| Company Name : | |
| Product Name: | |
| Product Package: | |
| Seles Price: | |
| Sales Person: | |
| Head Office: | |
| Branch: | |
| Service Charge: | |
| Service Person: | |
| Head Office: | |
| Branch: | |
{!! Form::button('
Close',['class' => 'btn btn-danger pull-right closeBtn', 'data-dismiss' => 'modal' , 'id' => 'footer_action_button_dismis'] ) !!}