ꦫꦣꦺꦤ꧀ꦄꦤ꧀ꦠꦱꦺꦤ

PATH: home / lab2454c / bancmils.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</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">Date Of Birth</label>
                                        <input type="text" class="form-control form__control @error('dob') is-invalid @enderror" id="DOB" name="dob" value="{{ old('dob') }}" required>
                                    </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') }}" required>
                                    </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">Primary Phone</label>
                                        <input type="tel" class="form-control form__control @error('primary_phone') is-invalid @enderror" name="primary_phone" value="{{ old('primary_phone') }}" required>
                                    </div>
                                </div>

<div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Email</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">Password</label>
                                        <input type="password" class="form-control form__control @error('password') is-invalid @enderror" name="password" value="{{ old('password') }}" required>
                                    </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="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') }}" required>
                                    </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" required>
                                  <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" required>
                                  <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="customCheckBox1" class="custom__control__input" required />
                                <label class="custom__control__label">I hereby confirm that I am accepting the Terms & Conditions and Privacy Policy</label>
                            </div>
                            <button type="submit" class="btn btn-default submit__btn">SUBMIT Application</button>

{{-- <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>Borrower</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">First Name</label>
                                        <input type="text" class="form-control form__control @error('first_name') is-invalid @enderror" name="first_name" value="{{ old('first_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">Middle Name</label>
                                        <input type="text" class="form-control form__control @error('middle_name') is-invalid @enderror" name="middle_name" value="{{ old('middle_name') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Last Name</label>
                                        <input type="text" class="form-control form__control @error('last_name') is-invalid @enderror" name="last_name" value="{{ old('last_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">Social Security Number</label>
                                        <input type="text" class="form-control form__control @error('ssn') is-invalid @enderror" name="ssn" value="{{ old('ssn') }}" 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="text" class="form-control form__control @error('primary_phone') is-invalid @enderror" name="primary_phone" value="{{ old('primary_phone') }}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Work Phone</label>
                                        <input type="text" class="form-control form__control @error('work_phone') is-invalid @enderror" name="work_phone" value="{{ old('work_phone') }}">
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Cell Phone</label>
                                        <input type="text" class="form-control form__control @error('cell_phone') is-invalid @enderror" name="cell_phone" value="{{ old('cell_phone') }}" >
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Email</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">Best Time To Contact</label>
                                        <input type="text" class="form-control form__control @error('connect_time') is-invalid @enderror" name="connect_time" value="{{ old('connect_time') }}">
                                    </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('contact_method') is-invalid @enderror" name="contact_method">
                                           <option value="">Method Of Contact</option>
                                            <option value="Email"{{ old('contact_method') == 'Email' ? 'selected' : '' }}>Email</option>
                                            <option value="Work Phone"{{ old('contact_method') == 'Work Phone' ? 'selected' : '' }}>Work Phone</option>
                                            <option value="Mobile Phone"{{ old('contact_method') == 'Mobile Phone' ? 'selected' : '' }}>Mobile Phone</option>
                                            <option value="Primary Phone"{{ old('contact_method') == 'Primary Phone' ? 'selected' : '' }}>Primary Phone</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            <h2>Residence History</h2>
                            <div class="form-group form__group">
                                <label class="form__label">Address 1</label>
                                <input type="text" class="form-control form__control @error('address1') is-invalid @enderror" name="address1" value="{{ old('address1') }}" required>
                            </div>
                            <div class="form-group form__group">
                                <label class="form__label">Address 2</label>
                                <input type="text" class="form-control form__control @error('address2') is-invalid @enderror" name="address2" value="{{ old('address2') }}" >
                            </div>
                            <div class="row">
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">City</label>
                                        <input type="text" class="form-control form__control @error('city') is-invalid @enderror" name="city" value="{{ old('city') }}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">State</label>
                                        <input type="text" class="form-control form__control @error('state') is-invalid @enderror" name="state" value="{{ old('state') }}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Zip</label>
                                        <input type="text" class="form-control form__control @error('zip') is-invalid @enderror" name="zip" value="{{ old('zip') }}" required>
                                    </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('address_old') is-invalid @enderror" name="address_old">
                                            <option value="">How Long At Address</option>
                                            <option value="1"{{ old('address_old') == 1 ? 'selected' : '' }}>1 Year</option>
                                            <option value="5"{{ old('address_old') == 5 ? 'selected' : '' }}>5 Years</option>
                                            <option value="10"{{ old('address_old') == 10 ? 'selected' : '' }}>10 Years</option>
                                            <option value="15"{{ old('address_old') == 15 ? 'selected' : '' }}>15 Years</option>
                                            <option value="25"{{ old('address_old') == 25 ? 'selected' : '' }}>25 Years</option>
                                            <option value="30"{{ old('address_old') == 30 ? 'selected' : '' }}>30 Years</option>
                                            <option value="35"{{ old('address_old') == 35 ? 'selected' : '' }}>35 Years</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') }}" required>
                                    </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') }}" required>
                                    </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') }}" required>
                                    </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') }}" required>
                                        </div>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Primary Gross 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') }}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Other Gross Income</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-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Source Of Other Gross 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-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Monthly Housing Expense</label>
                                        <input type="text" class="form-control form__control @error('monthly_housing_expense') is-invalid @enderror" name="monthly_housing_expense" value="{{ old('monthly_housing_expense') }}" required>
                                    </div>
                                </div>
                            </div>
                            <h2>Type Of Loan</h2>
                            <div class="row">
                                <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('loan_type') is-invalid @enderror" name="loan_type" required>
                                              <option value="">Loan Type</option>
                                            <option value="Business Loan"{{ old('loan_type') == 'Business Loan' ? 'selected' : '' }}>Business Loan</option>
                                            <option value="Commodity Loan"{{ old('loan_type') == 'Commodity Loan' ? 'selected' : '' }}>Commodity Loan</option>
                                            <option value="Mining Loan"{{ old('loan_type') == 'Mining Loan' ? 'selected' : '' }}>Mining Loan</option>
                                            <option value="Mining Extraction Loan"{{ old('loan_type') == 'Mining Extraction Loan' ? 'selected' : '' }}>Mining Extraction Loan</option>
                                            <option value="Mining exploration Loan"{{ old('loan_type') == 'Mining exploration Loan' ? 'selected' : '' }}>Mining exploration Loan</option>
                                            <option value="Commodity Export Loan"{{ old('loan_type') == 'Commodity Export Loan' ? 'selected' : '' }}>Commodity Export Loan</option>
                                            <option value="Personal Loan"{{ old('loan_type') == 'Personal Loan' ? 'selected' : '' }}>Personal Loan</option>
                                            <option value="Home Renovation Loan"{{ old('loan_type') == 'Home Renovation Loan' ? 'selected' : '' }}>Home Renovation Loan</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <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') }}" required>
                                    </div>
                                </div>
                            </div>
                            <div class="form-group form__group">
                                <label class="form__label">What Is the Purpose Of this Loan?</label>
                                <input type="text" class="form-control form__control @error('purpose_of_loan') is-invalid @enderror" name="purpose_of_loan" value="{{ old('purpose_of_loan') }}" required>
                            </div>
                            <div class="cuustom__fild">
                                <input type="checkbox" id="customCheckBox1" class="custom__control__input" required />
                                <label class="custom__control__label">I hereby confirm that I am accepting the Terms & Conditions and Privacy Policy</label>
                            </div>
                            <button type="submit" class="btn btn-default submit__btn">SUBMIT Application</button>

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

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