@extends('layouts.dashboard-app')

@section('main-content')
    <div class="content-body">
        <div class="container">
            <div class="row page-titles">
                <div class="col p-0">
                    <h4>Hello, <span>Welcome {{ auth()->user()->name }}</span></h4>

                </div>
                <div class="col p-0">
                    <ol class="breadcrumb">
                        <li class="breadcrumb-item"><a href="javascript:void(0)">From</a>
                        </li>
                        <li class="breadcrumb-item active">Basic</li>
                    </ol>
                </div>
            </div>
            <div class="row">
                <div class="col-lg-12">
                    <div class="card">
                        <div class="card-body">
                            @if ($errors->any())
                                <div class="alert alert-danger" role="alert">
                                    <button type="button" class="close" data-dismiss="alert" aria-label="Close">
                                        <span aria-hidden="true">×</span>
                                    </button>

                                    @foreach ($errors->all() as $error)
                                        {{ $error }}<br />
                                    @endforeach
                                </div>
                            @endif

                            <form class="form-horizontal form-label-left input_mask" method="post" id="elife_form"
                                autocomplete="off">
                                @csrf
                                <!-- Plan name -->
                                <input type="hidden" name="sale_type" value="{{ $type . ' ' . $ptype }}">
                                <div class="form-group">
                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <input type="hidden" name="generic_id"
                                            value="{{ $getfirst = empty($last) ? 1 : $last->id }}">
                                        <input class="form-control " id="leadno"
                                            value="{{ auth()->user()->agent_code . '-' . $getfirst . '-' . Carbon\Carbon::now()->format('M') . '-' . now()->year }}"
                                            placeholder="Lead Number" type="text" disabled>
                                        <input class="form-control " id="inputSuccess3" name="leadnumber"
                                            value="{{ auth()->user()->agent_code . '-' . $getfirst . '-' . Carbon\Carbon::now()->format('M') . '-' . now()->year }}"
                                            placeholder="Lead Number" type="hidden">
                                        <input type="hidden" name="channel_type" id="type"
                                            value="{{ $type }}">
                                        <input type="hidden" name="lead_type" id="type" value="{{ $ptype }}">
                                        <!-- <span class="fa fa-lock form-control-feedback left" aria-hidden="true"></span> -->
                                    </div>
                                    <div class="col-md-12 col-sm-12 col-xs-12">
                                        <label class="center">
                                            Personal Information
                                        </label>
                                    </div>
                                </div>


                                <!-- form group start -->
                                <!-- Customer name start -->
                                <div class="form-group row">

                                    <div class="col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <label for="cname">Customer Name</label>
                                        {{-- {{$id}} --}}
                                        <input class="form-control " id="cname" placeholder="Customer Name"
                                            name="cname" type="text" required value="{{ old('cname') }}"
                                            autocomplete="off">

                                    </div>
                                    <!-- </div>
                                                            <div class="item form-group"> -->
                                    <!-- required -->


                                    {{-- <span class="required">*</span> --}}


                                    <div class="col-md-3">
                                        <label for="cnumber">Code</label>

                                        <select name="code" id="" class="form-control">
                                            <option value="050">050</option>
                                            <option value="052">052</option>
                                            <option value="054">054</option>
                                            <option value="055">055</option>
                                            <option value="056">056</option>
                                            <option value="057">057</option>
                                            <option value="058">058</option>
                                        </select>



                                    </div>


                                    <div class="col-md-3">
                                        <label for="cnumber">Customer Number</label>

                                        <input class="form-control " placeholder="Customer Number i.e 1234567"
                                            name="cnumber" maxlength="7" required type="tel"
                                            oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);"
                                            onkeypress="return isNumberKey(event)" id="customer_number"
                                            value="{{ old('cnumber') }}" data-mask="9999999" data-validate-length-range="6"
                                            data-validate-words="2" />


                                    </div>

                                    {{-- <div class="col-md-2">
                                        <label for="cnumber">Customer Number</label>

                                        <input class="form-control " placeholder="Customer Number i.e 1234567"
                                            name="cnumber" maxlength="7" required type="tel"
                                            oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);"
                                            onkeypress="return isNumberKey(event)" id="customer_number"
                                            value="{{ old('cnumber') }}" data-mask="9999999" data-validate-length-range="6"
                                            data-validate-words="2" />


