<form action="index.php?module=wprequest&class=wage&event=[% if $Wage.WarrantyRequestWageID %]edit[% else %]create[% /if %]" method="post" name="hm" class="form-horizontal form-label-left">
    <div class="panel panel-fcs-border">
        <div class="panel-heading">
            <div class="row">
                <div class="col-sm-6">
                    <span class="fcs-card-title h2">[% $user->gettext('Kostenartikel hinzufügen') %]</span>
                </div>
                <div class="col-sm-6 text-right">
                    <div class="btn-group">
                        <input type="button" onclick="window.location.href = 'index.php?module=wprequest&class=wage';" value="[% $user->gettext('Liste') %]" class="btn btn-outline-secondary"  />
                        <input type="submit" value="[% $user->gettext('Speichern') %]" class="btn btn-outline-primary"  />
                    </div>
                </div>
            </div>
        </div>
        <div class="panel-body">

            <input type="hidden" name="WarrantyRequestWageID" value="[% $Wage.WarrantyRequestWageID %]" />

            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Händler Nr') %] *</label>
                <div class="col-lg-8">
                    <input type="text" name="Wage[DealerID]"  maxlength="255" value="[% $Wage.DealerID %]" class="form-control required"  required="required" />
                </div>
            </div>

            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Bezeichnung') %] *</label>
                <div class="col-lg-8">
                    <input type="text" name="Wage[Description]"  maxlength="255" value="[% $Wage.Description %]" class="form-control required"  required="required" />
                </div>
            </div>
            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Arbeit') %] *</label>
                <div class="col-lg-8">
                    <input type="number" name="Wage[WorkPrice]"  step="0.01" value="[% $Wage.WorkPrice %]" class="form-control required"  required="required" />
                </div>
            </div>
            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Reise') %] *</label>
                <div class="col-lg-8">
                    <input type="number" name="Wage[TravelPrice]" step="0.01" value="[% $Wage.TravelPrice %]" class="form-control required"  required="required" />
                </div>
            </div>
            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Km') %] *</label>
                <div class="col-lg-8">
                    <input type="number" name="Wage[KmPrice]" step="0.01" value="[% $Wage.KmPrice %]" class="form-control required"  required="required" />
                </div>
            </div>

            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Max Km') %]</label>
                <div class="col-lg-8">
                    <input type="number" name="Wage[maxKm]" value="[% $Wage.maxKm %]" class="form-control" />
                </div>
            </div>

            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Hinweis') %]</label>
                <div class="col-lg-8">
                    <input type="text" name="Wage[HintText]"  maxlength="200" value="[% $Wage.HintText %]" class="form-control" />
                </div>
            </div>

            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Gültig von') %]</label>
                <div class="col-lg-8">
                    <input type="date" name="Wage[ValidFrom]" value="[% $Wage.ValidFrom|date_format:"%Y-%m-%d" %]" class="form-control" />
                </div>
            </div>
            <div class="form-group row mb-3">
                <label class="col-lg-4 control-label">[% $user->gettext('Gültig bis') %]</label>
                <div class="col-lg-8">
                    <input type="text" name="Wage[ValidUntil]" value="[% $Wage.ValidUntil|date_format:"%Y-%m-%d" %]" class="form-control" />
                </div>
            </div>
        </div>
    </div>
</form>
