@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" autocomplete="off"
                                id="elife_form">
                                @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') }}">

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


                                    <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 0551234567"
                                            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)" onkeyup="TestNumber()"
                                            id="customer_number" value="{{ old('cnumber') }}" data-validate-length-range="7"
                                            data-validate-words="2" id="customer_number" />
                                        <input type="hidden" name="number_test" value="{{ old('cnumber') }}"
                                            id="number_tester">
                                        <p style="color:red;display:none;" id="dpExist">
                                            Number Already Exist
                                        </p>

                                    </div>


                                    {{-- <span class="required">*</span> --}}
                                    {{-- <div class="col-md-2">
                                    <label for="cnumber">Customer Number</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="058">058</option>
                                    </select>

                                </div> --}}
                                    {{-- <div class="col-md-6 col-sm-12 col-xs-12 form-group ">
                                        <label for=""></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="6" 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>
                                            <option value="">-- Product Type --</option>
                                            <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> --}}

                                        </select>

                                    </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('emirate_number') }}">
                                    </div>
                                    <!-- Customer Identity End -->

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

                                        <!-- salary_certificate_above_15000 Darham OR CREDIT CARD -->
                                        <!-- <select name="additional_document" class="form-control " id="document_option" style="display:block;" required=""> -->
                                        <!-- <option value="No Additional Documents " selected></option> -->
                                        <!-- </select> -->
                                        <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="No Additional Document Required" id="" class="hideonelife" {{old('additional_document') == 'No Additional Document Required' ? 'selected' : ''}}>No
                                        Additional Document Required</option> --}}
                                            {{-- <option value="Salary Certificate" id="" class="hideonelife"
                                                {{ 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 Deed" id=""
                                                {{ old('secondary_document') == 'Title Deed' ? 'selected' : '' }}>
                                                Title Deed</option>
                                            <option value="None Of These" id=""
                                                {{ old('additional_document') == 'None Of These' ? 'selected' : '' }}>
                                                None Of These</option>
                                            <option value="Utility Bill" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Utility Bill' ? 'selected' : '' }}>
                                                Utility
                                                Bill (Current)</option>
                                            <option value="Credit Card" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Credit Slip' ? 'selected' : '' }}>Credit
                                                Card</option>
                                            <option value="Pay Slip From Exchange" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Pay Slip From Exchange' ? 'selected' : '' }}>
                                                Pay
                                                Slip From Exchange</option>
                                            <option value="Title Deeds" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Title Deeds' ? 'selected' : '' }}>Title
                                                Deeds</option>
                                            <option value="Car Registration" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Car Mulkiya' ? 'selected' : '' }}>Car
                                                Mulkiya</option>
                                            <option value="Labour Contract" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Labour Contract' ? 'selected' : '' }}>
                                                Labour
                                                Contracts</option>
                                            <option value="Etisalat Postpaid/Elife Account" id=""
                                                class="hideonelife"
                                                {{ old('additional_document') == 'Erisalat Postpaid/Elife Account' ? 'selected' : '' }}>
                                                Etisalat
                                                Postpaid/Elife Account</option>
                                            <option value="Bank Statement Last 3 Months" id=""
                                                class="hideonelife"
                                                {{ old('additional_document') == 'Bank Statement Last 3 Months' ? 'selected' : '' }}>
                                                Bank
                                                Statement Last 3 Months</option>
                                            <option value="Customer has Existing billing (account 6 months old)"
                                                {{ old('additional_document') == 'Customer has Existing billing (account 6 months old)' ? 'selected' : '' }}
                                                id="" class="hideonelife">Customer has Existing billing (account
                                                6 months old)
                                            </option>
                                            <option value="DU Bill Last 3 Months"
                                                {{ old('additional_document') == 'DU Bill Last 3 Months' ? 'selected' : '' }}
                                                id="" class="hideonelife">DU Bill Last 3 Months
                                            </option> --}}
                                            <!-- <option value="24">24 Months</optio n> -->

