<div class="col-sm-4 col-sm-offset-4">
			<div class="well">
				<h2>Wordt koerier</h2>
				<div class="form-group">
					<input
						type="text"
						class="form-control"
						placeholder="IBAN"
						autocomplete="off"
						@keyup.enter="submit"
					>
				</div>
				<div class="form-group">
					<input
						type="text"
						class="form-control"
						placeholder="Geboorte Datum"
						onfocus="(this.type='date')"
						autocomplete="off"
						@keyup.enter="submit"
					>
				</div>
				<div class="form-group">
					<input id="box1" type="checkbox" />
					<label for="box1">Auto</label><i class="fa fa-car" aria-hidden="true"></i><br>

					<input id="box2" type="checkbox" />
					<label for="box2">Fiets</label><i class="fa fa-bicycle" aria-hidden="true"></i><br>

					<input id="box3" type="checkbox" />
					<label for="box3">Brommer/Scooter</label><i class="fa fa-motorcycle" aria-hidden="true"></i><br>

					<input id="box4" type="checkbox" />
					<label for="box4">Lopen</label><i class="fa fa-male" aria-hidden="true"></i><br>
				</div>

				<!-- <button class="btn btn-block" @click="submit()">Log In</button> -->
				<button class="btn btn-block" @click="submit()" v-bind:class="{ 'btn-loading disabled': loading }"><i class="fa fa-spin fa-spinner"></i><span>Verstuur</span></button>
				<br>
			</div>
		</div>