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@extends('layouts.app')

@section('title', 'Joruri Doctor | MPO Registration')

@section('content')
  <div class="main-content">
  <div class="main-content-inner">
      <div class="breadcrumbs ace-save-state" id="breadcrumbs">
         @include('layouts.header_menu')
      </div>
      <div class="page-content">
          <div class="row">
            <div class="col-xs-12">
              <div class="row">
                <div class="col-sm-3"></div>
                <div class="col-sm-6">
                  <div class="widget-box">
                    <div class="widget-header">
                      <h4 class="widget-title">MPO Registration</h4>
                      <div class="widget-toolbar">
                        <a href="#" data-action="collapse">
                          <i class="ace-icon fa fa-chevron-up"></i>
                        </a>

<a href="#" data-action="close">
                          <i class="ace-icon fa fa-times"></i>
                        </a>
                      </div>
                    </div>
                    <div class="widget-body">
                        @if ($errors->any())
                          <div class="alert alert-danger">
                              <ul>
                                  @foreach ($errors->all() as $error)
                                      <li>{{ $error }}</li>
                                  @endforeach
                              </ul>
                          </div>
                        @endif
                      <div class="widget-main">
                        <form action="{{route('store_mpo')}}" method="post">
                          @csrf

<div class="form-group">
                            <input class="form-control" type="text" name="customer_name" placeholder="MPO Name">
                            @error('customer_name')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <input class="form-control" type="number" name="customer_mobile" placeholder="MPO Mobile">
                            @error('customer_mobile')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <input class="form-control" type="email" name="customer_email" placeholder="MPO Email">
                            @error('customer_email')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <select class="chosen-select form-control" name="customer_company" data-placeholder="Company Name">
                              <option>Company</option>
                              @foreach($company as $company)
                                <option value="{{$company->company_name}}">{{$company->company_name}}</option>
                              @endforeach
                            </select>
                            @error('mpo_company')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <input class="form-control" type="password" name="password" placeholder="Password">
                            @error('password')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <input class="form-control" type="password" name="password_confirmation" placeholder="Confirm Password">
                            @error('password_confirmation')
                              <span class="invalid-feedback" role="alert">
                                  <strong style="color: red;">{{ $message }}</strong>
                              </span>
                            @enderror
                          </div>

<div class="form-group">
                            <select class="chosen-select form-control" data-placeholder="Service Area..." name="chamber_area" autocomplete="off">
                                <option>Service Area</option>
                            @foreach($upazilas as $upazilas)
                              <option value="{{$upazilas->id}}">{{$upazilas->name}} -- {{$upazilas->url}}</option>
                            @endforeach
                            </select>
                          </div>
                          
                          <div class="space-8"></div>
                          <div class="form-action center">
                            <button class="btn btn-warning btn-round" type="submit">MPO Registration</button>
                          </div>
                          
                        </form>
                      </div>
                    </div>
                  </div>
                </div>
              <div class="col-sm-3"></div>
            </div>
@endsection