<div class="modal-content">
    <div class="modal-header">
        <h5 class="modal-title"><?php echo @$title ?></h5>
        <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
    </div>
    <div class="modal-body">
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Tanggal Bayar</label>
            <div class="col-sm-3">
                <input type="date" class="form-control" id="tanggal" name="tanggal" value="<?php echo @$tanggal ?>" required>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Kode Masuk</label>
            <div class="col-sm-9">
                <input type="text" class="form-control" id="kode" name="kode" value="<?php echo @$kode ?>" readonly>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Nomor Nota</label>
            <div class="col-sm-9">
                <input type="text" class="form-control" id="nota" name="nota" value="<?php echo @$nota ?>" readonly>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Jumlah Hutang</label>
            <div class="col-sm-9">
                <input type="text" class="form-control" id="hutang" name="hutang" value="<?php echo @$hutang ?>" readonly>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Sisa</label>
            <div class="col-sm-9">
                <input type="text" class="form-control" id="sisa" name="sisa" value="<?php echo @$sisa ?>" readonly>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Jumlah Bayar</label>
            <div class="col-sm-9">
                <input type="number" class="form-control" id="bayar" name="bayar" autofocus required>
            </div>
        </div>
        <div class="form-group row">
            <label class="col-sm-3 col-form-label">Keterangan</label>
            <div class="col-sm-9">
                <textarea class="form-control" id="keterangan" name="keterangan"></textarea>
            </div>
        </div>
    </div>
    <input type="hidden" name="id" id="id" value="<?php echo @$id ?>">
    <div class="modal-footer right-content-between">
        <button type="submit" class="btn bg-gradient-success"><i class="fa fa-save"></i> Bayar</button>
        <button type="button" class="btn bg-gradient-danger" data-dismiss="modal"><i class="fa fa-times"></i> Batal</button>
    </div>
</div>