cityssm/lottery-licence-manager

<div class="modal">
  <div class="modal-background"></div>
  <div class="modal-card">
    <header class="modal-card-head">
      <h3 class="modal-card-title">Update a Bank Record</h3>
      <button class="delete is-close-modal-button" aria-label="close" type="button"></button>
    </header>
    <section class="modal-card-body">
      <form id="form--bankRecordEdit">
        <input id="bankRecordEdit--organizationID" name="organizationID" type="hidden" value="" />
        <input id="bankRecordEdit--recordIndex" name="recordIndex" type="hidden" value="" />

        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="bankRecordEdit--accountNumber">Account Number</label>
              <div class="control">
                <input class="input" id="bankRecordEdit--accountNumber" name="accountNumber" type="text" maxlength="20" autocomplete="off" required />
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label class="label" for="bankRecordEdit--bankingYear">Banking Year</label>
              <div class="control">
                <input class="input" id="bankRecordEdit--bankingYear" name="bankingYear" type="number" step="1" required onwheel="return false" />
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label class="label" for="bankRecordEdit--bankingMonth">Banking Month</label>
              <div class="control">
                <input class="input" id="bankRecordEdit--bankingMonth" name="bankingMonth" type="number" step="1" min="1" max="12" required onwheel="return false" />
              </div>
            </div>
          </div>
        </div>

        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="bankRecordEdit--bankRecordType">Record Type</label>
              <div class="control">
                <div class="select is-fullwidth">
                  <select id="bankRecordEdit--bankRecordType" name="bankRecordType" required></select>
                </div>
              </div>
            </div>
          </div>
          <div class="column is-5">
            <div class="field">
              <label class="label" for="bankRecordEdit--recordDateString">Record Date</label>
              <div class="control">
                <input class="input" id="bankRecordEdit--recordDateString" name="recordDateString" type="date" />
              </div>
            </div>
            <p class="help">
              Leave blank in not recorded.
            </p>
          </div>
        </div>

        <div class="field">
          <div class="control">
            <div class="facheck facheck-fas-checked is-info">
              <input id="bankRecordEdit--recordIsNA" name="recordIsNA" type="checkbox" value="1" />
              <label for="bankRecordEdit--recordIsNA">
                Mark Record as Not Applicable
              </label>
            </div>
          </div>
        </div>

        <div class="field mb-3">
          <label class="label" for="bankRecordEdit--recordNote">Optional Notes</label>
          <div class="control">
            <textarea class="textarea" id="bankRecordEdit--recordNote" name="recordNote"></textarea>
          </div>
        </div>
      </form>
    </section>
    <footer class="modal-card-foot justify-right">
      <button class="button is-success" type="submit" form="form--bankRecordEdit">
        <span class="icon">
          <i class="fas fa-save" aria-hidden="true"></i>
        </span>
        <span>Save Record</span>
      </button>
      <button class="button is-close-modal-button" type="button">Cancel</button>
      <div class="dropdown is-right is-up" id="bankRecordEdit--moreOptionsDropdown">
        <div class="dropdown-trigger">
          <button class="button" type="button" aria-haspopup="true">
            <i class="fas fa-angle-up" aria-hidden="true"></i>
            <span class="sr-only">More Options</span>
          </button>
        </div>
        <div class="dropdown-menu" role="menu">
          <div class="dropdown-content">
            <a class="dropdown-item" id="bankRecordEdit--deleteRecordButton" href="#">
              <span class="icon"><i class="fas fa-trash has-text-danger" aria-hidden="true"></i></span>
              <span>Delete Record</span>
            </a>
          </div>
        </div>
      </div>
    </footer>
  </div>
</div>