ADI #:

Model #:

Account #:

Customer Address*

</div>
                </div>

<div class="input-wrap">
                    <label id="lbl_name_{{$index}}" class="mobile-content">Contact Name*</label>
                    <div class="mobile-content">
                        <input id="cartLinesNameInputEditable_{{$index}}"
                               value="{{vm.billTo.firstName}} {{vm.billTo.lastName}}"
                               type="text"
                               ng-model-options="{ updateOn: 'blur' }" />
                    </div>
                </div>

<div class="input-wrap">
                    <label id="lbl_product_{{$index}}" class="mobile-content">Product*</label>
                    <div class="mobile-content">
                        <select data-rule-required="true" id="productselect_{{$index}}" class="w-60p" ng-change="vm.productChange(product, $index)" ng-model="product" ng-init="product=0" ng-required="required">
                            <option value="0"> Select One</option>
                            <option value="Software License">Software License</option>
                            <option value="Pole">Pole</option>
                        </select>
                        <input id="cartLinesPoleColorInputEditable_{{$index}}" type="text" class="input mt-10" ng-blur="vm.addPlaceHolder('PoleColor',$index)" ng-click="vm.removePlaceHolder('PoleColor',$index)" placeholder='Pole Color Required' style="display:none;" />
                        <input type="hidden" id="hdnCartLinesPoleColorInputEditable_{{$index}}" value='Pole Color Required' />

</div>
                </div>

</div>
            <hr />
            <div>
                <div>
                    <div class="row btns">
                        <button ng-click="vm.AddPopUpData(true)" class="btn primary submitButton btn-class" type="button">
                            Submit
                        </button>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>

Order Information Required