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PATH: home / lab2454c / westernclear.net / resources / views / frontend / pages / apply

@extends('frontend.layouts.master')

@section('title', 'Register')

@section('content')

<div class="header__banner__main header__banner__inner">
    @include('frontend.common.commonBanner')
    
    <div class="banner__content">
        <div class="container">
            <div class="banner__content__inner">
                <div class="banner__content__wrapp">
                    <h1>Register</h1>
                </div>
            </div>
        </div>
    </div>
</div>

<div class="body__content__main body__containt__main__inner">
    <div class="common__wrapp">
        <div class="container">
            <div class="login__box register__box">

<form method="POST" action="{{ route('apply') }}">
                @csrf

<div class="row">
                    <div class="col-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="first_name">
                                First name<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                            <input id="first_name" type="text" class="form-control form__control @error('first_name') is-invalid @enderror" name="first_name" value="{{ old('first_name') }}" required autocomplete="first_name" autofocus>
                        </div>
                    </div>
                    <div class="col-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="last_name">
                                Last name<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                             <input id="last_name" type="text" class="form-control form__control @error('last_name') is-invalid @enderror" name="last_name" value="{{ old('last_name') }}" required autocomplete="last_name" autofocus>
                        </div>
                    </div>

<div class="ccol-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="DOB">
                                Date of Birth<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                             <input id="DOB" type="text" class="form-control form__control @error('dob') is-invalid @enderror" name="dob" value="{{ old('dob') }}" required autocomplete="dob" autofocus>
                        </div>
                    </div>

<div class="ccol-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="email">
                                Email<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                            <input id="email" type="email" class="form-control form__control @error('email') is-invalid @enderror" name="email" value="{{ old('email') }}" required autocomplete="email">
                        </div>
                    </div>
                    <div class="ccol-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="password">
                                Password<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                            <input id="password" type="password" class="form-control form__control @error('password') is-invalid @enderror" name="password" required autocomplete="new-password">
                        </div>
                    </div>

<div class="ccol-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="password-confirm">
                                Confirm Password<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                            <input id="password-confirm" type="password" class="form-control form__control" name="password_confirmation" required autocomplete="new-password">
                        </div>
                    </div>

<div class="ccol-xl-4 col-lg-4 col-md-4">
                        <div class="form__group">
                            <label class="label__field" for="terms">
                                Accept privacy policy<span class="text-danger"> *</span>
                            </label>
                        </div>
                    </div>
                    <div class="col-xl-8 col-lg-8 col-md-8">
                        <div class="form__group">
                            <input type="checkbox" id="terms" required="">
                            <label for="terms" class="label-check">I accept privacy policy </label>
                        </div>
                    </div>
                </div>
                <div class="login__bottom__row">
                    <button type="submit" class="btn__action login__btn">Register</button>
                </div>
                </form>
            </div>
            
        </div>
    </div>
</div>

});
</script>

@endsection

[+] ..
[-] applySuccess.blade.php [edit]
[-] apply.blade.php [edit]
[-] payment.blade.php [edit]