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                            <div class="d-flex justify-content-between align-items-center">
                            <h6 class="fs-17 font-weight-600 mb-0 text-center"><i class="fa fa-list"></i> Create New Sales Tax Sheet</h6>
                            </div>
                        </div>
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                        	<table class="table table-condensed table-bordered">
                            	<tr><th colspan="2"><h4 class="text-center"><b>KARTHA FINANCIAL, INC.</b></h4></th></tr>
                            	<tr><th colspan="2" class="text-center">FACSIMILE TRANSMITTAL SHEET FOR SALES TAX INFO </th></tr>
                                <tbody  bgcolor="#FFFF99">
                                	<tr><th><div class="form-group">
                                    		<label>To</label>
                                    		<input type="text" class="form-control" name="to" required />
                                            </div></th>
                                        <th><div class="form-group">
                                    		<label>From</label>
                                    		<input type="text" class="form-control" name="from" required />
                                            </div></th></tr> 
                                    <tr><th><div class="form-group">
                                    		<label>FAX NUMBER</label>
                                    		<input type="text" class="form-control" name="fax" required />
                                            </div></th>
                                        <th><div class="form-group">
                                    		<label>DATE</label>
                                    		<input type="date" class="form-control" name="date" required />
                                            </div></th></tr> 
                                    <tr><th colspan="2">
                                    		<div  class="row">
                                    		<div class="form-group col-md-3">
                                    		<label>PHONE </label>
                                    		<input type="text" class="form-control" name="phone" required />
                                            </div>
                                            <div class="form-group col-md-5">
                                    		<label>EMAIL</label>
                                    		<input type="text" class="form-control" name="email" required />
                                            </div>
                                            <div class="form-group col-md-4">
                                    		<label>Total No of Pages Including Cover </label>
                                    		<input type="text" class="form-control" name="pages" required />
                                            </div>
                                            </div>
                                            </th></tr> 
                                    <tr><th colspan="2"><div class="form-group">
                                    		<label>COMPANY</label>
                                    		<input type="text" class="form-control" name="company" required />
                                            </div></th></tr>    
                                </tbody>
                            </table>
                            
                            <table class="table table-condensed table-bordered table2">
                            	<tr><th colspan="5"><b>Sales and Sales Tax Information should match with Cash Register Print Out or other Documents</b></th></tr>
                                <tr bgcolor="#CCCCCC"><th>Item</th><th>Jan 2020</th><th>Feb 2020</th><th>Mar 2020</th><th>Apr 2020</th></tr>
                                <tr><td>Gasoline Gals</td>
                                	<td><input type="text" class="form-control jan_vals" name="gasoline_gals[]" /></td>
                                    <td><input type="text" class="form-control feb_vals" name="gasoline_gals[]" /></td>
                                    <td><input type="text" class="form-control mar_vals" name="gasoline_gals[]" /></td>
                                    <td><input type="text" class="form-control apr_vals" name="gasoline_gals[]" /></td></tr>
                                <tr><td>Gasoline $$$</td>
                                	<td><input type="text" class="form-control jan_vals" name="gasoline[]" /></td>
                                    <td><input type="text" class="form-control feb_vals" name="gasoline[]" /></td>
                                    <td><input type="text" class="form-control mar_vals" name="gasoline[]" /></td>
                                    <td><input type="text" class="form-control apr_vals" name="gasoline[]" /></td></tr>
                                <tr><td>Cigarettes</td>
                                	<td><input type="text" class="form-control jan_vals" name="cigrate[]" /></td>
                                    <td><input type="text" class="form-control feb_vals" name="cigrate[]" /></td>
                                    <td><input type="text" class="form-control mar_vals" name="cigrate[]" /></td>
                                    <td><input type="text" class="form-control apr_vals" name="cigrate[]" /></td></tr>
                                <tr><td>Grocery</td>
                                	<td><input type="text" class="form-control jan_vals" name="grocery[]" /></td>
                                    <td><input type="text" class="form-control feb_vals" name="grocery[]" /></td>
                                    <td><input type="text" class="form-control mar_vals" name="grocery[]" /></td>
                                    <td><input type="text" class="form-control apr_vals" name="grocery[]" /></td></tr>
                                <tr bgcolor="#CCCCCC"><td>Total Sales</td>
                                	<td><input readonly="readonly" id="jan_sum" type="text" class="form-control" name="jan_sum" /></td>
                                    <td><input readonly="readonly" id="feb_sum" type="text" class="form-control" name="feb_sum" /></td>
                                    <td><input readonly="readonly" id="mar_sum" type="text" class="form-control" name="mar_sum" /></td>
                                    <td><input readonly="readonly" id="apr_sum" type="text" class="form-control" name="apr_sum" /></td>
                                    </tr>
                                <tr bgcolor="#FF9933"><th>Total Sales</th>
                                	<td><input id="jan_tax" type="text" class="form-control" name="jan_tax" /></td>
                                    <td><input id="feb_tax" type="text" class="form-control" name="feb_tax" /></td>
                                    <td><input id="mar_tax" type="text" class="form-control" name="mar_tax" /></td>
                                    <td><input id="apr_tax" type="text" class="form-control" name="apr_tax" /></td>
                                    </tr>
                            </table>
                            <p>State Sales Tax Division enforce every business owners to file and pay Use Tax for items that you
buy for business/personal using BUSINESS TAX ID # without paying sales tax. We are required
to report any such purchases and pay Use Tax. Please complete the following:</p>
							<table class="table table-condensed table-bordered table2">
                            	<tr><th></th><th>Retails Store</th><th>Internet</th></tr>
                               	<tr><td>Amount you paid for supplies/ merchandize used for your
                                        business (not for resale) including from Internet</td>
                                    <td><input type="text" class="form-control" name="bis_amt"/></td>
                                    <td><input type="text" class="form-control" name="bis_internet"/></td></tr>
                                <tr><td>Amount you paid for supplies/ merchandize used for your
                                    personal (not for resale) including from Internet</td>
                                    <td><input type="text" class="form-control" name="per_amt"/></td>
                                    <td><input type="text" class="form-control" name="per_internet"/></td></tr>
                            </table>	
                        </div>
                     </div>
                </div> 
                 
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