<div class="inline-field card card-body bg-light mb-3"> <div class="pull-right"> <a href="javascript:void(0)" class="inline-remove-field"><span class="fa fa-times glyphicon glyphicon-remove"></span></a> </div> <div class="row"> <div class="inline-form-field"> <input id="id" name="id" type="hidden" value=""> <div class="form-row"> <div class="form-group col"> <label for="club" class="col-form-label ">Клуб <strong class="text-danger">&#42;</strong> </label> <select class="form-control" column_class="col" data-role="select2" id="club" name="club" required><option value="5">Зеленоград-1</option><option value="9">Братиславская</option><option value="16">Жулебино</option><option value="6">Зеленоград-2</option><option value="20">Кожухово</option><option value="21">Королёв</option><option value="19">Краснодар</option><option value="10">Куркино</option><option value="15">Курск</option><option value="14">Люберцы</option><option value="13">Люблино</option><option value="12">Оренбург</option><option value="7">Реутов</option><option value="8">Реутов-2</option><option value="17">Самара</option><option value="11">Ховрино</option><option value="22">Чебоксары</option><option value="18">Южное Бутово</option><option value="23">Северное Измайлово</option></select> </div> <div class="form-group col"> <label for="discount_amount" class="col-form-label ">Номинал сертификата &nbsp; </label> <input class="form-control" column_class="col" id="discount_amount" min="0" name="discount_amount" type="number" value="0"> </div> </div> <div class="form-group "> <label for="raw_codes" class="col-form-label ">Коды &nbsp; </label> <textarea class="form-control" id="raw_codes" name="raw_codes"> </textarea> </div> </div> </div> </div>