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add-standard_driver_card.html
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<!DOCTYPE html>
<!--[if lt IE 7]> <html class="no-js lt-ie9 lt-ie8 lt-ie7" lang="en"> <![endif]-->
<!--[if IE 7]> <html class="no-js lt-ie9 lt-ie8" lang="en"> <![endif]-->
<!--[if IE 8]> <html class="no-js lt-ie9" lang="en"> <![endif]-->
<!--[if gt IE 8]><!--> <html class="no-js" lang="en"> <!--<![endif]-->
<head>
<base href="../../">
<meta charset="utf-8">
<!-- Use the .htaccess and remove these lines to avoid edge case issues.
More info: h5bp.com/i/378 -->
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<title></title>
<meta name="description" content="">
<meta name="author" content="">
<meta name="viewport" content="width=device-width, minimum-scale=1, maximum-scale=1">
<link rel="stylesheet" href="css/application.css">
<link rel="stylesheet" href="css/brand.css">
<link rel="sitemap" type="application/xml" title="Sitemap" href="/sitemap.xml" />
<!-- All JavaScript at the bottom, except this Modernizr build. -->
<script src="js/vendor/modernizr.custom.82447.js"></script>
<script src="js/WEX.js"></script>
</head>
<body>
<div class="container" data-page="cards">
<div class="ui-panel">
<header>
<h2>Add Card - Standard Driver Card</h2>
</header>
<div class="padding-all">
<div class="row">
<div class="span8 well">
<p>Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cras dolor velit, varius a mattis a, dictum in diam. Duis nibh sapien, sodales ac fermentum id, tempor nec augue. Sed tristique elit et sapien eleifend sodales. Nulla facilisi.</p>
</div>
</div>
</div>
<form action="#" class="form-horizontal">
<div class="padding-sides">
<fieldset>
<legend class="margin-no-bottom">Available Products</legend>
<div class="control-group">
<p>Please select products that are available for purchase:</p>
<div class="controls">
<label class="radio">
<input type="radio" name="available_products" value="all" checked>
Fuel, Service and Other miscellaneous items
</label>
<label class="radio">
<input type="radio" name="available_products" value="both">
Fuel and Service
</label>
<label class="radio">
<input type="radio" name="available_products" value="fuel">
Fuel Only
</label>
</div>
<div id="fuel_only" class="controls margin-top margin-left">
<label class="checkbox">
<input type="checkbox" name="diesel_only">
For fuel, allow Diesel fueld purchase only.
</label>
</div>
</div>
</fieldset>
<fieldset>
<legend class="margin-no-bottom">Driver Information</legend>
<div class="control-group">
<label class="control-label required" for="">Driver ID:</label>
<div class="controls"><input type="text" required></div>
</div>
<div class="control-group">
<label class="control-label required" for="">First Name:</label>
<div class="controls"><input type="text" required></div>
</div>
<div class="control-group">
<label class="control-label" for="">Middle Name:</label>
<div class="controls"><input type="text"></div>
</div>
<div class="control-group">
<label class="control-label required" for="">Last Name:</label>
<div class="controls"><input type="text" required></div>
</div>
<div class="control-group">
<label class="control-label required" for="">Embossing on Card:</label>
<div class="controls">
<input type="text" placeholder="18 character max" required>
<p class="help-block">Note: It is suggested that you use the cardholder name.</p>
</div>
</div>
</fieldset>
</div>
<div class="form-actions padding-sides">
<a href="#" class="pull-left">Cancel</a>
<button class="btn btn-primary btn-large pull-right">Next</button>
</div>
</form>
</div>
</div>
</body>
</html>