Current File : /home/inlingua/public_html/crm.vprotectindia.com/resources/views/unreg_payment.blade.php

@extends('layouts.user_guestapp')
@section('content')
<div class="container">


    <div class="row justify-content-center">
        <div class="col-md-8">
            <div class="card">
                <div class="card-header">Un Register Advance Payment</div>
<strong></strong>
                <div class="card-body">
                    <form method="POST" action="{{ route('pay.unregister') }}">
                        @csrf

                        <div class="form-group row">
                            <label for="name" class="col-md-4 col-form-label text-md-right">{{ __('Name') }}</label>

                            <div class="col-md-6">
                                <input id="name" type="text" {{ $user['htmltag'] }}  class="form-control{{ $errors->has('name') ? ' is-invalid' : '' }}" name="name" value="{{ $user['name'] }}{{ old('name') }}" required autofocus>

                                @if ($errors->has('name'))
                                    <span class="invalid-feedback" role="alert">
                                        <strong>{{ $errors->first('name') }}</strong>
                                    </span>
                                @endif
                            </div>
                        </div>

                 <div class="form-group row">
                            <label for="mobile" class="col-md-4 col-form-label text-md-right">{{ __('Mobile') }}</label>

                            <div class="col-md-6">
                                <input id="mobile" type="mobile" {{ $user['htmltag'] }} class="form-control{{ $errors->has('mobile') ? ' is-invalid' : '' }}" name="mobile" value="{{ $user['mobile'] }}{{ old('mobile') }}" required>

                                @if ($errors->has('mobile'))
                                    <span class="invalid-feedback" role="alert">
                                        <strong>{{ $errors->first('mobile') }}</strong>
                                    </span>
                                @endif
                            </div>
                        </div>

                        <div class="form-group row">
                            <label for="email" class="col-md-4 col-form-label text-md-right">{{ __('E-Mail Address') }}</label>

                            <div class="col-md-6">
                                <input id="email" type="email" {{ $user['htmltag'] }} class="form-control{{ $errors->has('email') ? ' is-invalid' : '' }}" name="email" value="{{ $user['email'] }}{{ old('email') }}" required>

                                @if ($errors->has('email'))
                                    <span class="invalid-feedback" role="alert">
                                        <strong>{{ $errors->first('email') }}</strong>
                                    </span>
                                @endif
                            </div>
                        </div>

                        <div class="form-group row">
                            <label for="Address" class="col-md-4 col-form-label text-md-right">{{ __('Address') }}</label>

                            <div class="col-md-6">
                                <textarea id="address" {{ $user['htmltag'] }} class="form-control{{ $errors->has('address') ? ' is-invalid' : '' }}" name="address" required>{{ $user['address'] }}
                                </textarea>
                                @if ($errors->has('address'))
                                    <span class="invalid-feedback" role="alert">
                                        <strong>{{ $errors->first('address') }}</strong>
                                    </span>
                                @endif
                            </div>
                        </div>

                        <div class="form-group row">
                            <label for="amount" class="col-md-4 col-form-label text-md-right">{{ __('Amount') }}</label>
                            <div class="col-md-6">
                                <input id="amount"  {{ $user['htmltag'] }} class="form-control" name="amount" required value="{{ $user['amount'] }}"> 
								<input type="hidden" value="{{ $user['order_id'] }}" name="orderid">
								<input type="hidden" value="{{ $user['payment_type'] }}" name="payment_type">
                            </div>
                        </div>

                        <div class="form-group row mb-0">
                            <div class="col-md-6 offset-md-4">
                                <button type="submit" class="btn btn-primary">
                                    {{ __('Pay  Now') }}
                                </button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>
@endsection