ꦫꦣꦺꦤ꧀ꦄꦤ꧀ꦠꦱꦺꦤ

PATH: home / lab2454c / aficb.com / resources / views / auth

@extends('frontend.layouts.loginLayout')

@section('title', 'Register')

@section('content')

<div class="body__container__wrapp body__container__wrapp__inner body__container__wrapp__inner__single">
    <div class="application__wrapp">
        <div class="container">
            <div class="col-xl-8 col-lg-8 col-md-10 offset-xl-2 offset-lg-2 offset-md-1 p-0">
                <div class="application__inner">
                    <div class="form__wrapp">
                        <form method="POST" action="{{ route('register') }}">
                            @csrf
                            <h2>General Information</h2>
                            <div class="row">
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Name<span class="text-danger">*</span></label>
                                        <input type="text" class="form-control form__control @error('name') is-invalid @enderror" name="name" value="{{ old('name') }}" required>
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Primary Phone</label>
                                        <input type="tel" class="form-control form__control @error('primary_phone') is-invalid @enderror" name="primary_phone" value="{{ old('primary_phone') }}">
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Date Of Birth</label>
                                        <input type="text" class="form-control form__control @error('dob') is-invalid @enderror" id="DOB" name="dob" value="{{ old('dob') }}">
                                    </div>
                                </div>
                                
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Social Security Number</label>
                                        <input type="text" class="form-control form__control @error('ssn') is-invalid @enderror" name="ssn" value="{{ old('ssn') }}">
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Driving License</label>
                                        <input type="text" class="form-control form__control @error('driving_license') is-invalid @enderror" name="driving_license" value="{{ old('driving_license') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Address</label>
                                        <textarea cols="30" rows="10" class="form-control form__control @error('address1') is-invalid @enderror" name="address1">{{ old('address1') }}</textarea>
                                        
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Email<span class="text-danger">*</span></label>
                                        <input type="email" class="form-control form__control @error('email') is-invalid @enderror" name="email" value="{{ old('email') }}" required>
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Whatsapp<span class="text-danger">*</span></label>
                                        <input type="tel" class="form-control form__control @error('whatsapp') is-invalid @enderror" name="whatsapp" value="{{ old('whatsapp') }}" required id="WHATSAPP">
                                    </div>
                                </div>

<div class="col-xl-10 col-lg-10 col-md-10">
                                    <label class="mb-2">Do you like to use your whatsapp number as Password ?</label>
                                    <div class="form-group form__group">
                                    
                                       <div class="form-check form-check-inline">
                                          <input class="form-check-input" type="radio" name="check_whatsapp" id="YesPass" value="Yes" {{(old('check_whatsapp') == 'Yes') ? 'checked' : ''}} required >
                                          <label class="form-check-label" for="YesPass">
                                            Yes
                                          </label>
                                        </div>
                                        <div class="form-check form-check-inline">
                                          <input class="form-check-input" type="radio" name="check_whatsapp" id="NoPass" value="No" {{(old('check_whatsapp') == 'No') ? 'checked' : ''}} required >
                                          <label class="form-check-label" for="NoPass">
                                            No
                                          </label>
                                        </div>
                                    </div>
                                </div>

<div class="col-xl-12 col-lg-12 col-md-12">
                                    <div class="form-group form__group">
                                        <label class="form__label">Password<span class="text-danger">*</span></label>
                                        <input type="password" class="form-control form__control @error('password') is-invalid @enderror" name="password" value="{{ old('password') }}" required id="PASSWORD">
                                    </div>
                                </div>
                            </div>

<h2>Company Details</h2>

<div class="row">
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Company Name</label>
                                        <input type="text" class="form-control form__control @error('company_name') is-invalid @enderror" name="company_name" value="{{ old('company_name') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">EIN</label>
                                        <input type="text" class="form-control form__control @error('ein') is-invalid @enderror" name="ein" value="{{ old('ein') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Address</label>
                                        <textarea cols="30" rows="10" class="form-control form__control @error('company_address') is-invalid @enderror" name="company_address">{{ old('company_address') }}</textarea>
                                        
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Company Phone</label>
                                        <input type="tel" class="form-control form__control @error('company_phone') is-invalid @enderror" name="company_phone" value="{{ old('company_phone') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Company Email</label>
                                        <input type="text" class="form-control form__control @error('company_email') is-invalid @enderror" name="company_email" value="{{ old('company_email') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Company Website</label>
                                        <input type="url" class="form-control form__control @error('company_website') is-invalid @enderror" name="company_website" value="{{ old('company_website') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <select class="form-control form__control selectpicker @error('company_association') is-invalid @enderror" name="company_association">
                                            <option value="">Association</option>
                                            <option value="SINDICATE"{{ old('company_association') == 'SINDICATE' ? 'selected' : '' }}>SINDICATE</option>
                                            <option value="FEDERATION"{{ old('company_association') == 'FEDERATION' ? 'selected' : '' }}>FEDERATION</option>
                                            <option value="COOPERATIVE"{{ old('company_association') == 'COOPERATIVE' ? 'selected' : '' }}>COOPERATIVE</option>
                                            <option value="OTHER"{{ old('company_association') == 'OTHER' ? 'selected' : '' }}>OTHER</option>
                                            
                                        </select>
                                    </div>
                                </div>
                            </div>

