<fieldset>
	<legend>ADSL Service Details</legend>

	<div class="row">
		<?php echo Form::input('plugin[service_number]',$o->service_number,array('class'=>'span2','label'=>'Service Number','placeholder'=>'Service Number')); ?>
	</div> <!-- /row -->

	<div class="row">
		<?php echo Form::input('plugin[service_address]',$o->service_address,array('class'=>'span6','label'=>'Service Address','placeholder'=>'Service Address')); ?>
	</div> <!-- /row -->

	<div class="row">
		<div class="input-append date" id="service_connect_date_label">
			<?php echo Form::input('service_connect_date_label',$o->display('service_connect_date'),array('class'=>'span2','label'=>'Service Connected','add-on'=>'<i class="icon-calendar"></i>','disabled')); ?>
		</div>

		<?php echo Form::hidden('plugin[service_connect_date]',$o->service_connect_date,array('id'=>'service_connect_date')); ?>
	</div> <!-- /row -->

	<div class="row">
		<div class="input-append date" id="service_contract_date_label">
			<?php echo Form::input('service_contract_date_label',$o->display('service_contract_date'),array('class'=>'span2','label'=>'Contract Start Date','add-on'=>'<i class="icon-calendar"></i>','disabled')); ?>
		</div>

		<?php echo Form::hidden('plugin[service_contract_date]',$o->service_contract_date,array('id'=>'service_contract_date')); ?>
	</div> <!-- /row -->

	<div class="row">
		<?php echo Form::input('plugin[service_username]',$o->service_username,array('class'=>'span6','label'=>'Service Username','placeholder'=>'Service Username')); ?>
	</div> <!-- /row -->

	<div class="row">
		<?php echo Form::input('plugin[service_password]',$o->service_password,array('class'=>'span6','label'=>'Service Password','placeholder'=>'Service Password')); ?>
	</div> <!-- /row -->

	<div class="row">
		<?php echo Form::input('plugin[ipaddress]',$o->ipaddress,array('class'=>'span6','label'=>'Service IP Address','placeholder'=>'Service IP Address')); ?>
	</div> <!-- /row -->
</fieldset>
