<div class="block">
<div class="content controls">
   <div class="form-row">
     <div class="col-md-2"><label>Sit. Trib. PIS</label></div>
     <div class="col-md-2">
       <div class="input-group">
        <input name="erpc_dom_sit_trib_pis_id" id="erpc_dom_sit_trib_pis_id" size="4"/>
           <div class="input-group-addon">
           <a href="erpc_dom_sit_trib_pis_helper.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-value="#erpc_dom_sit_trib_pis_id" data-description="#ds_sit_trib_pis" data-title="Selecione:">
             <span class="fa fa-search"></span></a>
           </div></div>
      </div>
      <div class="col-md-4"><input id="ds_sit_trib_pis" readonly/></div>
    </div>

    <div class="form-row">
      <div class="col-md-2"><label>Sit. Trib. COF</label></div>
      <div class="col-md-2">
        <div class="input-group">
         <input name="erpc_dom_sit_trib_cof_id" id="erpc_dom_sit_trib_cof_id" size="4"/>
            <div class="input-group-addon">
            <a href="erpc_dom_sit_trib_cof_helper.php" class='input-helper' data-remote="false" data-toggle="modal" data-target="#helper-modal-div" data-value="#erpc_dom_sit_trib_cof_id" data-description="#ds_sit_trib_cof" data-title="Selecione:">
              <span class="fa fa-search"></span></a>
            </div></div>
       </div>
       <div class="col-md-4"><input id="ds_sit_trib_cof" readonly/></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>
