<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('First')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-first" data-rule="required" min="0" class="form-control" name="row[first]" type="number" value="{$row.first|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('First_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-first_fee" data-rule="required" min="0" class="form-control" step="0.01" name="row[first_fee]" type="number" value="{$row.first_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('First_rider_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-first_rider_fee" data-rule="required" min="0" class="form-control" step="0.01" name="row[first_rider_fee]" type="number" value="{$row.first_rider_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Additional')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-additional" data-rule="required" min="0" class="form-control" name="row[additional]" type="number" value="{$row.additional|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Additional_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-additional_fee" data-rule="required" min="0" class="form-control" step="0.01" name="row[additional_fee]" type="number" value="{$row.additional_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Additional_rider_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-additional_rider_fee" data-rule="required" min="0" class="form-control" step="0.01" name="row[additional_rider_fee]" type="number" value="{$row.additional_rider_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Max_distance')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-max_distance" data-rule="required" min="0" class="form-control" step="1" name="row[max_distance]" type="number" value="{$row.max_distance|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Delivery_threshold')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-delivery_threshold" data-rule="required" min="0" class="form-control" step="1" name="row[delivery_threshold]" type="number" value="{$row.delivery_threshold|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>