                                    </div> --}}


                                    {{-- <div class="col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <label for="cnumber">Customer Number</label>
                                        <!-- <input type="number" maxlength="1" max="9" min="1" size="1" > -->
                                        {{-- <input class="form-control " placeholder="Customer Number i.e 0551234567" name="cnumber" onkeypress="return isNumberKey(event)"  id="customer_number" value="{{old('cnumber')}}"
                                    /> --}}
                                    {{-- <input class="form-control " placeholder="Customer Number i.e 1234567"
                                        name="cnumber" maxlength="7" required type="tel"
                                        oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);"
                                        onkeypress="return isNumberKey(event)" id="customer_number"
                                        value="{{old('cnumber')}}" data-mask="9999999" data-validate-length-range="6"
                                        data-validate-words="2" /> --}}

                                    {{-- <input class="form-control" placeholder="Customer Number i.e 1234567890"
                                            name="cnumber" maxlength="10" required type="tel"
                                            oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);"
                                            onkeypress="return isNumberKey(event)" id="customer_number"
                                            value="{{ old('cnumber') }}" data-mask="9999999999"
                                            data-validate-length-range="10" data-validate-words="2" /> --}}
                                    {{-- </div> --}}
                                    <!-- Customer number end -->
                                </div>
                                <!-- form-group end -->
                                <!--  #2 end -->
                                <!--  #2 nationality and age-->

                                <!-- form group start -->
                                <!-- Customer name start -->
                                <div class="form-group row">

                                    <div class="col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <label for="c_select">Country</label>
                                        <select name="nation" id="c_select" class="form-control" required>

                                            @foreach ($countries as $country)
                                                <option value="{{ $country->name }}">{{ $country->name }}</option>
                                            @endforeach
                                        </select>
                                    </div>
                                    <!-- </div>
                                                            <div class="item form-group"> -->
                                    <!-- required -->

                                    {{-- <span class="required">*</span> --}}
                                    <div class=" item col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <label for="age">Customer Age</label>
                                        <input class="form-control " id="age"
                                            placeholder="Customer Age not less than 21" name="age" required
                                            type="number" required onkeypress="return isNumberKey(event)"
                                            oninput="javascript: if (this.value.length > this.maxLength) this.value = this.value.slice(0, this.maxLength);"
                                            maxlength="2" value="{{ old('age') }}">
                                    </div>
                                    <!-- Customer number end -->
                                </div>
                                <!-- form-group end -->
                                <!--  #2 end -->
                                <!--  #3 start -->

                                <!-- form group start -->
                                <!-- Customer name start -->
                                <div class="form-group row">

                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <label for="simtype">Product Type</label>
                                        <select name="simtype" id="simtype" class="sim_type form-control" required
                                            {{-- onchange="check_elife_package(this,'{{ route('elife.plan') }}')"> --}}>
                                            <option value="">-- Product Type --</option>
                                            @if ($ptype == 'Postpaid')
                                                <option value="New"
                                                    @if (old('simtype') == 'New') {{ 'selected' }} @endif>New
                                                </option>
                                                <option value="MNP"
                                                    @if (old('simtype') == 'MNP') {{ 'selected' }} @endif>MNP
                                                </option>
                                                <option value="Migration"
                                                    @if (old('simtype') == 'Migration') {{ 'selected' }} @endif>Migration
                                                </option>
                                            @elseif($ptype == 'ITProducts')
                                                @foreach ($itproducts as $itp)
                                                    <option value="{{ $itp->id }}"
                                                        @if (old('simtype') == $itp->id) {{ 'selected' }} @endif>
                                                        {{ $itp->name }}</option>
                                                @endforeach
                                            @else
                                                <option value="Elife"
                                                    @if (old('simtype') == 'Elife') {{ 'selected' }} @endif>
                                                    Elife</option>
                                                <option value="Bitstream"
                                                    @if (old('simtype') == 'Bitstream') {{ 'selected' }} @endif>Bitstream
                                                </option>
                                                <option value="Fixed LTE"
                                                    @if (old('simtype') == 'Fixed LTE') {{ 'selected' }} @endif>Fixed LTE
                                                </option>
                                            @endif
                                        </select>

