<div class="modal fade" id="recRef" style="background-color:rgb(255, 255, 255, 0.0);">
    <div class="modal-dialog modal-lg modal-md">
      <div class="modal-content">
      
        <!-- Modal Header -->
        <div class="modal-header">
          <img src="{{asset('img/logo_CIE.png')}}" alt="" width="70px"><h5 class="modal-title ml-5">Rectificar referencia</h5>
          <button type="button" class="close" data-dismiss="modal">×</button>
        </div>
        
        <!-- Modal body -->
        <div class="modal-body">
          <div class="container">

            <form action="">
              <div class="row">

                <div class="col-md-12">
                  <label for="">Cliente</label>
                  <div class="input-group flex-nowrap">
                    <div class="input-group-prepend">
                      <span class="input-group-text" id="addon-wrapping" style="font-size:15px;"><i class="icon-user"></i></span>
                    </div>
                    <input type="text" disabled class="form-control inputs-rec-ref">
                  </div>
                </div>

                <div class="col-md-12 mt-5">
                  <div class="input-group flex-nowrap">
                    <div class="input-group-prepend">
                      <span class="input-group-text" id="addon-wrapping" style="font-size:15px;"><i class="icon-calendar"></i></span>
                    </div>
                    <input type="text" disabled class="form-control col-md-3 inputs-rec-ref">
                    <div class="input-group-prepend">
                      <span class="input-group-text" id="addon-wrapping" style="font-size:15px;"><i class="icon-box"></i></span>
                    </div>
                    <input type="text" disabled class="form-control col-md-4 inputs-rec-ref">
                    <div class="input-group-prepend">
                      <span class="input-group-text" id="addon-wrapping" style="font-size:15px;"><i class="icon-directions_ferry"></i></span>
                    </div>
                    <input type="text" disabled class="form-control col-md-4 inputs-rec-ref">
                  </div>
                </div>

                <div class="col-md-12">
                  <table class="table tab table-bordered">
                    <tr class="tab">
                      <th class="tab"></th>
                      <th class="tab"></th>
                    </tr>
                    <tr class="tab">
                      <th class="tab"></th>
                      <th class="tab"></th>
                    </tr>
                    <tr class="tab">
                      <th class="tab"></th>
                      <th class="tab"></th>
                    </tr>
                    <tr class="tab">
                      <th class="tab"></th>
                      <th class="tab"></th>
                    </tr>
                    <tr class="tab">
                      <th class="tab"></th>
                      <th class="tab"></th>
                    </tr>
                  </table>
                </div>

                <div class="col-md-12">
                  <label for="">Especificar rectificación: *</label>
                  <textarea class="form-control" style="border:#a3a3a3 solid 0.5px; border-bottom:2px #a3a3a3 solid;" required cols="100" maxlength="100" rows="5"></textarea>
                </div>

                <div class="col-md-12">
                  <label for="">Con cargo a: *</label><br>
                  <select class="form-control" style="border:#a3a3a3 solid 0.5px; border-bottom:2px #a3a3a3 solid;">
                    <option value="">Cliente</option>
                    <option value="">Empledo</option>
                    <option value="">Empresa</option>
                  </select>
                </div>

                <style>
                  .tab{
                    border: #c4c4c4 2px solid;
                  }
                </style>
              </div>
            </form>

          </div>
        </div>
        
        <!-- Modal footer -->
        <div class="modal-footer">
          <button type="button" class="btn btn-danger" data-dismiss="modal">Cerrar</button>
        </div>
        
      </div>
    </div>
</div>
