@extends('layouts.app')
@section('title', 'Account Setup')
@section('content')
@php
    $genders = [
        [
          'value' => 'male',
          'name' => 'Male',
        ],
        [
          'value' => 'female',
          'name' => 'Female',
        ]
    ];
@endphp
<section class="content">
    <div class="section-area">
      <div class="title">
         <span>Your Details</span>
      </div>
        <div class="info">
            <span>For the deposit, regulations require you to <br>provide the following details.</span>
        </div>
      <div class="process-section">
            <div class="row justify-content-center">
                <div class="col-md-8">
                  <form action="{{url('account/setup/2')}} " method="post">
                    {{ csrf_field() }}
                    <div class="process-section-inner">					                            <div class="process-section-single">                            <label>Name</label>                            <input class="form-control" type="text" name="name" value="" >                            @error('name')                              <label class="text-danger mt-3">{{ $message }}</label>                            @enderror                        </div>
                        <div class="process-section-single">
                            <label>Date of birth (MM/DD/YYYY)</label>
                            <div class="row">
                                  <div class="col-md-4">
                                        <select class="form-control" name="month">
                                            <option value='01'>01</option>
                                            <option value='02'>02</option>
                                            <option value='03'>03</option>
                                            <option value='04'>04</option>
                                            <option value='05'>05</option>
                                            <option value='06'>06</option>
                                            <option value='07'>07</option>
                                            <option value='08'>08</option>
                                            <option value='09'>09</option>
                                            <option value='10'>10</option>
                                            <option value='11'>11</option>
                                            <option value='12'>12</option>
                                        </select>
                                        @error('month')
                                            <label class="text-danger mt-3">{{$message}}</label>
                                        @enderror
                                  </div>
                                  <div class="col-md-4">
                                        <select class="form-control" name="day">
                                            <option value='01'>01</option>
                                            <option value='02'>02</option>
                                            <option value='03'>03</option>
                                            <option value='04'>04</option>
                                            <option value='05'>05</option>
                                            <option value='06'>06</option>
                                            <option value='07'>07</option>
                                            <option value='08'>08</option>
                                            <option value='09'>09</option>
                                            <option value='10'>10</option>
                                            <option value='11'>11</option>
                                            <option value='12'>12</option>
                                            <option value='13'>13</option>
                                            <option value='14'>14</option>
                                            <option value='15'>15</option>
                                            <option value='16'>16</option>
                                            <option value='17'>17</option>
                                            <option value='18'>18</option>
                                            <option value='19'>19</option>
                                            <option value='20'>20</option>
                                            <option value='21'>21</option>
                                            <option value='22'>22</option>
                                            <option value='23'>23</option>
                                            <option value='24'>24</option>
                                            <option value='25'>25</option>
                                            <option value='26'>26</option>
                                            <option value='27'>27</option>
                                            <option value='28'>28</option>
                                            <option value='29'>29</option>
                                            <option value='30'>30</option>
                                            <option value='31'>31</option>
                                        </select>
                                        @error('day')
                                            <label class="text-danger mt-3"> {{ $message }} </label>
                                        @enderror
                                  </div>
                                  <div class="col-md-4">
                                        <select class="form-control" name="year">
                                            <option value="2020">2020</option>
                                            <option value="2019">2019</option>
                                            <option value="2018">2018</option>
                                            <option value="2017">2017</option>
                                            <option value="2016">2016</option>
                                            <option value="2015">2015</option>
                                            <option value="2014">2014</option>
                                            <option value="2013">2013</option>
                                            <option value="2012">2012</option>
                                            <option value="2011">2011</option>
                                            <option value="2010">2010</option>
                                            <option value="2009">2009</option>
                                            <option value="2008">2008</option>
                                            <option value="2007">2007</option>
                                            <option value="2006">2006</option>
                                            <option value="2005">2005</option>
                                            <option value="2004">2004</option>
                                            <option value="2003">2003</option>
                                            <option value="2002">2002</option>
                                            <option value="2001">2001</option>
                                            <option value="2000">2000</option>
                                            <option value="1999">1999</option>
                                            <option value="1998">1998</option>
                                            <option value="1997">1997</option>
                                            <option value="1996">1996</option>
                                            <option value="1995">1995</option>
                                            <option value="1994">1994</option>
                                            <option value="1993">1993</option>
                                            <option value="1992">1992</option>
                                            <option value="1991">1991</option>
                                            <option value="1990">1990</option>
                                            <option value="1989">1989</option>
                                            <option value="1988">1988</option>
                                            <option value="1987">1987</option>
                                            <option value="1986">1986</option>
                                            <option value="1985">1985</option>
                                            <option value="1984">1984</option>
                                            <option value="1983">1983</option>
                                            <option value="1982">1982</option>
                                            <option value="1981">1981</option>
                                            <option value="1980">1980</option>
                                            <option value="1979">1979</option>
