form-left-nr.php

<label class="col-sm-2 control-label">COMPNAME<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="compname" readonly name="compname"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label">AKADBA</label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="akadba" readonly name="akadba"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label">PHYSADDR<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="physaddr" readonly name="physaddr"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<label class="col-sm-3 control-label">CITY/ST/ZIP<span class="required">*</span></label>
<div class="col-sm-3 inputGroupContainer">
   <div class="input-group">
      <input id="physcity" readonly name="physcity" placeholder="City" class="form-control required-left"  value="" type="text" >
   </div>
</div>

<div class="col-sm-3 inputGroupContainer">
   <div class="input-group">
      <input id="physstate" readonly name="physstate" placeholder="State"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<div class="col-sm-3 inputGroupContainer">
   <div class="input-group">
      <input id="physzip" readonly name="physzip" placeholder="Zip"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<label class="col-sm-12 control-label"><span class="required"></span></label>


<label class="col-sm-3 control-label "  >ADDRCHGREASON</label>
<div class="col-sm-9 inputGroupContainer " >
   <div class="input-group">
      <input id="addrchgreason" readonly name="addrchgreason"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >MAILADDR</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="mailaddr" readonly name="mailaddr"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-3 control-label "  >CITY/ST/ZIP</label>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="mailcity" readonly name="mailcity"  placeholder="City" class="form-control"  value="" type="text" >
   </div>
</div>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="mailstate" readonly name="mailstate"  placeholder="State" class="form-control "  value="" type="text" >
   </div>
</div>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="mailzip" readonly name="mailzip"  placeholder="Zip" class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-12 control-label"><span class="required"></span></label>
<label class="col-sm-2 control-label">VNUMBER<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="vnumber" readonly name="vnumber"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >ALTPHONE</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="altphone" readonly name="altphone"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >FNUMBER</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="fnumber" readonly name="fnumber"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >NNUMBER</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="nnumber" readonly name="nnumber"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >WEB</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="web" readonly name="web"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >EMAIL</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="email" readonly name="email"  class="form-control"  value="" type="email" >
   </div>
</div>
<label class="col-sm-2 control-label">EXEC1<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="exec1" readonly name="exec1"  class="form-control required-left"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label">OFFICERMAIL1</label>
<div class="col-sm-6 inputGroupContainer">
   <div class="input-group">
      <input id="officermail1" readonly name="officermail1"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label">GENDER1</label>
<div class="col-sm-2 inputGroupContainer">
   <input id="gender1" readonly name="gender1"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label">TITLE1<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="title1" readonly name="title1"  class="form-control required-left"  value="" type="text" >
   </div>
</div>

<!--  for more information -->
<!-- <label class="col-sm-12"> -->
<!-- <a class="col-sm-12 btn btn-primary" data-toggle="" data-target="#left"> to view more</a> -->
<!-- </label> -->
<label class="col-sm-2 control-label "  >EXEC2</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec2" readonly name="exec2"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL2</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail2" readonly name="officermail2"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER2</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender2" readonly name="gender2"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE2</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title2" readonly name="title2"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC3</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec3" readonly name="exec3"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL3</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail3" readonly name="officermail3"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER3</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender3" readonly name="gender3"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE3</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title3" readonly name="title3"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC4</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec4" readonly name="exec4"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL4</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail4" readonly name="officermail4"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER4</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender4" readonly name="gender4"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE4</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title4" readonly name="title4"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC5</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec5" readonly name="exec5"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL5</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail5" readonly name="officermail5"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER5</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender5" readonly name="gender5"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE5</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title5" readonly name="title5"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC6</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec6" readonly name="exec6"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL6</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail6" readonly name="officermail6"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER6</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender6" readonly name="gender6"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE6</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title6" readonly name="title6"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC7</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec7" readonly name="exec7"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL7</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail7" readonly name="officermail7"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER7</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender7" readonly name="gender7"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE7</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title7" readonly name="title7"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC8</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec8" readonly name="exec8"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL8</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail8" readonly name="officermail8"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER8</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender8" readonly name="gender8"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE8</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title8" readonly name="title8"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC9</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec9" readonly name="exec9"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL9</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail9" readonly name="officermail9"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER9</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender9" readonly name="gender9"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label "  >TITLE9</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="title9" readonly name="title9"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >EXEC10</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="exec10" readonly name="exec10"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >OFFICERMAIL10</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="officermail10" readonly name="officermail10"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >TITLE10</label>
<div class="col-sm-6 inputGroupContainer " >
   <div class="input-group">
      <input id="title10" readonly name="title10"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >GENDER10</label>
<div class="col-sm-2 inputGroupContainer " >
   <input id="gender10" readonly name="gender10"  class="form-control"  value="" type="text" >
</div>
<label class="col-sm-2 control-label">PRODUCTS<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <textarea id="products" readonly name="products"  class="form-control md-textarea required-left"  value="" rows="3" ></textarea>
   </div>
</div>
<label class="col-sm-2 control-label">LOCCOUNT<span class="required">*</span></label>
<div class="col-sm-10 inputGroupContainer">
   <div class="input-group">
      <input id="loccount" readonly name="loccount"  class="form-control required-left"  value="" type="text" >
   </div>
</div>
<label class="col-sm-3 control-label "  >EMPCHGREASON</label>
<div class="col-sm-9 inputGroupContainer " >
   <div class="input-group">
      <input id="empchgreason" readonly name="empchgreason"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >YEARESTAB</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="yearestab" readonly name="yearestab"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >DISTRIBTYPE</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="distribtyp" readonly name="distribtyp"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >OWNERTYPE</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="ownertype" readonly name="ownertype"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >SALES</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="sales" readonly name="sales"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >SQUAREFEET</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="squarefeet" readonly name="squarefeet"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >IMPORTS</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="imports" readonly name="imports"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >PARENTNAME</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="parentname" readonly name="parentname"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >PADDRESS</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="paddress" readonly name="paddress"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-3 control-label "  >CITY/ST/ZIP</label>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="parentcity" readonly name="parentcity" placeholder="City"  class="form-control"  value="" type="text" >
   </div>
</div>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="parentstat" readonly name="parentstat" placeholder="State" class="form-control"  value="" type="text" >
   </div>
</div>
<div class="col-sm-3 inputGroupContainer " >
   <div class="input-group">
      <input id="pzip5" readonly name="pzip5"  placeholder="Zip" class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-12 control-label"><span class="required"></span></label>
<!-- ONUMBER CHANGE TO PARENT PHONE LABEL -->
<label class="col-sm-3 control-label "  >PARENT PHONE</label>
<div class="col-sm-9 inputGroupContainer " >
   <div class="input-group">
      <input id="onumber" readonly name="onumber"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >ADVERTISER</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="advertiser" readonly name="advertiser"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >COMPANYID</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="companyid" readonly name="companyid"  class="form-control"  value="" type="text" >
   </div>
</div>
<div class = "hidden-fields">
   <label class="col-sm-2 control-label "  >HEADER</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="header" readonly name="header"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >PRIMARYSIC</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="primarysic" readonly name="primarysic"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >SIC2</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="sic2" readonly name="sic2"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >DATASOURCE</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="datasource" readonly name="datasource"  class="form-control"  value="" type="text" >
      </div>
   </div>
</div>
<label class="col-sm-2 control-label "  >CONTACT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="contact" readonly name="contact"  class="form-control"  value="" type="text" >
   </div>
</div>
<div class = "hidden-fields">
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="odatetime" readonly name="odatetime"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="ocommetns" readonly name="ocommetns"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="tdatetime" readonly name="tdatetime"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer" >
      <div class="input-group">
         <input id="tcomments" readonly name="tcomments"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="fcomments" readonly name="fcomments"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  ></label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="fdatetime" readonly name="fdatetime"  class="form-control"  value="" type="hidden" >
      </div>
   </div>
</div>
<div class = "hidden-fields">
   <label class="col-sm-2 control-label "  >OPERATOR</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="operator" readonly name="operator"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >CONFDATE</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="confdate" readonly name="confdate"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >LISTNUM</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="listnum" readonly name="listnum"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >QEFLAG</label>
<!--    <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="qeflag" readonly name="qeflag"  class="form-control"  value="Draft" type="text" >
      </div>
   </div> -->
</div>
<label class="col-sm-2 control-label "  >BOOKID</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="bookid" readonly name="bookid"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >NEWINYEAR</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="newinyear" readonly name="newinyear"  class="form-control"  value="" type="text" >
   </div>
</div>
<!-- <label class="col-sm-2 control-label "  >4COMMENTS</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="comments4" readonly name="comments4"  class="form-control"  value="" type="text" >
   </div>
</div>

