must* come first in the head; any other head content must come *after* these tags -->
<title>K-Monitor</title>
<!-- get fontawesome -->
<script src="https://use.fontawesome.com/ff50c4964e.js"></script>
<!-- Main Styles -->
<link href="/dist/css/main.css" rel="stylesheet">
<!-- plugins -->
<link href="/dist/css/bootstrap-select.min.css" rel="stylesheet">
<!-- HTML5 shim and Respond.js for IE8 support of HTML5 elements and media queries -->
<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/html5shiv/3.7.3/html5shiv.min.js"></script>
<script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
<![endif]-->
</head>
<body id="form">
<div class="container-fluid">
<div class="row">
<section class="col-md-6"><h1>PDF HERE</h1></section>
<section class="col-md-6">
<form class="form-horizontal" method="" action="">
<ul id="slide-list">
<li>
<!-- SLIDE 1 -->
<div class="row">
<div class="col-md-12">
<h1>Personal Information</h1>
<div class="form-group">
<div class="col-md-4">
<label for="spouse">Spouse:</label>
</div>
<div class="col-md-8">
<input class="form-control" type="text" name="spouse" class="form-control">
</div>
</div>
<div class="form-group">
<div class="col-md-4">
<label for="child">Child:</label>
</div>
<div class="col-md-8">
<input class="form-control" type="text" name="child[]" class="form-control">
</div>
</div>
<button class="btn btn-default repeater pull-right"><i class="fa fa-plus"></i> Add Field...</button>
</div>
</li>
<li>
<!-- SLIDE 2 -->
<div class="row">
<div class="col-md-12">
<h1>Any Properties declared?</h1>
<div class="radio">
<label for="radio1-1">
<input type="radio" id="radio1-1" name="radio1" value="yes" class="box-toggler" data-toggle-target=".contents-1"> Yes
</label>
</div>
<div class="radio">
<label for="radio1-2">
<input type="radio" id="radio1-2" name="radio1" value="no" class="box-toggler" data-toggle-target=".contents-1"> No
</label>
</div>
<div class="hidden contents-1" id="">
<div class="row">
<h2>Main information</h2>
</div>
<div class="row">
<div class="col-md-4">
<label for="location">Location:</label>
</div>
<div class="col-md-8">
<input class="form-control" type="text" name="location[]" class="form-control">
</div>
</div>
<div class="row">
<div class="col-md-4">
<label for="area">Area:</label>
</div>
<div class="col-md-4">
<input class="form-control" type="text" name="area[]" class="form-control">
</div>
<div class="col-md-4">
<select class=" form-control" name="unit[]" title="unit">
<option></option>
<option value="sq">Square meters</option>
<option value="ha">Hectares</option>
<option value="ac">Acres</option>
</select>
</div>
</div>
<div class="row">
<div class="col-md-4">
<label for="area">Cultivation:</label>
</div>
<div class="col-md-4">
<input class="form-control" type="text" name="cultivation[]" class="form-control">
</div>
<div class="col-md-4">
<div class="checkbox">
<label>
<input type="checkbox" name="cultivation-option-1[]"> Peppers
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="cultivation-option-2[]"> Peppers
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="cultivation-option-3[]"> Peppers
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="cultivation-option-4[]"> Peppers
</label>
</div>
<div class="row">
<div class="col-md-4">
<label>Other:</label>
</div>
<div class="col-md-8">
<input type="text" name="cultivation-other[]" class="form-control">
</div>
</div>
</div>
</div>
<div class="row">
<h2>Building Info</h2>
<div class="col-md-4">
<h3>Nature of use</h3>
<div class="checkbox">
<label>
<input type="checkbox" name="building-option-1[]"> Homes
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="building-option-2[]"> Industrial
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="building-option-3[]"> Offices
</label>
</div>
<div class="row">
<div class="col-md-4">
<label>Other:</label>
</div>
<div class="col-md-8">
<input type="text" name="building-other[]" class="form-control">
</div>
</div>
</div>
<div class="col-md-8">
<label>Area:</label>
<div class="row">
<div class="col-md-6">
<input type="text" class="form-control" name="building-area[]">
</div>
<div class="col-md-6">
<select class=" form-control" name="unit[]" title="unit">
<option></option>
<option value="sq">Square meters</option>
<option value="ha">Hectares</option>
<option value="ac">Acres</option>
</select>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<h2>Legal Designation</h2>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-option-1[]"> Homes
