<div class="context-main-bg context-main p-3">
    <legend class="text-center">Create Membership Product</legend>
    <hr>
    {ADMIN_BREADCRUMBS}
    <form action="" method="post">
        <fieldset>
            <!-- Name -->
            <div class="mb-3 row">
                <label for="name" class="col-lg-3 col-form-label text-end">Name:</label>
                <div class="col-lg-6">
                    <input type="text" class="form-control" name="name" id="name" value="{name}">
                </div>
            </div>
            <!-- Monthly Price -->
            <div class="mb-3 row">
                <label for="monthly_price" class="col-lg-3 col-form-label text-end">Monthly Price:</label>
                <div class="col-lg-6">
                    <input type="number" class="form-control" name="monthly_price" id="monthly_price" value="{monthly_price}">
                    <small class="form-text text-muted">Integer required: $4.99 : 499</small>
                </div>
            </div>

            <!-- Yearly Price -->
            <div class="mb-3 row">
                <label for="yearly_price" class="col-lg-3 col-form-label text-end">Yearly Price:</label>
                <div class="col-lg-6">
                    <input type="number" class="form-control" name="yearly_price" id="yearly_price" value="{yearly_price}">
                    <small class="form-text text-muted">Integer required: $4.99 : 499</small>
                </div>
            </div>


            <!-- Description -->
            <div class="mb-3 row">
                <label for="description" class="col-lg-3 col-form-label text-end">Description:</label>
                <div class="col-lg-6">
                    <textarea class="form-control" name="description" id="description" rows="6" maxlength="2000" required>{description}</textarea>
                    <small class="form-text text-muted">Max: 2000 characters</small>
                </div>
            </div>

            <!-- Hidden Token -->
            <input type="hidden" name="token" value="{TOKEN}">
        </fieldset>

        <!-- Submit Button -->
        <div class="text-center">
            <button type="submit" name="submit" value="submit" class="btn btn-primary btn-lg center-block">Send</button>
        </div>
    </form>
</div>