<div class="js-gls-poland-delivery-options-form gls-poland-delivery-options-form"
     data-carrier-id="{$carrier_id|intval}"
     data-reference-id="{$reference_id|intval}"
>
  <input type="hidden"
         name="gls_poland[{$carrier_id|intval}][parcel_shop_id]"
         value=""
         class="js-gls-poland-parcel-shop-input"
  >

  <div class="mx-1">
    <div class="inpost-shipping-machine-info js-gls-poland-parcel-shop-info-container" style="display: none">
      <p class="inpost-shipping-machine-name">
        {l s='Selected ParcelShop' d='Modules.Glspoland.Checkout'}:
        <span class="js-gls-poland-parcel-shop-name"></span>
      </p>
      <p class="inpost-shipping-machine-address js-gls-poland-parcel-shop-address"></p>
    </div>

    <div class="form-group mb-0">
      <button type="button"
              class="btn btn-primary gls-poland-parcel-shop-select-button js-gls-poland-parcel-shop-select-button"
              data-selected-text="{l s='Change the selected ParcelShop' d='Modules.Glspoland.Checkout'}"
      >
        {l s='Select a ParcelShop' d='Modules.Glspoland.Checkout'}
      </button>
    </div>
  </div>
</div>
