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PATH: home / lab2454c / bancmils.com / resources / views / frontend / pages

@extends('frontend.layouts.loginLayout')

@section('title', 'Request a Demo')

@section('content')

<div class="body__container__wrapp body__container__wrapp__inner body__container__wrapp__inner__single body__container__wrapp__inner__single__request">
    <div class="application__wrapp application__inner__request">
        <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('requestDemoStore') }}">
                            @csrf
                            <h2>Request A Demo</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">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">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">Phone Number</label>
                                        <input type="text" class="form-control form__control @error('phone') is-invalid @enderror" name="phone" value="{{old('phone')}}" required maxlength="15">
                                    </div>
                                </div>
                                <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')}}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Company Size</label>
                                        <input type="text" class="form-control form__control @error('company_size') is-invalid @enderror" name="company_size" value="{{old('company_size')}}" 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('industry') is-invalid @enderror" name="industry">
                                            <option value="">Select Industry</option>
                                            <option value="Technology"{{ old('industry') == 'Technology' ? 'selected' : '' }}>Technology</option>
                                            <option value="Mining"{{ old('industry') == 'Mining' ? 'selected' : '' }}>Mining</option>
                                            <option value="Agriculture"{{ old('industry') == 'Agriculture' ? 'selected' : '' }}>Agriculture</option>
                                            <option value="Aerospace"{{ old('industry') == 'Aerospace' ? 'selected' : '' }}>Aerospace</option>
                                            <option value="Transport"{{ old('industry') == 'Transport' ? 'selected' : '' }}>Transport</option>
                                            <option value="Construction"{{ old('industry') == 'Construction' ? 'selected' : '' }}>Construction</option>
                                            <option value="Telecommunication "{{ old('industry') == 'Telecommunication ' ? 'selected' : '' }}>Telecommunication </option>
                                            <option value="Education"{{ old('industry') == 'Education' ? 'selected' : '' }}>Education</option>
                                            <option value="Pharmaceutical "{{ old('industry') == 'Pharmaceutical ' ? 'selected' : '' }}>Pharmaceutical </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">Job Title</label>
                                        <input type="text" class="form-control form__control @error('job_title') is-invalid @enderror" name="job_title" value="{{old('job_title')}}" required>
                                    </div>
                                </div>
                                <div class="col-xl-6 col-lg-6 col-md-6">
                                    <div class="form-group form__group">
                                        <label class="form__label">Country</label>
                                        <input type="text" class="form-control form__control @error('country') is-invalid @enderror" name="country" value="{{old('country')}}">
                                    </div>
                                </div>
                                <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')}}">
                                    </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')}}">
                                    </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('zipcode') is-invalid @enderror" name="zipcode" value="{{old('zipcode')}}">
                                    </div>
                                </div>
                            </div>
                            <button type="submit" class="btn btn-default submit__btn">SUBMIT</button>
                            <button type="button" class="btn btn-default submit__btn" onclick="window.location='{{ route('home') }}'">Back</button>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>

@endsection

[+] event
[-] faq.blade.php [edit]
[+] ..
[-] dynamicPage.blade.php [edit]
[-] contact.blade.php [edit]
[-] requestADemo.blade.php [edit]
[-] team.blade.php [edit]
[+] career