<%=t('callback_request.description')%> <%= form_for @request, :remote=> true, :html=>{class: "form-horizontal", role: "form"} do |f| %> <%= hidden_field_tag :modal, @modal %> <% if @request.errors.any? %>

<%=t 'callback_request.errors', n: pluralize(@request.errors.count, "error") %>

<%= message %>

<% end %>

<%= f.label :name, t('callback_request.fields.name'), class: "col-sm-2 control-label" %>

<%= f.text_field :name, :class=>'form-control' %>

<%= f.label :phone, t('callback_request.fields.phone'), class: "col-sm-2 control-label" %>

<%= f.text_field :phone, :class=>'form-control' %>

<%= f.label :notes, t('callback_request.fields.notes'), class: "col-sm-2 control-label" %>

<%= f.text_area :notes, :class=>'form-control' %>

<%-# = f.submit t('callback_request.submit'), :class=>'btn btn-primary' -%>

<% end %>