<inputid="datepicker"type="text"class="form-control required"data-parsley-trigger="change"data-parsley-minlength="2"required=""name="payment_date_<?=$brk_data['broker_id']?>"placeholder="Pick Last Paid Date"autocomplete="off">
<inputid="datepicker"type="text"class="form-control required"data-parsley-trigger="change"data-parsley-minlength="2"required=""name="last_payment_date"placeholder="Pick Last Paid Date"autocomplete="off">