<div class="block">
    <div class="content controls">
      <div class="form-row">
        <div class="col-md-2"><label>Nr. Loja</label></div>
        <div class="col-md-2"><input type=number name="nr_loja" id="nr_loja" class=" form-control" maxlength="04" size=4/></div>
        <div class="col-md-1"><label>Status</label></div>
        <div class="col-md-1">
          <div class="checked inline"><label> <input type=radio class= name=st_acao_ativo value="1"/> Sim </label></div>
        </div>
        <div class="col-md-1">
          <div class="checked inline"><label> <input type=radio class= name=st_acao_ativo value="0"/> Não </label></div>
        </div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>Razão Social</label></div>
        <div class="col-md-10"><input type=text name="ds_social" id="ds_social" class=" form-control" maxlength="100"/></div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>Nome Fantasia</label></div>
        <div class="col-md-6"><input type=text name="nm_fantasia" id="nm_fantasia" class=" form-control" maxlength="40"/></div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>CEP</label></div>
        <div class="col-md-2">
          <div class="input-group">
            <input type=text name="id_cep" id="id_cep" maxlenght="8" size="4" class="mask_cep">
            <div class="input-group-addon">
            <a href="helper-cep.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-value="#id_cep" data-description="#ds_endereco" data-title="Selecione:">
            <span class="fa fa-search"></span></a>
          </div>
          </div>
        </div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>Endereço</label></div>
        <div class="col-md-10"><input type=text name="ds_endereco" id="ds_endereco" class=" form-control" maxlength="100"/></div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>Bairro</label></div>
        <div class="col-md-4"><input type=text name="nm_bairro" id="nm_bairro" class=" form-control" maxlength="60"/></div>
      </div>

      <div class="form-row">
        <div class="col-md-2"><label>UF</label></div>
        <div class="col-md-2">
            <div class="input-group">
            <input name="ds_uf" id="ds_uf" class=" form-control" maxlength="2"/>
            <div class="input-group-addon">
              <a href="helper-descricao-uf.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-value="#ds_uf" data-description="#ds_estado" data-title="Selecione:">
              <span class="fa fa-search"></span></a>
            </div>
            </div>
        </div>
            <div class="col-md-2"><input name="ds_estado" id="ds_estado" readonly/></div>
      </div>

    <div class="row clear">&nbsp;</div>
    <div class="form-row">
      <div class="col-md-2"><label>Município</label></div>
      <div class="col-md-2">
        <div class="input-group">
          <input type=number name="id_municipio" id="id_municipio" maxlenght="10" size="4">
            <div class="input-group-addon">
            <a href="helper-id-municipio.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-parameter="" data-value="#id_municipio" data-description="#ds_municipio" data-title="Selecione:">
            <span class="fa fa-search"></span></a>
            </div>
         </div>
      </div>
      <div class="col-md-2"><input name="ds_municipio" id="ds_municipio" readonly></div>

    </div>

    <div class="form-row">
      <div class="col-md-2"><label>Pais</label></div>
      <div class="col-md-2">
        <div class="input-group">
        <input type=number name="id_pais" id="id_pais"/>
        <div class="input-group-addon">
          <a href="helper-paises-bacen.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-value="#id_pais" data-description="#ds_pais" data-title="Selecione:">
          <span class="fa fa-search"></span></a>
        </div>
        </div>
      </div>
      <div class="col-md-2"><input name="ds_pais" id="ds_pais" readonly/></div>

    </div>


    <div class="form-row">
      <div class="col-md-2"><label>Cx.Postal</label></div>
      <div class="col-md-1"><input type=number name="nr_cxpostal" id="nr_cxpostal"/></div>
      <div class="col-md-3">&nbsp;</div>
      <div class="col-md-1"><label>Tipo</label></div>
      <div class="col-md-2">
              <select name="id_tipo" id="tp_conversao">
                <option value="F">F - Fisico</option>
                <option value="J">J - Juridico</option>
                <option value="X">X - Outros</option>
              </select>
      </div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>CNPJ</label></div>
      <div class="col-md-4"><input name="nr_cnpj" id="nr_cnpj" class="mask_cnpj"/></div>

      <div class="col-md-1"><label>RG</label></div>
      <div class="col-md-4"><input type=number name="nr_rg" id="nr_rg"></div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>DDI</label></div>
      <div class="col-md-1"><input type=number name="nr_ddi" id="nr_ddi" maxlength="02"></div>
      <div class="col-md-2"><label>DDD</label></div>
      <div class="col-md-1"><input type=number name="nr_ddd" id="nr_ddd" maxlength="02"></div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>Telefone</label></div>
      <div class="col-md-2"><input type=number name="nr_telefone" id="nr_telefone" maxlength="09" class="mask_nr_tel"></div>

      <div class="col-md-2">&nbsp;</div>
      <div class="col-md-2"><label>Fax</label></div>
      <div class="col-md-2"><input type=text name="nr_fax" id="nr_fax" class="mask_nr_tel"/></div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>Insc. Estadual</label></div>
      <div class="col-md-3"><input type=number name="nr_iestadual" id="nr_iestadual"/></div>

      <div class="col-md-1">&nbsp;</div>
      <div class="col-md-2"><label>Insc. Municipal</label></div>
      <div class="col-md-3"><input type=number name="nr_imunicipal" id="nr_imunicipal"/></div>
     </div>

     <div class="form-row">
       <div class="col-md-2"><label>E-mail</label></div>
       <div class="col-md-3"><input type=text name="id_email" id="id_email" maxlength="40"/></div>

       <div class="col-md-1">&nbsp;</div>
       <div class="col-md-2"><label>Departamento</label></div>
       <div class="col-md-3"><input type=text name="ds_depto" id="ds_depto" maxlength="40"/></div>
     </div>

    <div class="form-row">
      <div class="col-md-2"><label>Home Page</label></div>
      <div class="col-md-3"><input name="ds_homepage" id="ds_homepage" maxlength="100"/></div>

      <div class="col-md-1">&nbsp;</div>
      <div class="col-md-2"><label>Nr.Telex</label></div>
      <div class="col-md-1"><input type=number name="nr_telex" id="nr_telex" maxlength="20"/></div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>CBO</label></div>
      <div class="col-md-1"><input type=number name="id_cbo" id="id_cbo"/></div>

      <div class="col-md-1">&nbsp;</div>
      <div class="col-md-2"><label>CNAE</label></div>
      <div class="col-md-1"><input type=number name="id_cnae" id="id_cnae"/></div>
    </div>

    <div class="row clear">&nbsp;</div>
    <div class="form-row">
      <div class="col-md-2"><label>Complemento</label></div>
      <div class="col-md-6"><input name="ds_complemento" id="ds_complemento" maxlength="100"/></div>
    </div>
</div>
</div>

    <!-- modal do helper -->
    <div class="row-clear">&nbsp;</div>
    <div class="modal modal-white modal-draggable fade" id="helper-modal-div" tabindex="-1" role="dialog" aria-labelledby="helper-modal-label" aria-hidden="true">
      <div class="modal-dialog modal-lg">
        <div class="modal-content">
          <div class="modal-header">
            <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
            <h4 class="modal-title" id="helper-modal-label">Helper</h4>
          </div>
          <div class="modal-body">
            ...
          </div>
          <div class="modal-footer">
            <button type="button" class="btn btn-default" data-dismiss="modal" id="modalCancel">Cancelar</button>
            <button type="button" class="btn btn-primary" data-dismiss="modal" id="modalOk" disabled="disabled">Selecionar</button>
          </div>
        </div>
      </div>
    </div>
