@extends('adminlayout.admin')
@section('content')
<style >
   .cursor{
   cursor: pointer;
   }
   .nk-content-fluid{
   margin-top: 65px;
   position: relative;
   }
   .team-info li{
   font-size: .7900rem !important;
   }
   .margin-top{
        margin-top: 10px;
   }
</style>
<div class="nk-content nk-content-fluid">
   <div class="container-xl wide-lg">
      <div class="nk-content-body">
         <div class="nk-block-head nk-block-head-sm">
            <div class="nk-block-between">
               <div class="nk-block-head-content">
                  <h3 class="nk-block-title page-title">Lic Pay </h3>
                  <div class="nk-block-des text-soft">
                     
                  </div>
               </div>
               <!-- .nk-block-head-content -->
            </div>
            <!-- .nk-block-between -->
         </div>
         <!-- .nk-block-head -->
         <form method="post" action="{{  route('save_pay_lic') }}" enctype="multipart/form-data">
            @csrf
            <div class="container">
                <div class="row">
                    <div class="col-sm-6">
                        <div class="form-group ">
                            <label for="exampleInputEmail1">Ca Numbar</label>
                            <input type="text" name="canumber" class="form-control" value="{{  old('canumber') }}">
                            <span class="text-danger">@if ($errors->has('canumber')){{  $errors->first('canumber') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group margin-top">
                            <label for="exampleInputEmail1">Mode</label>
                            <select class="form-control form-control-lg" name="mode">
                                <option value="offline">offline</option>
                                <option value="online">online</option>
                            </select>
                            <span class="text-danger">@if ($errors->has('mode')){{  $errors->first('mode') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group ">
                            <label for="exampleInputEmail1">Amount</label>
                            <input type="text" name="amount" class="form-control" value="{{  old('amount') }}">
                            <span class="text-danger">@if ($errors->has('amount')){{  $errors->first('amount') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Ad1</label>
                            <input type="text" name="ad1" class="form-control" value="{{  old('ad1') }}">
                            <span class="text-danger">@if ($errors->has('ad1')){{  $errors->first('ad1') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Ad2</label>
                            <input type="text" name="ad2" class="form-control" value="{{  old('ad2') }}">
                            <span class="text-danger">@if ($errors->has('ad2')){{  $errors->first('ad2') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Ad3</label>
                            <input type="text" name="ad3" class="form-control" value="{{  old('ad3') }}">
                            <span class="text-danger">@if ($errors->has('ad3')){{  $errors->first('ad3') }}@endif</span>
                        </div>
                    </div>
                    
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Latitude</label>
                            <input type="text" name="latitude" class="form-control" value="{{  old('latitude') }}">
                            <span class="text-danger">@if ($errors->has('latitude')){{  $errors->first('latitude') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Longitude</label>
                            <input type="text" name="longitude" class="form-control" value="{{  old('longitude') }}">
                            <span class="text-danger">@if ($errors->has('longitude')){{  $errors->first('longitude') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Bill Number</label>
                            <input type="text" name="billNumber" class="form-control" value="{{  old('billNumber') }}">
                            <span class="text-danger">@if ($errors->has('billNumber')){{  $errors->first('billNumber') }}@endif</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Bill Amount</label>
                            <input type="text" name="billAmount" class="form-control" value="{{  old('billAmount') }}">
                            <span class="text-danger">@if ($errors->has('billAmount')){{  $errors->first('billAmount') }}@endif</span>
                        </div>
                    </div>
                   
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Bill Net Amount</label>
                            <input type="text" name="billnetamount" class="form-control" value="{{  old('billnetamount') }}">
                            <span class="text-danger">@if ($errors->has('billnetamount')){{  $errors->first('billnetamount') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Bill Date</label>
                            <input type="date" name="billdate" class="form-control" value="{{  old('billdate') }}">
                            <span class="text-danger">@if ($errors->has('billdate')){{  $errors->first('billdate') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Accept Payment</label>
                            <select class="form-control form-control-lg" name="acceptPayment">
                                <option value="true">true</option>
                                <option value="false">false</option>
                            </select>
                            <span class="text-danger">@if ($errors->has('acceptPayment')){{  $errors->first('acceptPayment') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Accept PartPay</label>
                            <select class="form-control form-control-lg" name="acceptPartPay">     
                                <option value="false">false</option>
                                <option value="true">true</option>
                            </select>
                            <span class="text-danger">@if ($errors->has('acceptPartPay')){{  $errors->first('acceptPartPay') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Cell Number</label>
                            <input type="text" name="cellNumber" class="form-control" value="{{  old('cellNumber') }}">
                            <span class="text-danger">@if ($errors->has('cellNumber')){{  $errors->first('cellNumber') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Due From</label>
                            <input type="date" name="dueFrom" class="form-control" value="{{  old('dueFrom') }}">
                            <span class="text-danger">@if ($errors->has('dueFrom')){{  $errors->first('dueFrom') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Due To</label>
                            <input type="date" name="dueTo" class="form-control" value="{{  old('dueTo') }}">
                            <span class="text-danger">@if ($errors->has('dueTo')){{  $errors->first('dueTo') }}@endif</span>
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Validation Id</label>
                            <input type="text" name="validationId" class="form-control" value="{{  old('validationId') }}">
                            <span class="text-danger">@if ($errors->has('validationId')){{  $errors->first('validationId') }}@endif</span>
                        </div>
                    </div>
                    
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="exampleInputEmail1">Bill Id</label>
                            <input type="text" name="billId" class="form-control" value="{{  old('billId') }}">
                            <span class="text-danger">@if ($errors->has('billId')){{  $errors->first('billId') }}@endif</span>
                        </div>
                    </div>
                    
                        
                    </div>
                    <button type="submit" class="btn btn-primary margin-top">Submit</button>
                </div>
            </div>
         </form>
         <!-- .nk-block -->
      </div>
   </div>
</div>
@endsection