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-option-2[]"> Industrial
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-option-3[]"> Offices
</label>
</div>
<div class="row">
<div class="col-md-4">
<label>Other:</label>
</div>
<div class="col-md-8">
<input type="text" name="legal-status-other[]" class="form-control">
</div>
</div>
</div>
<div class="col-md-6">
<h2>Legal Status</h2>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-status-option-1[]"> Homes
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-status-option-2[]"> Industrial
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" name="legal-status-option-3[]"> Offices
</label>
</div>
<div class="form-group">
<div class="col-md-4">
<label>Other:</label>
</div>
<div class="col-md-8">
<input type="text" name="legal-status-other[]" class="form-control">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<h2>Ownership Ratio</h2>
</div>
<div class="col-md-2">
<input class="form-control" type="text">
</div>
<div class="col-md-2"><span class="out-of center-block">/</span></div>
<div class="col-md-2">
<input class="form-control" type="text">
</div>
<div class="col-md-2"><span class="or center-block">OR</span></div>
<div class="col-md-4">
<div class="input-group">
<input type="text" class="form-control" placeholder="percentage..." aria-describedby="percent-addon">
<span class="input-group-addon" id="percent-addon">%</span>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<h2>Acquisition Info</h2>
</div>
<div class="row">
<div class="col-md-3">
<select id="select1" class=" form-control" name="acquisition[]" data-live-search="true" title="Enter value">
<option value="1">Fast Cars</option>
<option value="2">Danger</option>
<option value="3">Fire</option>
<option value="4">Knives</option>
<option value="other">Other...</option>
</select>
<input type="text" name="acquisition-other[]" id="select1-other" class="hidden form-control other-input" placeholder="Enter value for the selection here">
</div>
<div class="col-md-3">
<input class="form-control" name="acquisition-year[]" type="number" placeholder="year" maxlength="4" min="1800" max="2017">
</div>
<div class="col-md-3">
<select class="form-control " name="acquisition-month[]" placeholder="month" title="month" data-live-search="true">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
<div class="col-md-3">
<input class="form-control" name="acquisition-day[]" type="number" placeholder="day" maxlength="2" min="1" max="31">
</div>
</div>
<button class="btn btn-default repeater" type="button"><i class="fa fa-plus"></i> Add another entry...</button>
</div>
<div class="row property-type">
<div class="col-md-12">
<h2>Type of property</h2>
</div>
<div class="col-md-4">
<div class="radio">
<label class="center-block text-center">
<i class="fa fa-5x fa-home"></i><br />
<input type="radio" name="property-type[]">
</label>
</div>
</div>
<div class="col-md-4">
<div class="radio">
<label class="center-block text-center">
<i class="fa fa-5x fa-map-o"></i><br />
<input type="radio" name="property-type[]">
</label>
</div>
</div>
<div class="col-md-4">
<div class="radio">
<label class="center-block text-center">
<i class="fa fa-5x fa-asterisk"></i><br />
<input type="radio" name="property-type[]">
</label>
</div>
</div>
</div>
</div>
<button id="section-repeater" class="hidden btn btn-lg btn-default repeater"><i class="fa fa-plus"></i> Add another location</button>
<textarea class="feedback-flag form-control" rows="4" placeholder="something wrong?"></textarea>
<!-- eof hidden contents box -->
</div>
</div>
</li>
<!-- slide 3 -->
<li>
<div class="row">
<div class="col-md-12">
<h2>Moveable assets</h2>
</div>
<div class="col-md-10">
<h3>Classic Vehicles <small>if any</small></h3>
<div class="row">
<div class="col-md-4">
<select class="form-control" name="classic-vehicle-type[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input class="form-control" name="classic-vehicle-brand[]" type="text">
</div>
<div class="col-md-4">
<select class="form-control" name="classic-vehicle-ownership[]" title="ownership">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-3"><input class="form-control" name="classic-vehicle-year[]" type="number" placeholder="year" maxlength="4" min="1800" max="2017"></div>
<div class="col-md-3">