                                    </div>

                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <label for="plantype">Plan Type</label>
                                        <select name="plantype" id="plantype" class="fast_forward form-control" required
                                            onchange="check_plan_type_package(this, '{{ route('elife.plan_type') }}'); check_elife_package(this, '{{ route('elife.plan') }}');">
                                            <option value="" disabled selected>-- Plan Type --</option>
                                            <option value="1">2p</option>
                                            <option value="2" class="hideit">3p</option>
                                        </select>

                                    </div>

                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group hideiton">
                                        <label for="promotion">Promotion</label>
                                        <select name="promotion" id="p__select" class="form-control" required
                                            onchange="check_elife_package(this,'{{ route('elife.plan') }}')">
                                            <option value="" disabled selected>-- Select Promotion --</option>
                                        </select>

                                    </div>

                                    <input type="hidden" id="elife_addon_url" value="{{ route('elife.addon') }}">
                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group">
                                        <label for="zonetype">Select Plan</label>
                                        <select name="plan_elife" id="c__select" class="form-control elife_plan"
                                            style=""
                                            onchange="elife_plan_month($(this).val(),'ElifePlanFetch','{{ route('ajaxRequest.post') }}'); check_offers_package(this, '{{ route('elife.Offers') }}');">
                                            <option value="">Select Plan</option>
                                        </select>
                                    </div>


                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <label for="zonetype">Select Addon</label>
                                        <select name="addon" id="addon_fetch" class="form-control elife_plan"
                                            style="">
                                            <option value="" selected disabled>Select Addon</option>
                                        </select>
                                    </div>


                                    {{-- <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <label for="offers">Offers</label>
                                        <input type="text" id="offers" name="offers" class="form-control" readonly>
                                    </div> --}}

                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group">
                                        <label for="offers">Offers</label>
                                        <input type="text" id="offers" name="offers" class="form-control"
                                            readonly>
                                    </div>



                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group " id="zone"
                                        style="display:none;">
                                        <label for="zonetype">Zone</label>
                                        <select name="zone" id="zonetype" class="sim_type form-control" required>
                                            <option value="">-- Select Zone --</option>
                                            <option value="Defender"
                                                @if (old('zone') == 'Defender') {{ 'selected' }} @endif>
                                                Defender</option>
                                            <option value="Non Defender"
                                                @if (old('zone') == 'Non Defender') {{ 'selected' }} @endif>Non Defender
                                            </option>
                                            <option value="Shared Zone"
                                                @if (old('zone') == 'Shared Zone') {{ 'selected' }} @endif>Shared Zone
                                            </option>
                                        </select>

                                    </div>
                                    <div class="col-md-3 col-sm-3 col-xs-12 form-group ">
                                        <label for="gender">Gender</label>

                                        <select name="gender" id="gender" class="gender form-control" required>
                                            <option value="">-- Select Gender --</option>
                                            <option value="Male"
                                                @if (old('gender') == 'Male') {{ 'selected' }} @endif>Male
                                            </option>
                                            <option value="Female"
                                                @if (old('gender') == 'Female') {{ 'selected' }} @endif>
                                                Female</option>
                                            <option value="Other"
                                                @if (old('gender') == 'Other') {{ 'selected' }} @endif>
                                                Other</option>
                                        </select>

                                    </div>
                                    <div class="col-md-3 col-sm-3 col-xs-12 form-group ">
                                        <label for="emirate">Select Emirate</label>

                                        <select name="emirates" id="emirate" class="emirates form-control" required>
                                            <option value="">Select Emirates</option>
                                            @foreach ($emirates as $emirate)
                                                <option value="{{ $emirate->name }}"
                                                    @if (old('emirates') == $emirate->name) {{ 'selected' }} @endif>
                                                    {{ $emirate->name }}</option>
                                            @endforeach
                                        </select>

                                    </div>

                                    <!-- Customer number end -->
                                    <div class=" item col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <!-- <input class="form-control " id="inputSuccess3" placeholder="Customer Number" data-inputmask="'mask' : '(999) 999-9999'" data-validate-length-range="6" data-validate-words="2" name="name" placeholder="both name(s) e.g Jon Doe" required="required" type="num"> -->
                                        <label for="emirate_id">Document Type</label>

