@extends('User.Layout.main_layout') 	
@section('title','View Policies and Process')
@section('main_container')

<!-- partial -->
<div class="main-panel">          
    <div class="content-wrapper">
        <div class="page-header">
            <h3 class="page-title">
            Add Payment
            </h3>
            <nav aria-label="breadcrumb">
              <ol class="breadcrumb">
                <li class="breadcrumb-item"><a href="#">Home</a></li>
                <li class="breadcrumb-item active" aria-current="page">Payment</li><br>
                
              </ol>
            </nav>
        </div>
        <div class="row">
            <div class="col-lg-12">
                <div class="card">
                    <div class="card-body">
                        <div class="col-lg-3 form-group">
                            <label for="exampleInputUsername1">Payment Mode<span style="color:red">*</span></label>
                            <select  name="" id="myselection" value=""  class="form-control">
                                <option value="">Select </option>
                                <option style="margin-right:200px;" value="One" selected>Cheque/DD</option>
                                <option style="margin-right:200px;" value="Two" >NEFT</option>
                                <option style="margin-right:200px;" value="Three">Bank Deposit</option>
                                <option style="margin-right:200px;" value="Four" >Cash Payment</option>
                            </select>
                        </div>

                        <form action="{{url('/add_payment/'.$fetch->form_id)}}" method="post" enctype="multipart/form-data"> 
                        @csrf
                        <input type="hidden" name="form_id" value="<br />
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                        <input type="hidden" name="customer_id" value="<br />
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                        <input type="hidden" name="payment_mode" value="Cheque/DD"/>
                        <div id="showOne" class="myDiv col-lg-8 row" style="border-style: ridge;">
                            <div class="col-lg-12">
                            </div><br>
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Date<span style="color:red">*</span></label>
                                        <input type="date" min="2024-09-19" class="form-control" id="exampleInputUsername1" name="payment_date" value="{{old('payment_date')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Amount<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="amount" value="{{old('amount')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Account No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="account_no" value="{{old('account_no')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Cheque No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="cheque_no" value="{{old('cheque_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="col-lg-6 row"><br>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Currency<span style="color:red">*</span></label>
                                        <select  name="currency"  class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="INR">India (INR)</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">State<span style="color:red">*</span></label>
                                        <select  name="state" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="Gujarat">Gujarat</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Bank Name<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="bank_name" value="{{old('bank_name')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Reference No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="payment_ref_no" value="{{old('payment_ref_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            <button type="submit" class="btn btn-primary mr-2" name="submit" value="Send">Submit</button><br>
                            
                        </div>
                        </form>

                        <form action="{{url('/add_payment/'.$fetch->form_id)}}" method="post" enctype="multipart/form-data"> 
                        @csrf
                        <input type="hidden" name="form_id" value="<br />
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                        <input type="hidden" name="customer_id" value="<br />
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                        <input type="hidden" name="payment_mode" value="NEFT"/>
                        <div id="showTwo" class="myDiv col-lg-8 row" style="border-style: ridge;display: none">
                            <div class="col-lg-12">
                            </div><br>
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Date<span style="color:red">*</span></label>
                                        <input type="date" min="2024-09-19" class="form-control" id="exampleInputUsername1" name="payment_date" value="{{old('payment_date')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Amount<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="amount" value="{{old('amount')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">UTR No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="utr_no" value="{{old('utr_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Currency<span style="color:red">*</span></label>
                                        <select  name="currency" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="INR">India (INR)</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">State<span style="color:red">*</span></label>
                                        <select  name="state" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="Gujarat">Gujarat</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Reference No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="payment_ref_no" value="{{old('payment_ref_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            <button type="submit" class="btn btn-primary mr-2" name="submit" value="Send">Submit</button>
                        </div>
                        </form>

                        <form action="{{url('/add_payment/'.$fetch->form_id)}}" method="post" enctype="multipart/form-data"> 
                        @csrf
                        <input type="hidden" name="form_id" value="<br />
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                        <input type="hidden" name="customer_id" value="<br />
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                        <input type="hidden" name="payment_mode" value="Bank Deposit"/>
                        <div id="showThree" class="myDiv col-lg-8 row" style="border-style: ridge;display: none">
                            <div class="col-lg-12">
                            </div><br>
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Date<span style="color:red">*</span></label>
                                        <input type="date" min="2024-09-19" class="form-control" id="exampleInputUsername1" name="payment_date" value="{{old('payment_date')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Amount<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="amount" value="{{old('amount')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Account No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="account_no" value="{{old('account_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Currency<span style="color:red">*</span></label>
                                        <select  name="currency" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="INR">India (INR)</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">State<span style="color:red">*</span></label>
                                        <select  name="state" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="Gujarat">Gujarat</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Reference No<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="payment_ref_no" value="{{old('payment_ref_no')}}" required>
                                    </div>
                                </div>
                            </div>
                            <button type="submit" class="btn btn-primary mr-2" name="submit" value="Send">Submit</button>
                        </div>
                        </form>

                        <form action="{{url('/add_payment/'.$fetch->form_id)}}" method="post" enctype="multipart/form-data"> 
                        @csrf
                        <input type="hidden" name="form_id" value="<br />
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                        <input type="hidden" name="customer_id" value="<br />
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                        <input type="hidden" name="payment_mode" value="Cash Payment"/>
                        <div id="showFour" class="myDiv col-lg-8 row" style="border-style: ridge;display: none">
                            <div class="col-lg-12">
                            </div><br>
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Payment Date<span style="color:red">*</span></label>
                                        <input type="date" min="2024-09-19" class="form-control" id="exampleInputUsername1" name="payment_date" value="{{old('payment_date')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Amount<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="amount" value="{{old('payment_date')}}" required>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Person Name<span style="color:red">*</span></label>
                                        <input type="text" class="form-control" id="exampleInputUsername1" name="person_name" value="{{old('person_name')}}" required>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="col-lg-6 row">
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">Currency<span style="color:red">*</span></label>
                                        <select  name="currency" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="INR">India (INR)</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">State<span style="color:red">*</span></label>
                                        <select  name="state" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="Gujarat">Gujarat</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="form-group">
                                        <label for="exampleInputUsername1">IIMT_ID<span style="color:red">*</span></label>
                                        <select  name="iimt_id" class="form-control" required>
                                            <option value="">Select </option>
                                            <option style="margin-right:200px;" value="1">Chintan</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            <button type="submit" class="btn btn-primary mr-2" name="submit" value="Send">Submit</button>
                        </div>
                        </form> 
                    </div>
                </div>
            </div>
        </div>
    </div>
        <!-- content-wrapper ends -->

@endsection