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42 lines
1.3 KiB
42 lines
1.3 KiB
- disabled ||= false
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.form-horizontal
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.form-group
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= f.label "Name of Agency:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :agency_name, class: "form-control", disabled: disabled
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.form-group
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= f.label "Contact Name:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :contact_name, class: "form-control", disabled: disabled
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.form-group
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= f.label "Street Address:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :street_address, class: "form-control", disabled: disabled
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.form-group
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= f.label "City:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :city, class: "form-control", disabled: disabled
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.form-group
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= f.label "State:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :state, class: "form-control", disabled: disabled
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.form-group
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= f.label "Postal Code:", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :postal_code, class: "form-control", disabled: disabled
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.form-group
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= f.label "Phone Number", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :phone_number, class: "form-control", disabled: disabled
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.form-group
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= f.label "email", class: "col-sm-2 control-label"
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.col-sm-10
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= f.text_field :email, class: "form-control", disabled: disabled
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