                                        <select name="emirate_id" class="form-control " required id="emirate_id">
                                            <option value="">-- Document Type --</option>
                                            <option value="Emirate ID" id=""
                                                @if (old('emirate_id') == 'Emirate ID') {{ 'selected' }} @endif>Emirate ID
                                            </option>
                                            <option value="Passport" id=""
                                                @if (old('emirate_id') == 'Passport') {{ 'selected' }} @endif>Passport
                                            </option>
                                            <!-- <option value="24">24 Months</option> -->
                                        </select>

                                    </div>


                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group" style="display: none;"
                                        id="show_emirate_id">
                                        <label for="emirate_number">Emirate ID # </label>
                                        <input class="form-control " id="emirate_number" data-mask="999-9999-9999999-9"
                                            data-validate-length-range="6" data-validate-words="2" name="emirate_number"
                                            placeholder="Emirate ID" type="tel" value="{{ old('emirate_number') }}">
                                    </div>
                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group" style="display: none;"
                                        id="show_passport">
                                        <label for="emirate_number">Passport ID #</label>
                                        <input class="form-control " id="passport_number" data-mask="999-9999-9999999-9"
                                            data-validate-length-range="6" data-validate-words="2" name="passport_number"
                                            placeholder="Emirate ID" type="tel"
                                            value="{{ old('passport_number') }}">
                                    </div>
                                    <!-- Customer Identity End -->


                                    <div class=" item col-md-6 col-sm-12 col-xs-12 form-group"
                                        style="">

                                        <label for="hideme_document">Document Details</label>

                                        <select name="additional_document" class="form-control " id="hideme_document"
                                            style="display:block" {{ $ptype == 'elife' ? '' : 'required' }}>
                                            <option value="" selected disabled>-- Document Details --</option>
                                            <option value="Salary Certificate" id="" class=""
                                                {{ old('additional_document') == 'Salary Certificate ' ? 'selected' : '' }}>
                                                Salary Certificate</option>
                                            <option value="Tenancy Contract" id=""
                                                {{ old('additional_document') == 'Renancy Contract' ? 'selected' : '' }}>
                                                Tenancy Contract</option>
                                            <option value="Title Deeds" id="" class=""
                                                {{ old('additional_document') == 'Title Deeds' ? 'selected' : '' }}>Title
                                                Deeds</option>
                                            <option value="None Of These" id=""
                                                {{ old('additional_document') == 'None Of These' ? 'selected' : '' }}>
                                                None Of These</option>
                                        </select>

                                    </div>

                                    <div class=" item col-md-6 col-sm-12 col-xs-12 form-group"
                                        style="display:{{ $ptype == 'elife' ? 'block' : 'block' }}">

                                        <label for="hideme_document">Secondary Document Details</label>

                                        <select name="secondary_document" class="form-control " id="hideme_document"
                                            style="display:block" {{ $ptype == 'elife' ? '' : 'required' }}>
                                            <option value="" selected disabled>-- Secondary Document Details --</option>
                                            <option value="Salary Certificate" id="" class=""
                                            {{ old('additional_document') == 'Salary Certificate ' ? 'selected' : '' }}>
                                            Salary Certificate</option>
                                        <option value="Tenancy Contract" id=""
                                            {{ old('additional_document') == 'Renancy Contract' ? 'selected' : '' }}>
                                            Tenancy Contract</option>
                                        <option value="Title Deeds" id="" class=""
                                            {{ old('additional_document') == 'Title Deeds' ? 'selected' : '' }}>Title
                                            Deeds</option>
                                        <option value="None Of These" id=""
                                            {{ old('additional_document') == 'None Of These' ? 'selected' : '' }}>
                                            None Of These</option>
                                        </select>

                                    </div>
                                    <div class="col-md-12 col-sm-12 col-xs-12 form-group ">
                                        <label for="language">Language</label>
                                        <select name="language" class="form-control " required id="language">
                                            <option value="">Select Language</option>
                                            <option value="English" {{ old('language') == 'English' ? 'selected' : '' }}>
                                                English</option>
                                            <option value="Arabic" {{ old('language') == 'Arabic' ? 'selected' : '' }}>
                                                Arabic
                                            </option>
                                            <option value="Hindi/Urdu">Hindi / Urdu</option>
                                        </select>
                                    </div>



                                    <div class=" item col-md-4 col-sm-6 col-xs-12 form-group">
                                        <label for="emirate_number">Vila/Flat No</label>
                                        <input class="form-control " id="flat_no" name="flat" type="text"
                                            placeholder="Address">
                                    </div>
                                    <div class=" item col-md-4 col-sm-6 col-xs-12 form-group">
                                        <label for="emirate_number">Street</label>
                                        <input class="form-control " id="flat_no" name="street" type="text"
                                            placeholder="Address">