<select name="classic-vehicle-month[]" class="form-control selectpicker" placeholder="month" title="month" data-live-search="true">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i> Add field</button>
<h3>Air/Water Vehicles <small>if any</small></h3>
<div class="row">
<div class="col-md-4">
<select class="form-control" name="aw-vehicle-type[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input class="form-control" name="aw-vehicle-brand[]" type="text">
</div>
<div class="col-md-4">
<select class="form-control" name="aw-vehicle-ownership[]" title="ownership">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-3"><input name="aw-vehicle-year[]" class="form-control" type="number" placeholder="year" maxlength="4" min="1800" max="2017"></div>
<div class="col-md-3">
<select class="form-control selectpicker" name="aw-vehicle-month[]" placeholder="month" title="month" data-live-search="true">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i> Add field</button>
<h3>Artwork <small>if any</small></h3>
<div class="row">
<div class="col-md-4">
<select class="form-control" name="art-type[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input class="form-control" name="art-name[]" placeholder="name" type="text">
</div>
<div class="col-md-4">
<input class="form-control" name="art-number[]" placeholder="#" type="text">
</div>
<div class="col-md-4">
<select class="form-control" name="art-ownership[]" title="ownership">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-3"><input name="art-year[]" class="form-control" type="number" placeholder="year" maxlength="4" min="1800" max="2017"></div>
<div class="col-md-3">
<select class="form-control selectpicker" name="art-month[]" placeholder="month" title="month" data-live-search="true">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i> Add field</button>
</div>
</li>
<!-- Slide 4 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Are there any other savings?</h1>
<div class="radio">
<label for="radio2-1">
<input type="radio" id="radio2-1" name="radio2" value="yes" class="box-toggler" data-toggle-target=".contents-2"> Yes
</label>
</div>
<div class="radio">
<label for="radio1-2">
<input type="radio" id="radio2-2" name="radio2" value="no" class="box-toggler" data-toggle-target=".contents-2"> No
</label>
</div>
<div class="hidden contents-2" id="">
<div class="row">
<div class="col-md-10">
<h2>Savings Deposit</h2>
<div class="row">
<div class="col-md-4">
<input type="text" name="savings-number[]" class="form-control">
</div>
<div class="col-md-4">
<select class="form-control" name="savings-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
<div class="col-md-10">
<h2>Financial institution accounts</h2>
<div class="row">
<div class="col-md-4">
<input type="text" name="fia-number[]" class="form-control">
</div>
<div class="col-md-4">
<select class="form-control" name="fia-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
<div class="col-md-10">
<h2>Cash</h2>
<div class="row">
<div class="col-md-4">
<select class="form-control" name="cash-type[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input type="text" name="cash-number[]" class="form-control">
</div>
<div class="col-md-4">
<select class="form-control" name="cash-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</li>
<!-- slide 5 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Are there any debts?</h1>
<div class="radio">
<label for="radio3-1">
<input type="radio" id="radio3-1" name="radio3" value="yes" class="box-toggler" data-toggle-target=".contents-3"> Yes
</label>
</div>
<div class="radio">
<label for="radio3-2">
<input type="radio" id="radio3-2" name="radio3" value="no" class="box-toggler" data-toggle-target=".contents-3"> No
</label>
</div>
<div class="hidden contents-3" id="">
<div class="row">
<div class="col-md-10">
<h2>Debts</h2>
<div class="row">
<div class="col-md-4">
<select class="form-control" name="debt-type[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-8">
<input type="text" name="debt-text[]" class="form-control" placeholder="description">
</div>
<div class="col-md-4">
<input type="text" name="debt-amount[]" class="form-control" placeholder="description">
</div>
<div class="col-md-8">
<select class="form-control" name="debt-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
</div>
</div>
</div>
</div>
</li>
<!-- slide 6 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Other Comments</h1>
<div class="radio">
<label for="radio4-1">
