@extends('layouts.frontend')
@section('title', 'Bank Details')
@section('content')  
<div class="clearfix"></div>
<section class="inner-content">
  <div class="clearfix"></div>
  <div class="container">
    <div class="form-block col-md-9 padding-left-none">
      <h2 class="product-title">{{ $product_details->product_name}}</h2>
      @if(Session::get('success'))
        <div class="alert alert-success">
          {{Session::get('success')}}
        </div>
      @endif
        @if(Session::get('failure'))
          <div class="alert alert-danger">
            {{Session::get('failure')}}
          </div>
      @endif
      @if (count($errors) > 0)
        <div class="alert alert-danger">
          <strong>Whoops!</strong> All field are required..<br><br>
            <ul>
              @foreach ($errors->all() as $error)
                <li>{{ $error }}</li>
              @endforeach
            </ul>
        </div>
      @endif
      <form name="frmbankdetails" id="frmbankdetails" method="post" class="form-horizontal" action="{{url('bank-details')}}">
        <input type="hidden" name="_token" value="{{ csrf_token() }}">
        <div class="bg">
          <div class="steps-tabs">
            <ul >
              
              <li>Cover <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li class="active">Bank Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li >Confirmation <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
            </ul>
          </div>

          <div class="text">
            <p class="blue">
               We’re almost finished. To complete your policy set up, we just need to set up your monthly direct debit.
            </p>
          </div>
        
              <div class="fornRow" style=" FONT-SIZE: 13PX;">
                <table width="100%" border="0" cellspacing="0" cellpadding="10">
                  <tr>
                    <!-- <td width="29" align="left" valign="middle" class="blue">
                         
                        <a href="javascript:void(0)" class="hintanchor"><img src="{{ asset('assets/images/help-2.gif') }}" width="21" height="21" title='Please provide accurate answers. Any information not disclosed may result in your claim being disallowed by the insurer'/></a>
                        </td> -->
                        <td  align="left" valign="middle" class="list__info">
                          Do you hold a UK Bank / Building Society account of which you are the account holder? </strong>
                        </td>
                        <td width="148" align="left" valign="middle" class="list__info"><table border="0" cellspacing="4" cellpadding="4">
                          <tr>
                            <td width="105" align="left" valign="middle">
                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="question1" name ="question1" formControlName="yes" class="custom-control-input" value="Yes" checked>
                              <label class="radio-label" for="question1">Yes</label> 
                            </td>

                            <td width="100" align="left" valign="middle">

                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="questionNo_" name ="question1" formControlName="yes" class="custom-control-input" value="No">
                              <label class="radio-label" for="questionNo_">No</label>
                              </div>

                              <!-- <input  name="" id="" type='radio' value='No'/>No -->
                            </td>
                          </tr>
                          <tr> 
                            <td align="left" valign="middle" colspan="2">
                              <label for="" generated="true" class="error" style="display:none;">Please Answer this question</label>
                            </td>
                          </tr>
                    </table></td>
                  </tr>

                  @if($product_details->id=="144" || $product_details->id=="151")
                   <tr>
                    <!-- <td width="29" align="left" valign="middle" class="blue">
                         
                        <a href="javascript:void(0)" class="hintanchor"><img src="{{ asset('assets/images/help-2.gif') }}" width="21" height="21" title='Please provide accurate answers. Any information not disclosed may result in your claim being disallowed by the insurer'/></a>
                        </td> -->
                        <td  align="left" valign="middle" class="list__info">
                          Is this account authorised to have direct debits applied to it? </strong>
                        </td>
                        <td width="148" align="left" valign="middle" class="list__info"><table border="0" cellspacing="4" cellpadding="4">
                          <tr>
                            <td width="105" align="left" valign="middle">
                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="question4" name ="question4" formControlName="yes" class="custom-control-input" value="Yes" checked>
                              <label class="radio-label" for="question4">Yes</label> 
                            </td>

                            <td width="100" align="left" valign="middle">

                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="questionNo_" name ="question4" formControlName="yes" class="custom-control-input" value="No">
                              <label class="radio-label" for="questionNo_">No</label>
                              </div>

                              <!-- <input  name="" id="" type='radio' value='No'/>No -->
                            </td>
                          </tr>
                          <tr> 
                            <td align="left" valign="middle" colspan="2">
                              <label for="" generated="true" class="error" style="display:none;">Please Answer this question</label>
                            </td>
                          </tr>
                    </table></td>
                  </tr>
                  @endif