                                    </div>
                                    <div class=" item col-md-4 col-sm-6 col-xs-12 form-group">
                                        <label for="emirate_number">Area</label>
                                        <input class="form-control " id="flat_no" name="area" type="text"
                                            placeholder="Address">

                                    </div>
                                    <div class="col-md-6 col-sm-6 col-xs-12 form-group ">
                                        <label for="zonetype">Eid / Makani #</label>

                                        <input type="text" name="elife_makani_number" id="elife_makani_number"
                                            class="form-control" placeholder="Eid / Makani #">
                                    </div>
                                    <div class="container-fluid">
                                        <div class="row">
                                            <div id="location_error"></div>
                                        </div>
                                    </div>
                                    <div class="col-md-6">
                                        <label for="add_location">Search Location</label>
                                        <div class="input-group mb-3">


                                            <input id="pac-input" class="controls form-control" type="text"
                                                placeholder="Enter a location" name="location">

                                        </div>
                                    </div>
                                    <div class="col-md-6">
                                        <div class="fom-group">
                                            <label for="add_location">Add Latitude and Langitude</label>
                                            <input type="text" class="form-control" id="add_lat_lng"
                                                name="add_lat_lng" value="{{ old('add_lat_lng') }}">
                                        </div>
                                    </div>
                                    <div class="col-md-6 hidden d-none">
                                        <div class="fom-group">
                                            <label for="add_location">Choosen Lead Number</label>
                                            <input type="text" class="form-control" id="aff_number" name="aff_number"
                                                value="{{ request()->session()->get('choosen_lead_number') }}">
                                        </div>
                                    </div>
                                    <div class="container">
                                        <div id="map"></div>
                                        <style>
                                            #map {
                                                height: 100%;
                                            }
                                        </style>
                                    </div>






                                    <div class="container-fluid">
                                    </div>
                                    {{-- @include('dashboard.include.mnp') --}}
                                    {{-- @include('dashboard.include.new-package') --}}
                                    {{-- @include('dashboard.include.elife-package') --}}
                                    {{-- @include('dashboard.include.itp') --}}

                                    <div class="item col-md-12 col-sm-12 col-xs-12 form-group ">
                                        <!-- <h3>Remarks</h3> -->
                                        <h4>Reference *</h4>

                                        <div class="form-group">
                                            <input name="reference" id="reference" class="form-control"
                                                placeholder="Reference"></input>
                                        </div>
                                    </div>

                                    <div class="item col-md-12 col-sm-12 col-xs-12 form-group ">
                                        <!-- <h3>Remarks</h3> -->
                                        <h4>Remarks *</h4>

                                        <div class="form-group">
                                            <textarea name="remarks_process_elife" id="remarks_process" cols="30" rows="10"
                                                class="form-control remarks_elife">Please Verify</textarea>
                                            <!-- <input type="text" name="remarks_process" id="remarks_process" class="form-control"> -->
                                        </div>
                                    </div>
                                    {{-- <div class="form-group"> --}}
                                    <div class="col-md-9 col-sm-9 col-xs-12 col-md-offset-3">
                                        <input type="button" value="Submit"
                                            class="btn btn-success  submit_mnp submit_button_on_no" name="upload"
                                            id="submit_button"
                                            onclick="VerifyLead('{{ route('elife.lead.submit') }}','elife_form','{{ route('home') }}')">
                                        {{-- <input value="Follow Up" class="btn btn-success follow_up_mnp follow_up_new"
                                            data-toggle="modal" data-target="#myModalElife" id="follow_up_new"> --}}
                                        <input type="reset" value="Reset" class="btn btn-primary reset"
                                            name="reset" id="reset">


                                        {{-- </div> --}}
                                    </div>
                                </div>

                                <div class="ln_solid"></div>
                                {{-- lorem --}}
                                <div class="alert alert-danger print-error-msg" style="display:none">
                                    <ul></ul>
                                </div>
                                {{-- lorem --}}




                            </form>

                        </div>
                    </div>
                </div>

            </div>

        </div>
        <!-- #/ container -->
    </div>
@endsection

<script>

</script>