                                            <option value="No Additional Document Required" id=""
                                                class="hideonelife"
                                                {{ old('additional_document') == 'No Additional Document Required' ? 'selected' : '' }}>
                                                No Additional Document Required</option>
                                            <option value="Salary Certificate" id="" class="hideonelife"
                                                {{ 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="Utility Bill" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Utility Bill' ? 'selected' : '' }}>
                                                Utility Bill (Current)</option>
                                            <option value="Credit Card" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Credit Slip' ? 'selected' : '' }}>Credit
                                                Card</option>
                                            <option value="Pay Slip From Exchange" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Pay Slip From Exchange' ? 'selected' : '' }}>
                                                Pay Slip From Exchange</option>
                                            <option value="Title Deeds" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Title Deeds' ? 'selected' : '' }}>Title
                                                Deeds</option>
                                            <option value="Car Registration" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Car Registration' ? 'selected' : '' }}>
                                                Car Mulkiya</option>
                                            <option value="Labour Contract" id="" class="hideonelife"
                                                {{ old('additional_document') == 'Labour Contract' ? 'selected' : '' }}>
                                                Labour Contracts</option>
                                            <option value="Etisalat Postpaid/Elife Account" id=""
                                                class="hideonelife"
                                                {{ old('additional_document') == 'Etisalat Postpaid/Elife Account' ? 'selected' : '' }}>
                                                Etisalat Postpaid/Elife Account</option>
                                            <option value="Bank Statement Last 3 Months" id=""
                                                class="hideonelife"
                                                {{ old('additional_document') == 'Bank Statement Last 3 Months' ? 'selected' : '' }}>
                                                Bank Statement Last 3 Months</option>
                                            <option value="Customer has Existing billing (account 6 months old)"
                                                {{ old('additional_document') == 'Customer has Existing billing (account 6 months old)' ? 'selected' : '' }}
                                                id="" class="hideonelife">Customer has Existing billing (account
                                                6 months old)
                                            </option>
                                            <option value="DU Bill Last 3 Months"
                                                {{ old('additional_document') == 'DU Bill Last 3 Months' ? 'selected' : '' }}
                                                id="" class="hideonelife">DU Bill Last 3 Months
                                            </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="col-md-3 col-sm-3 col-xs-12 form-group ">
                                        <label for="emirate">Select Area</label>
                                        <input type="text" name="area" id="area_name" class="form-control">
                                    </div>



                                    <div class="container-fluid">
                                        <div class="container-fluid mb-5" style="border:1px solid black; padding:20px 30px;">

                                            <div class="container-fluid">
                                                <div class="row">
                                                    <div id="location_error"></div>
                                                </div>
                                            </div>
                                            <div class="row">
                                                <div class="col-md-6">
                                                    <div class="input-group mb-3">
                                                        <input type="text" class="form-control"
                                                            placeholder="Customer Location Url" name="add_location"
                                                            id="add_location" onkeyup="check_location_url()"
                                                            value="https://maps.google.com?q=0,0">
                                                        <div class="input-group-append">
                                                            <button class="btn btn-outline-secondary" type="button"
                                                                onclick="check_location_url()" id="checker">Fetch
                                                                Location</button>
                                                        </div>
                                                    </div>
                                                </div>

                                            </div>
                                            <div class="row">
                                                <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="0,0">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="row">
                                                <div class="col-md-12">
                                                    <span class="red" style="color:green"
                                                        onclick="ConfirmLocationURL()">Confirm Location URL</span>
                                                </div>
                                            </div>
                                            <h6>Choose Schedule Time </h6>

                                            <div class="row">
                                                <div class="col-md-6">
                                                    <div class="fom-group">
                                                        <label for="add_location">Start Date</label>
                                                        <input type="text" class="form-control" name="start_date"
                                                            id="start_date" readonly="" value="02/10/2024">
                                                    </div>
                                                </div>
                                                <div class="col-md-6">
                                                    <div class="fom-group">
                                                        <label for="add_location">Start Time</label>
                                                        <input type="time" class="form-control" name="start_time"
                                                            id="start_date">
                                                    </div>
                                                </div>
                                            </div>
                                            <span class="red" style="color:red;text-center">System Automatically Add 2
                                                Hrs from choosen time</span>

                                            <div class="row hidden d-none">
                                                <div class="col-md-6">
                                                    <div class="fom-group">
                                                        <label for="add_location">Allocate To:</label>

                                                        <select name="assing_to" id="assing_to" class="form-control">
                                                            <option value="">Allocate to</option>
                                                            <option value="136" selected="">
                                                                Hassan</option>
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>

                                            <br>

                                        </div>
                                    </div>

                                    @include('dashboard.include.mnp')
                                    @include('dashboard.include.new-package')
                                    {{-- @include('dashboard.include.elife-package') --}}
                                    {{-- @include('dashboard.include.itp') --}}
                                </div>

                                <div class="ln_solid"></div>

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


                            </form>

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

            </div>

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