@extends('layouts.admin')
@section('pageTitle')
<title>Best Insurance | Affiliates</title>
@stop
@section('content')
<section class="content ">
  <div class="box">

    <!-- If any email validation occurred then Display previous entered data after submit -->
    {{--*/
      if(isset($requestData)){

    }else{
    $requestData['uid'] = '';
    $requestData['name'] = '';
    $requestData['Legal_Entity'] = '';
    $requestData['email'] = '';
    $requestData['source'] = '';
    $requestData['first_name'] ='';
    $requestData['last_name'] = '';
    $requestData['broker_firm'] = '';
    $requestData['broker_advisor'] = '';

    $requestData['ho_name'] = '';
    $requestData['ho_address'] = '';
  }
  /*--}}


  <!-- /.box-header -->
  <div class="box-body">
    {{Form::open(array('url' => '/account/affiliates','id' => 'formValidation', 'method' => 'POST'))}}
    <div class="form-group  col-md-12 text-red">* Password will be automatically generated and will be sent to given email. </div>
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('UID',array())}}
      {{Form::number('uid',$requestData['uid'],array('required' => true,'class' =>'form-control'))}}
       @if($errors->has('uid'))
        <label id="email-error" class="error" for="uid">{{$errors->first('uid')}} </label>
       @endif
    </div>
    <!-- <div class="form-group  col-md-12"></div> -->
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('Name of the organization',array())}}
      {{Form::text('name',$requestData['name'],array('required' => true,'class' =>'form-control'))}}

      @if($errors->has('name'))
        <label id="email-error" class="error" for="name">{{$errors->first('name')}} </label>
      @endif
    </div>
    <!-- <div class="form-group  col-md-12"></div> -->
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('first name',array())}}
      {{Form::text('first_name',$requestData['first_name'],array('required' => true,'class' =>'form-control'))}}


    </div>
    <!-- <div class="form-group  col-md-12"></div> -->
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('last name',array())}}
      {{Form::text('last_name',$requestData['last_name'],array('required' => true,'class' =>'form-control'))}}
    </div>
    <!-- <div class="form-group  col-md-12"></div> -->
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('Legal_Entity',array())}}
      {{Form::text('Legal_Entity',$requestData['Legal_Entity'],array('required' => true,'class' =>'form-control'))}}
    </div>
    <!-- <div class="form-group  col-md-12"></div> -->
    <div class="form-group  col-md-6 required">
      <span class=" control-label "></span>
      {{Form::label('Email',array())}}
      {{Form::email('email',$requestData['email'],array('class' =>'form-control'))}}
      @if($errors->has('email'))
        <label id="email-error" class="error" for="name">{{$errors->first('email')}} </label>
      @endif
    </div>
          <!-- <div class="form-group  col-md-12"></div>
          <div class="form-group  col-md-6">
            {{Form::label('password',array())}}
            {{Form::password('password',array('class' =>'form-control'))}}
          </div> -->
          <!-- <div class="form-group  col-md-12"></div> -->
          <div class="form-group  col-md-6">
            {{Form::label('source',array())}}
            {{Form::text('source',$requestData['source'],array('class' =>'form-control'))}}
          </div>

          <!-- <div class="form-group  col-md-12"></div> -->
          <div class="form-group  col-md-6">
            {{Form::label('Introducing Broker Firm',array())}}
            {{Form::text('broker_firm',$requestData['broker_firm'],array('class' =>'form-control'))}}
          </div>


          <!-- <div class="form-group  col-md-12"></div> -->
          <div class="form-group  col-md-6">
            {{Form::label('Introducing Broker Advisor',array())}}
            {{Form::text('broker_advisor',$requestData['broker_advisor'],array('class' =>'form-control'))}}
          </div>
          <div class="form-group  col-md-12"></div>

          <div class="form-group  col-md-6">
            <label class="checkbox-inline">
              <input type="checkbox" value="1" name="bai" checked>BAI
            </label>
            <label class="checkbox-inline">
              <input type="checkbox" value="1"  name="bi" checked>BI
            </label>
          </div>


          <hr/>
          <!-- head office -->
          <div class="form-group  col-md-12">
            <h3>Head Office details</h3>
          </div>
          <div class="form-group  col-md-6 required">
            {{Form::label('HO Name',array())}}
            {{Form::text('ho_name',$requestData['ho_name'],array('class' =>'form-control required'))}}
             @if($errors->has('ho_name'))
            <label id="email-error" class="error" for="ho_name">{{$errors->first('ho_name')}} </label>
            @endif
          </div>
          <div class="form-group  col-md-6 required">
            {{Form::label('HO Address',array())}}
            {{Form::text('ho_address',$requestData['ho_address'],array('class' =>'form-control required'))}}
          </div>
          <!-- end of head office -->
          <div class="form-group  col-md-12"></div>
          <div class="form-group  col-md-6">
            {{Form::submit('Submit',array('class' => 'btn btn-success'))}}
          </div>
          {{Form::close()}}
          
        </div>
        <!-- /.box-body -->
      </div>
      <!-- </div> -->

    </section>

    @stop
    @section('pageBottomJs')
    <style type="text/css">
    /* for validation msg */
    .error{
      color:red;
    }
  </style>
  <script type="text/javascript">
   $(document).ready(function(){

    // trim blank spaces 
    $('#formValidation').submit( function(e){
      $(this).find('input:text').each(function(){
        $(this).val($.trim($(this).val()));
      });
    });
    $('#formValidation').validate({
      rules:{
        uid:{
          required:true,
          maxlength:11
        },
        name:{
          required:true,
          maxlength:100
        },
        Legal_Entity:{
          required:true,
          maxlength:255
        },
        user_name:{
          required:true,
          maxlength:50
        },
        first_name:{
          required:true,
          maxlength:50
        },
        last_name:{
          required:true,
          maxlength:50
        },
        password:{
          required:true,
          maxlength:8
        }
      },
      messages:{
        uid:'* Please enter UID and maximum length should be 11 characters.',
        name:'* Please enter name and maximum length should be 100 characters.',
        Legal_Entity:'* Please enter legal entity and maximum length should be 255 characters.',
        user_name:'* Please enter email and maximum length should be 50 characters.',
        password:'* Please enter password and maximum length should be 8 characters.',
        first_name: "* Please enter first name and length should be 50 characters",
        last_name: "* Please enter last name and length should be 50 characters",
        ho_name: "* Please enter Head office name",
        ho_address:"* Please enter Head office address"
      }
    });  
  });
</script>
@stop