<form role="form" class="form-horizontal" id="create_tax_rates_form" action="#">

            <div class="modal-header">

            <button type="button" class="close" data-dismiss="modal" aria-hidden="true">&times;</button>

            <h4 class="modal-title">ADD TAX RATES</h4>

            <font style="color:#333;">Please fill in the information below. The field labels marked with * are required input fields.</font>

            </div>

            <div class="modal-body">

            <div class="row form-group">

             <div class="col-md-12">

                    <h5>Name *</h5>

                    <p>

                    <input type="text" class="form-control" value="<?php echo $id; ?>" name="tax_name" id="tax_name">

                    </p>

                    <h5>Code *</h5>

                    <p>

                    <input type="text" class="form-control" name="cat_name" id="cat_name">

                    </p>

                    <h5>Rate *</h5>

                    <p>

                    <input type="text" class="form-control" name="cat_name" id="cat_name">

                    </p>

                    <h5>Type *</h5>

                    <p>

                    <select id="form-field-select-3" class="form-control">

                                <option value="">&nbsp;</option>

                                <option value="AL">Alabama</option>

                                <option value="AK">Alaska</option>

                                <option value="AZ">Arizona</option>

                             </select>

                    </p>

                    

                                <div class="modal-footer">

            <input type="submit" name="add_category" value="Add Tax Rates" class="btn btn-primary">

            </div>

            </div>

            </div>

            </div>



  </form>

		<!-- start: JAVASCRIPTS REQUIRED FOR THIS PAGE ONLY VALIDATION-->

		<script src="<?php echo asset_url(); ?>js/form-validation-tax_rates.js"></script>

		<!-- end: JAVASCRIPTS REQUIRED FOR THIS PAGE ONLY  VALIDATION-->

                        

		<script>

			jQuery(document).ready(function() {

				FormValidator.init();

			});

		</script>          

