<form action="" method="post" name="modif_sucursal" id="modif_sucursal">
    <div class="modal fade" id="modificar_sucursal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel">
    	<div class="modal-dialog" role="document">
    		<div class="modal-content">
    			<div class="modal-header">
    				<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
    				<h4 class="modal-title">Modificar Sucursal</h4>
    			</div>
				<div class="modal-body">
					<div id="resultados_mod"></div> 
					<input type="hidden" class="form-control" id="id" name="id" required >
					<div class="">
              			<label>Nombre</label>
              			<input type="text" class="form-control" id="nombre" name="nombre"  required>
            		</div> <!-- /.form-group -->
            		<div class="">
              			<label>Dirección</label>
              			<input type="text" class="form-control" id="direccion" name="direccion"  required>
            		</div> <!-- /.form-group -->
            		<div class="">
              			<label>Dirección de Envio</label>
              			<input type="text" class="form-control" id="direccion_envio" name="direccion_envio"  required>
            		</div> <!-- /.form-group -->
            		<div class="">
              			<label>Teléfono</label>
              			<input type="text" class="form-control" id="telefono" name="telefono"  required>
            		</div> <!-- /.form-group -->
            		<div class="">
              			<label>Teléfono Móvil</label>
              			<input type="text" class="form-control" id="celular" name="celular"  required>
            		</div> <!-- /.form-group -->
            		<div class="">
              			<label>E-Mail</label>
              			<input type="text" class="form-control" id="correo" name="correo"  required>
            		</div> <!-- /.form-group -->
					<div class="modal-footer">
                        <button type="button" class="btn btn-default" data-dismiss="modal">Cerrar</button>
                        <button type="submit" id="mod_sucursal"  class="btn btn-success">Modificar</button>
                    </div>
				</div>
    		</div>
    	</div>
    </div>
</form>