                  <tr>
                     
                        <td width="421" align="left" valign="middle" class="list__info">
                             Are you the only person required to authorise debits from this account? </strong>
                        </td>
                        <td width="148" align="left" valign="middle" class="list__info"><table border="0" cellspacing="4" cellpadding="4">
                          <tr>
                            <td width="105" align="left" valign="middle">
                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="question2" name ="question2" formControlName="yes" class="custom-control-input" value="Yes" checked>
                              <label class="radio-label" for="question2">Yes</label>
                              </div>


                              <!-- <input name="" id="" type='radio' value='Yes' class="required" title="Please Answer this question" checked /> Yes  -->
                            </td>

                            <td width="100" align="left" valign="middle">
                            <div class="form-froup custom-control custom-radio radio">
                            <input type="radio" id="questionNo" name ="question2" formControlName="yes" class="custom-control-input" value="No">
                            <label class="radio-label" for="questionNo">No</label>
                            </div>
                            <!-- 
                            <input  name="" id="" type='radio' value='No'/>No -->
                            </td>
                          </tr>
                          <tr> 
                            <td align="left" valign="middle" colspan="2">
                              <label for="" generated="true" class="error" style="display:none;">Please Answer this question</label>
                            </td>
                          </tr>
                    </table></td>
                  </tr>

                  <tr>
                    <!-- <td width="29" align="left" valign="middle" class="blue">
                         
                        <a href="javascript:void(0)" class="hintanchor"><img src="{{ asset('assets/images/help-2.gif') }}" width="21" height="21" title='Please provide accurate answers. Any information not disclosed may result in your claim being disallowed by the insurer'/></a>
                        </td> -->
                        <td width="421" align="left" valign="middle" class="list__info">
                         Please confirm you can afford the monthly payments? </strong>
                        </td>
                        <td width="148" align="left" valign="middle" class="list__info"><table border="0" cellspacing="4" cellpadding="4">
                          <tr>
                            <td width="105" align="left" valign="middle">
                            
                            <div class="form-froup custom-control custom-radio radio">
                            <input type="radio" id="question3" name ="question3" formControlName="yes" class="custom-control-input" value="Yes" checked>
                            <label class="radio-label" for="question3">Yes</label>
                            </div>


                              <!-- <input name="question3" id="" type='radio' value='Yes' class="required" title="Please Answer this question" checked /> Yes  -->
                            </td>

                            <td width="100" align="left" valign="middle">
                             
                            <div class="form-froup custom-control custom-radio radio">
                              <input type="radio" id="question3_no" name ="question3" formControlName="yes" class="custom-control-input" value="No">
                              <label class="radio-label" for="question3_no">No</label>
                              </div>
                              <!-- <input  name="question3" id="" type='radio' value='No'/>No -->
                            </td>
                          </tr>
                          <tr> 
                            <td align="left" valign="middle" colspan="2">
                              <label for="" generated="true" class="error" style="display:none;">Please Answer this question</label>
                            </td>
                          </tr>
                    </table></td>
                  </tr>
                </table>
              </div>
          <div class="text">
    
              <div class="clearfix"></div>    
          </div> <!-- end text -->

          <div class="form-group">

          <p class="p-bottom" style="padding-left: 16px; padding-bottom: 15px;"><b>
                        Please enter your bank details</b> <br></p>
            <label class="control-label col-sm-12 t-l"><span style="color:red">*</span> Name(s) of account holder(s) </label>
            <div class="col-sm-12 padding-right-none">
              <input name="accountname1"  id="accountname1"  class="form-control required inp__" title="Please Enter Name of Account Holder" value="{{ (isset($personal_data->accountname) ? $personal_data->accountname:"") }}" maxLength=300 style="width:280px;" />
            </div>
          </div>
          <div class="form-group">
            <label class="control-label col-sm-12 t-l col-xs-12"><span style="color:red">*</span> Bank or Building Society account Number</label>
            <div class="col-sm-12 padding-right-none ac-number col-xs-12">
              <input  name="accountnumber1" id="accountnumber1" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -8, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber2)" >
              <input  name="accountnumber2" id="accountnumber2" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -7, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber3)">
              <input  name="accountnumber3" id="accountnumber3" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -6, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber4)">
              <input  name="accountnumber4" id="accountnumber4" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -5, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber5)">
              <input  name="accountnumber5" id="accountnumber5" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -4, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber6)">
              <input  name="accountnumber6" id="accountnumber6" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -3, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber7)">
              <input  name="accountnumber7" id="accountnumber7" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -2, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber8)">
              <input  name="accountnumber8" id="accountnumber8" class="form-control required inp__" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -1, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" >
            </div>
            <label for="accountnumber" class="error"></label>
          </div>
          <div class="form-group">
            <label class="control-label col-sm-12 t-l"><span style="color:red">*</span> Branch sort Code</label>
            <div class="col-sm-12 padding-right-none ac-number col-xs-12">
              <input name="sortcode1" class="form-control required inp__" id="sortcode1" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -6, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode2)">
              <input name="sortcode2" class="form-control required inp__" id="sortcode2" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -5, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode3)">
              <input name="sortcode3" class="form-control required inp__" id="sortcode3" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -4, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode4)">
              <input name="sortcode4" class="form-control required inp__" id="sortcode4" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -3, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode5)">
              <input name="sortcode5" class="form-control required inp__" id="sortcode5" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -2, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode6)">
              <input name="sortcode6" class="form-control required inp__" id="sortcode6" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -1, 1):"") }}" maxLength=1 size="1">
              <br>
              <label for="sortcode" class="error"></label>
            </div>