<input type="radio" id="radio4-1" name="radio4" value="yes" class="box-toggler" data-toggle-target=".contents-4"> Yes
</label>
</div>
<div class="radio">
<label for="radio4-2">
<input type="radio" id="radio4-2" name="radio4" value="no" class="box-toggler" data-toggle-target=".contents-4"> No
</label>
</div>
<div class="hidden contents-4" id="">
<div class="row">
<div class="col-md-10">
<h2>Comments</h2>
<div class="row">
<div class="col-md-12">
<textarea name="other-comment" class="form-control" placeholder="other comments" rows="6"></textarea>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</li>
<!-- slide 7 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Other forms of income</h1>
<div class="radio">
<label for="radio5-1">
<input type="radio" id="radio5-1" name="radio5" value="yes" class="box-toggler" data-toggle-target=".contents-5"> Yes
</label>
</div>
<div class="radio">
<label for="radio5-2">
<input type="radio" id="radio5-2" name="radio5" value="no" class="box-toggler" data-toggle-target=".contents-5"> No
</label>
</div>
<div class="hidden contents-5" id="">
<div class="row">
<div class="col-md-12">
<h2>Other Income</h2>
<div class="row">
<div class="col-md-6">
<input type="text" name="profession[]" class="form-control" placeholder="profession">
</div>
<div class="col-md-6">
<input type="text" name="employer[]" class="form-control" placeholder="employer">
</div>
<div class="col-md-3">
<select class="form-control" name="currently-employed[]" title="curently employed">
<option></option>
<option>yes</option>
<option>no</option>
</select>
</div>
<div class="col-md-3"><input type="text" name="salary[]" class="form-control" placeholder="salary"></div>
<div class="col-md-3">
<select class="form-control" name="salary-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-3"><input type="text" name="frequency[]" class="form-control" placeholder="frequency"></div>
</div>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i> Add entry...</button>
</div>
</div>
</div>
</li>
<!-- slide 8 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Economic Interest</h1>
<div class="radio">
<label for="radio6-1">
<input type="radio" id="radio6-1" name="radio6" value="yes" class="box-toggler" data-toggle-target=".contents-6"> Yes
</label>
</div>
<div class="radio">
<label for="radio6-2">
<input type="radio" id="radio6-2" name="radio6" value="no" class="box-toggler" data-toggle-target=".contents-6"> No
</label>
</div>
<div class="hidden contents-6" id="">
<div class="row">
<div class="col-md-10">
<h2>Company Information</h2>
<div class="row">
<div class="col-md-8">
<input class="form-control" name="company[]" placeholder="company">
</div>
<div class="col-md-8">
<input class="form-control" name="company-location[]" placeholder="address">
</div>
<div class="col-md-4">
<select class="form-control" name="company-type[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
</div>
<div class="col-md-10">
<h2>form of economic interest at the beginning</h2>
<div class="row">
<div class="col-md-8">
<select class="form-control" name="interest-start[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>other</option>
</select>
</div>
</div>
</div>
<div class="col-md-10">
<h2>form of economic interest at present</h2>
<div class="row">
<div class="col-md-8">
<select class="form-control" name="interest-now[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>other</option>
</select>
</div>
</div>
</div>
<div class="col-md-10">
<h2>Share of economic interest at the beginning</h2>
<div class="row">
<div class="col-md-8">
<div class="row">
<div class="col-md-2">
<input class="form-control" name="part-of-start[]" type="text">
</div>
<div class="col-md-2"><span class="out-of center-block">/</span></div>
<div class="col-md-2">
<input class="form-control" type="text" name="total-start[]">
</div>
<div class="col-md-2"><span class="or center-block">OR</span></div>
<div class="col-md-4">
<div class="input-group">
<input type="text" class="form-control" name="percentage-start[]" placeholder="percentage..." aria-describedby="percent-addon">
<span class="input-group-addon" id="percent-addon">%</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-10">
<h2>Share of economic interest at present</h2>
<div class="row">
<div class="col-md-8">
<div class="row">
<div class="col-md-2">
<input class="form-control" name="part-of-now[]" type="text">
</div>
<div class="col-md-2"><span class="out-of center-block">/</span></div>