<h2>Employer</h2>
                            <div class="row">
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Present Employer</label>
                                        <input type="text" class="form-control form__control @error('present_employer') is-invalid @enderror" name="present_employer" value="{{ old('present_employer') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Occupation</label>
                                        <input type="text" class="form-control form__control @error('occupation') is-invalid @enderror" name="occupation" value="{{ old('occupation') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Time At Current Employer</label>
                                        <input type="text" class="form-control form__control @error('present_employer_time') is-invalid @enderror" name="present_employer_time" value="{{ old('present_employer_time') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <div class="form-group form__group">
                                            <label class="form__label">Years In Profession</label>
                                            <input type="text" class="form-control form__control @error('profession_experience') is-invalid @enderror" name="profession_experience" value="{{ old('profession_experience') }}" >
                                        </div>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Estimated Monthly Income</label>
                                        <input type="text" class="form-control form__control @error('primary_gross_income') is-invalid @enderror" name="primary_gross_income" value="{{ old('primary_gross_income') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Other Income Amount</label>
                                        <input type="text" class="form-control form__control @error('other_gross_income') is-invalid @enderror" name="other_gross_income" value="{{ old('other_gross_income') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-12 col-lg-12 col-md-12">
                                    <div class="form-group form__group">
                                        <label class="form__label">Source Of Other Income</label>
                                        <input type="text" class="form-control form__control @error('other_gross_income_source') is-invalid @enderror" name="other_gross_income_source" value="{{ old('other_gross_income_source') }}" >
                                    </div>
                                </div>

<div class="col-xl-12 col-lg-12 col-md-12">
                                    <div class="form-group form__group">
                                        <label class="form__label">Minimum Gross or Salary</label>
                                        <input type="text" class="form-control form__control @error('minimum_gross_salary') is-invalid @enderror" name="minimum_gross_salary" value="{{ old('minimum_gross_salary') }}" >
                                    </div>
                                </div>

<div class="col-xl-12 col-lg-12 col-md-12">
                                    <div class="form-group form__group">
                                        <label class="form__label">Max Amount /month Transaction</label>
                                        <input type="text" class="form-control form__control @error('max_amount_transaction') is-invalid @enderror" name="max_amount_transaction" value="{{ old('max_amount_transaction') }}" >
                                    </div>
                                </div>
                            </div>

<h2>Loan & Investment</h2>
                            <div class="row">
                                
                                <div class="col-xl-12 col-lg-12 col-md-12">
                                    <div class="form-group form__group">
                                        <label class="form__label">Requested Loan Amount</label>
                                        <input type="text" class="form-control form__control @error('requested_loan_amount') is-invalid @enderror" name="requested_loan_amount" value="{{ old('requested_loan_amount') }}">
                                    </div>
                                </div>

</div>

<label class="mb-2">Apply for Investment ?</label>
                            <div class="form-group form__group">
                            
                               <div class="form-check form-check-inline">
                                  <input class="form-check-input" type="radio" name="apply_investment" id="YesInvest" value="Yes" {{(old('apply_investment') == 'Yes') ? 'checked' : ''}}>
                                  <label class="form-check-label" for="YesInvest">
                                    Yes
                                  </label>
                                </div>
                                <div class="form-check form-check-inline">
                                  <input class="form-check-input" type="radio" name="apply_investment" id="NoInvest" value="No" {{(old('apply_investment') == 'No') ? 'checked' : ''}}>
                                  <label class="form-check-label" for="NoInvest">
                                    No
                                  </label>
                                </div>
                            </div>

<div class="form-group form__group">
                                <label class="form__label">How much apply for Investment?</label>
                                <input type="text" class="form-control form__control @error('investment_amount') is-invalid @enderror" name="investment_amount" value="{{ old('investment_amount') }}" >
                            </div>

<div class="form-group form__group">
                                <label class="form__label">What Is the Purpose Of Investment?</label>
                                <input type="text" class="form-control form__control @error('purpose_of_investment') is-invalid @enderror" name="purpose_of_investment" value="{{ old('purpose_of_investment') }}" >
                            </div>

<div class="form-group form__group">
                                <label class="form__label">What Is expected return on Investment?</label>
                                <input type="text" class="form-control form__control @error('investment_return') is-invalid @enderror" name="investment_return" value="{{ old('investment_return') }}" >
                            </div>

<div class="form-group form__group">
                                <label class="form__label">When you want to get Return?</label>
                                <input type="text" class="form-control form__control @error('return_time') is-invalid @enderror" name="return_time" value="{{ old('return_time') }}" >
                            </div>

@include('auth.questions')

<div class="cuustom__fild mt-4">
                                <input type="checkbox" id="confirmBox" class="custom__control__input" required />
                                <label class="custom__control__label" for="confirmBox">I hereby confirm that I am accepting the 
                                    <a href="{{ url('terms-conditions') }}" target="_blank">Terms & Conditions</a> and 
                                    <a href="{{ url('privacy-policy') }}" target="_blank">Privacy Policy</a>
                                </label>
                            </div>
                            <button type="submit" class="btn btn-default submit__btn">SUBMIT</button>

</script>

$(function(){
   $('#DOB').datepicker({
      format: "yyyy-mm-dd",
      todayHighlight: true,
      orientation: "auto",
      autoclose:true,
      clearBtn:true,
      endDate: '-0m',
      orientation: 'bottom'
    });
 });
</script>
@endsection

[+] ..
[-] questions.blade.php [edit]
[-] register.blade.php [edit]
[-] login.blade.php [edit]
[+] passwords
[-] verify.blade.php [edit]