          </div>

<!--direct debit date section -->
<div class="form-group">
            
            
            @if($product_details->id=="144" || $product_details->id=="151")
            
            <div class="col-sm-12 padding-right-none">

            
              <input type="hidden" name="preferreddate" id="preferreddate" value="1">
            </div>

            @else
            <label class="control-label col-sm-12 t-l">Select Direct Debit Date</label>
            <div class="col-sm-12 padding-right-none">

              <select class="form-control required inp__ w-90" id="preferreddate" name="preferreddate"  title="Please enter your preferred Direct Debit date">
                <option value="">DD</option>
                <option value="1" {{ ($personal_data->preferreddate == '1' ? "selected":"") }}>1</option>
                <option value="7" {{ ($personal_data->preferreddate == '7' ? "selected":"") }}>7</option>
                <option value="11" {{ ($personal_data->preferreddate == '11' ? "selected":"") }}>11</option>
                <option value="16" {{ ($personal_data->preferreddate == '16' ? "selected":"") }}>16</option>
                <option value="21" {{ ($personal_data->preferreddate == '21' ? "selected":"") }}>21</option>
                <option value="26" {{ ($personal_data->preferreddate == '26' ? "selected":"") }}>26</option>
                
              </select>
            </div>

            @endif
          </div>
          <!--end direct debit date section -->


          <div class="clearfix"></div>
          <div class="small-btn2">
            <a id="sortValidate" title="Please click on validate" onclick="javascript:showbankdetails()" style="cursor:pointer;" >Validate</a>
          </div>

          <div style="display: none !important;">
          <td class="fornRow"  id="bankdetails" style="padding-left:0px;display:none !important;">
            <table class="bank-validate-form" width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td width="10%" align="left" valign="middle"><strong>IBAN:<br /></strong>
                  <INPUT  name=iban class="form-control" id="iban" value="{{ (isset($personal_data->iban) ? $personal_data->iban:"") }}" readonly="readonly">
                </td>
                <td width="10%" align="left" valign="middle"><strong>Bank:<br /></strong>
                  <INPUT  name=bank class="form-control" id="bank" value="{{ (isset($personal_data->bank) ? $personal_data->bank:"") }}" readonly="readonly">
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Bank BIC:<br /></strong>
                  <input  name="bankbic" class="form-control" id="bankbic" value="{{ (isset($personal_data->bankbic) ? $personal_data->bankbic:"") }}" readonly="readonly"/>
                </td>
                <td align="left" valign="middle"><strong>Branch:<br /></strong>
                  <input  name="branch" class="form-control" id="branch" value="{{ (isset($personal_data->branch) ? $personal_data->branch:"") }}" readonly="readonly" />
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Branch BIC:<br /></strong>
                  <input  name="branchbic" class="form-control" id="branchbic" value="{{ (isset($personal_data->branchbic) ? $personal_data->branchbic:"") }}" readonly="readonly" />
                </td>
                <td align="left" valign="middle"><strong>Town:<br /></strong>
                  <input  name="town" class="form-control" id="town" value="{{ (isset($personal_data->town) ? $personal_data->town:"") }}" readonly="readonly" />
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Post Code<br /></strong>
                  <input  name="postcode" class="form-control" id="postcode" value="{{ (isset($personal_data->bank_postcode) ? $personal_data->bank_postcode:"") }}" readonly="readonly" /></td>
                <td align="left" valign="middle"><strong>Phone:<br /></strong>
                  <input  name="phone" class="form-control" id="phone" value="{{ (isset($personal_data->bank_phone) ? $personal_data->bank_phone:"") }}" readonly="readonly" /></td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Address:<br /></strong>
                  <textarea  name="address" class="form-control input input-middle" id="address" >{{ (isset($personal_data->branch_address) ? $personal_data->branch_address:"") }}</textarea></td>
                <td align="left" valign="middle">&nbsp;</td>
              </tr>
            </table>
          </td>
        </div>
          @if($product_details->id == Config::get('constant.SHEPHERDS_FRIENDLY_LONGTERM') || $product_details->id == Config::get('constant.SHEPHERDS_FRIENDLY_SHORTERM'))

