<?php
/**
 * Created by PhpStorm.
 * User: roysinclair
 * Date: 2016/02/29
 * Time: 8:33 AM
 */
?>
<div class="row">
    <div class="<?php echo $boxSize ?>">
        <div class='circle-small'>
            <h5 class='margin-top-30' style='color:#fff;'>Questions?</h5>
            <p class='small text-center' style='color:#fff;'>Please don't hesitate to contact us if you have any queries</p>
            <h5 style='color:#fff;'>business@sabullion.co.za</h5>
            <h5 style='color:#fff;'>+21 21 447 3240</h5>
        </div>
        <h1 class="text-center">Login Details</h1>
        <h5 class="text-center">Please fill in your login details below <br> to become a Client</h5>
        <form role="form">
            <div class="form-body padding-top35px">
                <input type="hidden" name="emailAddress" value="<?php echo $_REQUEST["email"] ?>" id='emailAddress'>
                <div class="form-group form-md-line-input form-md-floating-label">
                    <input type="email" class="form-control input-lg" value="<?php echo $_REQUEST["email"] ?>" disabled>
                    <label for="form_control_1">Email Address</label>
                    <!-- <span class="help-block hiddenContent"></span> -->
                </div>
                <div class="form-group form-md-line-input form-md-floating-label" id="password">
                    <input type="password" class="form-control input-lg" value="">
                    <label for="form_control_1">Password</label>  
                    <span class="help-block hiddenContent"></span>
                </div>
                <div class="form-group form-md-line-input form-md-floating-label" id="confirmPassword">
                    <input type="password" class="form-control input-lg" value="">
                    <label for="form_control_1">Re-type Password</label>
                    <span class="help-block hiddenContent"></span>
                </div>
            </div>
            <div class="form-actions noborder">
                <div class="padding-top52px"></div>
                <button type="button" class="btn purple btn-lg" id="setPassword">Continue</button>
            </div>
        </form>
    </div>
</div>