<label class="col-sm-2 control-label "  >5COMMENTS</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="comments5" readonly name="comments5"  class="form-control"  value="" type="text" >
   </div>
</div>
 -->

<div class = "hidden-fields">
   <label class="col-sm-2 control-label "  >PDATETIME</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="pdatetime" readonly name="pdatetime"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >PCOMMENTS</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="pcomments" readonly name="pcomments"  class="form-control"  value="" type="text" >
   </div>
</div>
<label class="col-sm-2 control-label "  >OAGENT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <!-- <input id="oagent" readonly name="oagent"  class="form-control"  value="" type="hidden" > -->
   </div>
</div>
<label class="col-sm-2 control-label "  >TAGENT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
     <!--  <input id="tagent" readonly name="tagent"  class="form-control"  value="" type="hidden" > -->
   </div>
</div>
<label class="col-sm-2 control-label "  >FAGENT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <!-- <input id="fagent" readonly name="fagent"  class="form-control"  value="" type="hidden" > -->
   </div>
</div>
<label class="col-sm-2 control-label "  >4DATETIME</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <!-- <input id="datetime4" readonly name="datetime4"  class="form-control"  value="" type="text" > -->
   </div>
</div>

<label class="col-sm-2 control-label "  >4AGENT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <!-- <input id="agent4" readonly name="agent4"  class="form-control"  value="" type="hidden" > -->
   </div>
</div>
<label class="col-sm-2 control-label "  >5DATETIME</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <!-- <input id="datetime5" readonly name="datetime5"  class="form-control"  value="" type="text" > -->
   </div>
</div>

<label class="col-sm-2 control-label "  >5AGENT</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
    <!--   <input id="agent5" readonly name="agent5"  class="form-control"  value="" type="hidden" > -->
   </div>
</div>
<label class="col-sm-2 control-label "  >PRIORITY</label>
<div class="col-sm-10 inputGroupContainer " >
   <div class="input-group">
      <input id="priority" readonly name="priority"  class="form-control"  value="" type="text" >
   </div>
</div>
   <label class="col-sm-3 control-label "  >SYSGENCOMMENTS</label>
   <div class="col-sm-9 inputGroupContainer " >
      <div class="input-group">
         <input id="sysgencomments" readonly name="sysgencomments"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >ADDRESSERROR</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="addresserror" readonly name="addresserror"  class="form-control"  value="" type="text" >
      </div>
   </div>
   <label class="col-sm-2 control-label "  >DPVFOOTNOTE</label>
   <div class="col-sm-10 inputGroupContainer " >
      <div class="input-group">
         <input id="dpvfootnote" readonly name="dpvfootnote"  class="form-control"  value="" type="text" >
      </div>
   </div>
</div>