          @elseif($product_details->id=="144" || $product_details->id=="151")


           <input type="hidden" name="directdebits" id="directdebits" value="{{ (isset($personal_data->directdebits) ? $personal_data->directdebits:"") }}" />
          <!--end account details section -->
          
          <!--originator section -->
                            
          <div class="form-group" style="display:none;">
            <label class="control-label col-sm-4">5.Originator Identification Number</label>
            <div class="col-sm-8 padding-right-none ac-number">
                      
            </div>  
          </div>
                            
          <!--end originator section -->
          <!--instructions to bank section -->
                    
          <div class="full-boxes">
                    <div class="m-box color-text-box">
                      <p class="p-bottom"><b>
                        Your monthly premium will be collected by Creation.</b></p>
                      <p>We will lodge your Direct Debit instruction against the account provided within the next 5 working days. Your Direct Debit instruction will be confirmed to you by email within 3 working days or no later than 5 working days before the first collection.</p>
                      <p> Your first direct debit will be taken in 10 working days, and at the same time each month. Please contact us if you would like to change your payment date.</p>
                      <p>The name that will appear on your bank statement is Creation Consumer Finance.
                      If there are any changes to the date, amount or frequency of your Direct Debit, we
                      will always give you 10 working days’ notice in advance of your account being
                      debited or as otherwise agreed.</p>


                          <br/><br/>
 

                        <p class="p-bottom"><b>Contact Details</b> </p>
                        <p>If you have any questions or concerns please see our contact details below:</p>

                        <p><b>Telephone number: </b> 0371 376 9200</p>
                        <p><b>Opening hours: </b> Mon - Fri: 8:30am - 5:30pm and Saturdays: 8:30am - 5:00pm</p>
                        <p><b>Address: </b>Creation Customer Enquiries, Chadwick House, Blenheim Court, Solihull, B912AA</p>
                        <p><b>Email: </b><a href="mailto:insurancefinance@creation.co.uk" target="_blank">insurancefinance@creation.co.uk</a></p>   
                        <p>All Direct Debits are protected by a guarantee. The guarantee is detailed below:</p>           
                        
            </div>                    
                    <div class="m-box color-text-box bord__wrp">
                        
                        
                        <div class="row d-flex justify-content-between acccutimgs">
                           
                            <div class="col-md-12 ">
                            <p class="sub-text col-md-8" style="margin-top: 25px;">The Direct Debit Guarantee</p> 
                            <div class="col-md-2 pull-right text-right"> 
                            <img src="{{asset('assets/images/debit_logo.jpg')}}" alt="" class="img-fluid" width="150px" style="float: right;"></div></div>
                        
                            <div class="col-12">
                              <ul class="list__gurt">
                              <li>The Guarantee is offered by all banks and building societies that accept instructions to pay by Direct Debit.</li>
                              <li>If there are any changes to the amount, date or frequency of your Direct Debit,Creation Premium Finance will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Creation Premium Finance to collect a payment, confirmation of the amount and date will be given to you at the time of the request</li>

                              <li>If an error is made in the payment or your Direct Debit by Creation Consumer Finance or your bank or building society you are entitled to a full and immediate refund from your bank or building society
                                 </li>
                              <li>If you receive a refund that you are not entitled to, you must pay back when Creation Premium Finance asks you to.
                                </li>

                                <li>You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be requested. Please also notify us.</li>
                               
                            </ul></div>

                          </div>
                      </div>

  
                  </div>

          @else
          <input type="hidden" name="directdebits" id="directdebits" value="{{ (isset($personal_data->directdebits) ? $personal_data->directdebits:"") }}" />
          <!--end account details section -->
          
