<input type="hidden" name="pagesub" value="thongtin">
<input type="hidden" name="invoice_id" value="{_INVOICE_ID_}">
<div class="pane_block100">
    <div
        style="clear:both;width: 100%;background-color: #FFC;margin-bottom: 4px; -moz-box-sizing:border-box;box-sizing:border-box;">
        <div id="idreceiver" class="inputex" style="width: 100%;"></div>
    </div>
    <input type="text" name="receiver_name" class="input_invoice" value="" style="width: 50%;float: left;"
        placeholder="+tên mới">
    <input type="text" name="receiver_phone" class="input_invoice" value="" style="width: 50%;float:right;"
        placeholder="+điện thoại"><br>
    <input type="text" name="receiver_address" class="input_invoice" value=""
        style="width: 100%;margin-top:4px;float: left;" placeholder="+địa chỉ">
</div>
<div class="pane_block100">
    Giao hàng trước thời điểm <br>
    <input class="date input_invoice" id="date_delivery_max" name="date_delivery_max" type="text"
        style="float: right;width: 100%;font-weight: bold;" onclick="javascript:NewCssCal('date_delivery_max')"
        value="{_DDM_}">
</div>
<div class="pane_block100">
    <div
        style="clear:both;width: 100%;background-color: #FFC;margin-bottom: 4px; -moz-box-sizing:border-box;box-sizing:border-box;">
        <div id="idshipping_office" class="inputex" style="width: 100%;"></div>
    </div>

    <input type="text" name="shipping_office_name" class="input_invoice" value="" style="width: 50%;float: left;"
        placeholder="+tên mới">
    <input type="text" name="shipping_office_phone" class="input_invoice" value="" style="width: 50%;float:right;"
        placeholder="+điện thoại">
    <input type="text" name="shipping_office_address" class="input_invoice" value="" style="width: 100%;float: left;"
        placeholder="+địa chỉ">
</div>
<div class="pane_block100">
    <div
        style="clear:both;width: 100%;background-color: #FFC;margin-bottom: 4px; -moz-box-sizing:border-box;box-sizing:border-box;">
        <div id="idshipper" class="inputex" style="width: 100%;"></div>
    </div>

    <input type="text" name="shipper_name" class="input_invoice" value="" style="width: 50%;float: left;"
        placeholder="+tên mới">
    <input type="text" name="shipper_phone" class="input_invoice" value="" style="width: 50%;float:right;"
        placeholder="+điện thoại">
</div>
<div class="pane_block100">
    <textarea name="comment" style="width: 100%;" value="{_CMT_}" placeholder="Ghi chú"> </textarea>
</div>
<div style="clear: both;width: 100%;">
    <input type="submit" class="btndlg ok" value="Ghi" name="B1" style="width:100%;float:right">
</div>