 />
                </form>
            </div>
            <div class="modal-footer" style="margin-top:0;">
                <button type="button" class="btn btn-default" data-dismiss="modal" data-i18n="cancel">Cancel</button>
                <button type="button" class="btn btn-primary" data-loading-text="Submitting..." data-i18n="retrieve;[placeholder]submitting">RETRIEVE</button>
            </div>
        </div>
    </div>
</div>