<div class="col-md-2">
<input class="form-control" type="text" name="total-now[]">
</div>
<div class="col-md-2"><span class="or center-block">OR</span></div>
<div class="col-md-4">
<div class="input-group">
<input type="text" class="form-control" name="percentage-now[]" placeholder="percentage..." aria-describedby="percent-addon">
<span class="input-group-addon" id="percent-addon">%</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-10">
<h2>Share of profit</h2>
<div class="row">
<div class="col-md-8">
<div class="input-group">
<input type="text" class="form-control" name="percentage-start[]" placeholder="percentage..." aria-describedby="percent-addon">
<span class="input-group-addon" id="percent-addon">%</span>
</div>
</div>
</div>
</div>
<div class="col-md-10">
<h2>Position</h2>
<div class="row">
<div class="col-md-8">
<select class="form-control" name="position[]" title="type">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>other</option>
</select>
</div>
</div>
</div>
</div>
</div>
<button class="btn btn-default repeater hidden"><i class="fa fa-plus"></i>Add entry...</button>
</div>
</div>
</li>
<!-- slide 9 -->
<li>
<div class="row">
<div class="col-md-12">
<h1>Any presents, benefits or subsidies?</h1>
<div class="radio">
<label for="radio7-1">
<input type="radio" id="radio7-1" name="radio7" value="yes" class="box-toggler" data-toggle-target=".contents-7"> Yes
</label>
</div>
<div class="radio">
<label for="radio7-2">
<input type="radio" id="radio7-2" name="radio7" value="no" class="box-toggler" data-toggle-target=".contents-7"> No
</label>
</div>
<div class="hidden contents-7" id="">
<div class="row">
<div class="col-md-10">
<h2>Benefits</h2>
<div class="row">
<div class="col-md-4">
<input type="text" name="-benefit-date[]" class="form-control" placeholder="date">
</div>
<div class="col-md-8">
<select class="form-control" name="benefit-type[]" title="product">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input type="text" name="benefit-amount[]" class="form-control" placeholder="amount">
</div>
<div class="col-md-4">
<select class="form-control" name="benefit-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<div class="checkbox">
<label>
<input type="checkbox" name="benefit-btl[]"> By The Law!
</label>
</div>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
<div class="col-md-10">
<h2 class="clearfix">Presents</h2>
<div class="row">
<div class="col-md-4">
<input type="text" name="present-date[]" class="form-control" placeholder="date">
</div>
<div class="col-md-8">
<select class="form-control" name="present-type[]" title="product">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<input type="text" name="present-amount[]" class="form-control" placeholder="amount">
</div>
<div class="col-md-4">
<select class="form-control" name="present-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
<div class="col-md-4">
<div class="checkbox">
<label>
<input type="checkbox" name="present-btl[]"> By The Law!
</label>
</div>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
<div class="col-md-10">
<h2 class="clearfix">Subsidies</h2>
<div class="row">
<div class="col-md-6">
<input type="text" name="subsidie-recipient[]" class="form-control" placeholder="recipient">
</div>
<div class="col-md-6">
<input type="text" name="subsidie-acquisition[]" class="form-control" placeholder="acquisition">
</div>
<div class="col-md-4">
<input type="text" name="subsidie-date[]" class="form-control" placeholder="date">
</div>
<div class="col-md-4">
<input type="text" name="subsidie-provider[]" class="form-control" placeholder="provider">
</div>
<div class="col-md-4">
<input type="text" name="subsidie-purpose[]" class="form-control" placeholder="purpose">
</div>
<div class="col-md-4">
<input type="text" name="subsidie-amount[]" class="form-control" placeholder="amount">
</div>
<div class="col-md-4">
<select class="form-control" name="subsidie-currency[]" title="currency">
<option></option>
<option>Alfetta</option>
<option>500</option>
<option>Whatever</option>
</select>
</div>
</div>
<button class="btn btn-default repeater"><i class="fa fa-plus"></i>Add an entry...</button>
</div>
</div>
</div>
</div>
</div>
</li>
</ul>
<button class="btn btn-lg btn-primary btn-block" type="submit"><i class="fa fa-heartbeat"></i> LIBERATE!</button >
</form>
</section>
</div>
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