    <div class="row marginbot40">
        <div class="col-md-3">
            <div class="form-group-lg form-group-icon-left form-group-filled">
                <div class="group">
                    <?php echo $this->formElement($form->get('pickup_city[]')); ?>
                    <span class="highlight"></span>
                    <span class="bar"></span>
                    <?php echo $this->translate($this->formLabel($form->get('pickup_city[]'))); ?>
                </div>
            </div>
        </div>

        <div class="col-md-3">
            <div class="form-group-lg form-group-icon-left">
                <div class="group">
                    <?php echo $this->formElement($form->get('drop_city[]')); ?>
                    <span class="highlight"></span>
                    <span class="bar"></span>
                    <?php echo $this->translate($this->formLabel($form->get('drop_city[]'))); ?>
                </div>
            </div>
        </div>

        <div class="col-md-3">
            <div class="form-group-lg form-group-icon-left">
                <div class="col-sm-7 padding0">
                    <div class="group">
                        <?php echo $this->formElement($form->get('pickup_date[]')); ?>
                        <span class="highlight"></span>
                        <span class="bar"></span>
                        <?php echo $this->translate($this->formLabel($form->get('pickup_date[]'))); ?>
                    </div>
                </div>

                <div class="col-sm-5 padding0">
                    <div class="group">
                        <div class="input-group clockpicker" data-placement="bottom" data-align="left" data-donetext="Done">
                            <?php echo $this->formElement($form->get('pickup_time[]')); ?>
                            <span class="input-group-addon">
                            <span class="glyphicon glyphicon-time"></span>
                            </span>
                            <?php echo $this->translate($this->formLabel($form->get('pickup_time[]'))); ?>
                        </div>
                    </div>
                </div>
            </div>
        </div>

        <div class="col-md-3">
            <div class="form-group-lg form-group-icon-left">
                <div class="group">
                    <?php echo $this->formElement($form->get('number_of_days[]')); ?>
                    <span class="highlight"></span>
                    <span class="bar"></span>
                    <?php echo $this->translate($this->formLabel($form->get('number_of_days[]'))); ?>
                </div>
            </div>
        </div>
        <div class="Xbtn col-md-2" onclick="mcClose($(this).parent())">X</div>
    </div>