                                            <option value="1978">1978</option>
                                            <option value="1977">1977</option>
                                            <option value="1976">1976</option>
                                            <option value="1975">1975</option>
                                            <option value="1974">1974</option>
                                            <option value="1973">1973</option>
                                            <option value="1972">1972</option>
                                            <option value="1971">1971</option>
                                            <option value="1970">1970</option>
                                            <option value="1969">1969</option>
                                            <option value="1968">1968</option>
                                            <option value="1967">1967</option>
                                            <option value="1966">1966</option>
                                            <option value="1965">1965</option>
                                            <option value="1964">1964</option>
                                            <option value="1963">1963</option>
                                            <option value="1962">1962</option>
                                            <option value="1961">1961</option>
                                            <option value="1960">1960</option>
                                            <option value="1959">1959</option>
                                            <option value="1958">1958</option>
                                            <option value="1957">1957</option>
                                            <option value="1956">1956</option>
                                            <option value="1955">1955</option>
                                            <option value="1954">1954</option>
                                            <option value="1953">1953</option>
                                            <option value="1952">1952</option>
                                            <option value="1951">1951</option>
                                            <option value="1950">1950</option>
                                            <option value="1949">1949</option>
                                            <option value="1948">1948</option>
                                            <option value="1947">1947</option>
                                            <option value="1946">1946</option>
                                            <option value="1945">1945</option>
                                            <option value="1944">1944</option>
                                            <option value="1943">1943</option>
                                            <option value="1942">1942</option>
                                            <option value="1941">1941</option>
                                            <option value="1940">1940</option>
                                            <option value="1939">1939</option>
                                            <option value="1938">1938</option>
                                            <option value="1937">1937</option>
                                            <option value="1936">1936</option>
                                            <option value="1935">1935</option>
                                            <option value="1934">1934</option>
                                            <option value="1933">1933</option>
                                            <option value="1932">1932</option>
                                            <option value="1931">1931</option>
                                            <option value="1930">1930</option>
                                        </select>
                                  </div>
                            </div>
                        </div>
                        <div class="process-section-single">
                            <label>Gender</label>
                            <select class="form-control" name="gender">
                                @foreach($genders as $gender)
                                  <option value="{{$gender['value']}}" {{ (isset($account) && $gender['value'] == $account->gender) ? 'selected' : ''}}>{{$gender['name']}}</option>
                                @endforeach
                            </select>
                            @error('gender')
                                <label class="text-danger mt-3">{{ $message }}</label>
                            @enderror
                        </div>
                        <div class="process-section-single">
                            <label>Address</label>
                            <input class="form-control" type="text" name="address" value="{{ $account->address ?? ''}}">
                            @error('address')
                              <label class="text-danger mt-3">{{ $message }}</label>
                            @enderror
                        </div>
                        <div class="process-section-single">
                          <div class="row">
                                <div class="col-md-6">
                                      <label>City</label>
                                      <input class="form-control" type="text" name="city" value="{{ $account->city ?? '' }}">
                                      @error('city')
                                        <label class="text-danger mt-3">{{ $message }}</label>
                                      @enderror
                                </div>
                                <div class="col-md-6">
                                      <label>State</label>                                                                            <select class="form-control" name="state_id">                                            <option value="">Select State</option>
                                                                                        
                                      </select>
                                      @error('state_id')
                                          <label class="text-danger mt-3">{{ $message }}</label>
                                      @enderror
                                </div>
                          </div>
                        </div>
                        <div class="process-section-single">
                          <div class="row">
                                <div class="col-md-6">
                                      <label>Postal Code</label>
                                      <input class="form-control" type="text" name="postal_code" value="{{ $account->postal_code ?? '' }}">
                                      @error('postal_code')
                                        <label class="text-danger mt-3">{{ $message }}</label>
                                      @enderror
                                </div>
                                <div class="col-md-6">
                                      <label>Mobile Phone Number</label>
                                      <input class="form-control" type="text" name="mobile_no" value="{{ $account->mobile_no ?? '' }}">
                                      @error('mobile_no')
                                        <label class="text-danger mt-3">{{ $message }}</label>
                                      @enderror
                                </div>
                          </div>
                        </div>
                        <div class="process-section-single">
                                <label>
                                      <input type="checkbox" name="term-condition" value="1">
                                      Send me information about PAYMENT or other relevant offers. PAYMENT will not sell my personal informaition to others for marketing purposes, and i can opt out of offers at any time in my account setting or by clicking unsubscribe in my emails.
                                </label>								 @error('term-condition')								 <label class="text-danger mt-3">{{ $message }}</label>								  @enderror
                        </div>
                        <div class="card-action-area">
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="secondry-btn">
                                        <a href="{{url('account/setup/step/1')}}"><button type="button">Back</button></a>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="main-btn">
                                        <button type="submit">Continue</button>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </form>
                    </div>
                </div>
            </div>
      </div>
    </div>
</section>
@endsection