    <form id="form_add" autocomplete="off">
      <div class="modal-header">
        <h1 class="modal-title fs-4"><?= $title ?></h1>
        <!-- <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button> -->
      </div>
      <div class="modal-body px-0 mx-3">
        <div class="w-100 row mx-0">

          <div class=" mb-3">
            <label for="name" class="ps-1 mb-1">Nama <span class="text-danger" style="font-size: 12px;">*</span></label>
            <input type="text" class="form-control" id="name" placeholder="Masukan nama pelanggan disini" name="name" />
            <span class="text-danger ps-1 error-message-name" style="font-size: 12px; display: none;" ></span>
          </div>
          <div class=" mb-3 col-md-6">
            <label for="phone" class="ps-1 mb-1">Telepon </label>
            <input type="number" class="form-control" id="phone" placeholder="Masukan nomor telepon disini" name="phone" />
            <span class="text-danger ps-1 error-message-phone" style="font-size: 12px; display: none;" ></span>
          </div>
          <div class="col-12 col-md-6 mb-3 mb-md-4">
              <label for="package" class="ps-1 mb-1">Paket Internet <span class="text-danger" style="font-size: 12px;">*</span></label>
              <select class="form-control select2" name="package" id="package" style="width: 100%">
                <option value="">Pilih Paket Internet</option>
              </select>
              <span class="text-danger ps-1 error-message-package" style="font-size: 12px; display: none;"></span>
          </div>
          <div class="col-12 col-md-6 mb-3 mb-md-4">
              <label for="subdistrict" class="ps-1 mb-1">Kecamatan <span class="text-danger" style="font-size: 12px;">*</span></label>
              <select class="form-control select2" name="subdistrict" id="subdistrict" style="width: 100%">
                <option value="">Pilih Kecamatan</option>
              </select>
              <span class="text-danger ps-1 error-message-subdistrict" style="font-size: 12px; display: none;"></span>
          </div>
          <div class="col-12 col-md-6 mb-3 mb-md-4">
              <label for="village" class="ps-1 mb-1">Desa <span class="text-danger" style="font-size: 12px;">*</span></label>
              <select class="form-control select2" name="village" id="village" style="width: 100%">
                <option value="">Pilih Desa</option>
              </select>
              <span class="text-danger ps-1 error-message-village" style="font-size: 12px; display: none;"></span>
          </div>
          <div class=" mb-3 ">
            <label for="description" class="ps-1 mb-1">Keterangan</label>
            <textarea type="text" class="form-control" id="description" placeholder="Masukan Keterangan pelanggan disini" name="description" ></textarea>
            <span class="text-danger ps-1 error-message-description" style="font-size: 12px; display: none;" ></span>
          </div>
          
        </div>
      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Tutup</button>
        <button type="submit" class="btn btn-primary">Simpan</button>
      </div>
    </form>