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<div class="modal fade" id="request-information-modal" tabindex="-1" role="dialog" aria-labelledby="request-information-modal-label" aria-hidden="true">
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
<h4 class="modal-title" id="request-information-modal-label">request-information</h4>
</div>
<div class="modal-body">
<form id="request_information_form" role="form" action="" method="POST">
<div class="form-group">
<label for="notification_url">notification-url</label>
<input type="text" class="form-control" name="notification_url" id="notification_url">
</div>
<div class="form-group">
<label for="source">source</label>
<input type="text" class="form-control" name="source" id="source">
</div>
<div class="form-group">
<label for="order_number">order-number</label>
<input type="text" class="form-control" name="order_number" id="order_number">
</div>
<div class="form-group">
<label for="request_id">request-id</label>
<input type="text" class="form-control" name="request_id" id="request_id">
</div>
<div class="form-group">
<label for="order_version">order-version</label>
<input type="text" class="form-control" name="order_version" id="order_version">
</div>
<div class="form-group">
<label for="request_action">request-action</label>
<input type="text" class="form-control" name="request_action" id="request_action">
</div>
<div class="form-group">
<label for="request_sub_action">request-sub-action</label>
<input type="text" class="form-control" name="request_sub_action" id="request_sub_action">
</div>
<!--
<div class="form-group">
<input type="hidden" name="uf_action" id="uf_action">
<button type="button" class="btn btn-primary" onclick="submit(this.form);">Submit</button>
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
</div>
-->
</form>
</div>
</div>
</div>
</div>
<script type="text/javascript">
function submit(form){
$('#service-status-modal').modal('hide');
form.action = form.uf_action.value;
form.submit();
return;
}
</script>
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