          <!--originator section -->
                            
          <div class="form-group" style="display:none;">
            <label class="control-label col-sm-4">5.Originator Identification Number</label>
            <div class="col-sm-8 padding-right-none ac-number">
                      
            </div>  
          </div>
                            
          <!--end originator section -->
          <!--instructions to bank section -->
                    
          <div class="full-boxes">
                    <div class="m-box color-text-box">
                      <p class="p-bottom"><b>
                        Please note the following information</b> <br/></p>
                        <p>In the future if there is a change to the date, amount or frequency of your Direct Debit, we will always give you 5 working days notice in advance of your account being debited.
                        </p>
                        <p>Your Direct Debit instruction will be confirmed to you by email within 3 working days or no later than 5 working days before the first collection.
                        </p>
                        <p>We will lodge your Direct Debit instruction against the account provided within the next 5 working days.</p>
                        <p>The name that will appear on your bank statement will show as Best Insurance. 


                          <br/><br/></p>
 

                        <p class="p-bottom"><b>Contact Details</b> </p>
                        <p>If you have any questions or concerns please see our contact details below:</p>

                        <p><b>Telephone number: </b> 01582 280140</p>
                        <p><b>Opening hours: </b> 9am - 9pm Monday to Friday</p>
                        <p><b>Address: </b> Associated Premium Funding Limited 721 Capability Green, Luton, LU1 3LU</p>
                        <p><b>Email: </b><a href="mailto:enquiries@bexhilluk.com" target="_blank">enquiries@bexhilluk.com</a></p>   
                        <p>All Direct Debits are protected by a guarantee. The guarantee is detailed below:</p>           
                        
            </div>                    
                    <div class="m-box color-text-box bord__wrp">
                        
                        
                        <div class="row d-flex justify-content-between acccutimgs">
                           
                            <div class="col-md-12 ">
                            <p class="sub-text col-md-8" style="margin-top: 25px;">The Direct Debit Guarantee</p> 
                            <div class="col-md-2 pull-right text-right"> 
                            <img src="{{asset('assets/images/debit_logo.jpg')}}" alt="" class="img-fluid" width="150px" style="float: right;"></div></div>
                        
                            <div class="col-12">
                              <ul class="list__gurt">
                              <li>This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.</li>
                              <li>If there are any changes to the amount, date or frequency of your Direct Debit Associated Premium Funding Limited will notify you 10 working days in advance of your account being debited or as otherwise agreed. if you request Associated Premium Funding Limited to collect a Payment confirmation the amount and date will be given to you at the time of the request</li>

                              <li>If an error is made in the payment of your Direct Debit, by Associated Premium Funding Limited or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society - if you receive a refund you are not entitled to, you must pay it back when Associated Premium Funding Limited asks you to.
                                 </li>
                              <li>You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.
                                </li>
                               
                            </ul></div>

                          </div>
                      </div>

  
                  </div>
           
          @endif
          <!--end instructions to bank section -->
          <div class="col-sm-4" id="errContainer"></div>
          <div class="clearfix"></div>

         

        </div> <!-- bg cover-questions end -->
        <!-- redirection section -->
        <div class="form-btns">
            <div class="medium-btn2 pull-left"><a href="{{ url('cover') }}/{{ encryptUrl($personal_data->quote_id) }}/{{ $personal_data->product_id }}/{{ $personal_data->excessperiod }}">Back</a></div>
            <button type="submit" class="medium-btn btn-default pull-right" >Continue</button>
        </div>
        <!--end redirection section -->

        <input type="hidden" id="hidden_product_id" name="hidden_product_id" value="{{ $personal_data->product_id }}">
        <input type="hidden" id="hidden_quote_id" name="hidden_quote_id" value="{{ $personal_data->quote_id }}">

        
      </form>
      <br clear="all" />
    </div> <!-- Left side content -->
    
    <div class="col-md-3 padding-none right-col border-left-none">
      @include('slices.frontend.get-a-quot.right_bottom')
      
    </div>

  </div>
</section>

<div class="clearfix"></div>
@endsection
@section('page-script')
<script type="text/javascript" src="https://code.jquery.com/jquery-2.0.0.js"></script>
<script src="https://ajax.aspnetcdn.com/ajax/jquery.validate/1.11.1/jquery.validate.js"></script>
<script src="{{ URL::asset('assets/js/get-a-quote/bank_details.js') }}"></script>
<script src="{{ URL::asset('assets/js/get-a-quote/bank_details_validation.js') }}"></script>
<style type="text/css">
  .blue_form{
    color: #2ea4c5;
  }
</style>
@stop