@extends('musharaf.baseLanding')
@section('css')
<!-- bootstrap 4.x is supported. You can also use the bootstrap css 3.3.x versions -->
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css">
<link href="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/css/fileinput.min.css" media="all" rel="stylesheet" type="text/css" />
<!-- if using RTL (Right-To-Left) orientation, load the RTL CSS file after fileinput.css by uncommenting below -->
<!-- link href="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/css/fileinput-rtl.min.css" media="all" rel="stylesheet" type="text/css" /-->
<script src="https://code.jquery.com/jquery-3.3.1.min.js"></script>
<!-- piexif.min.js is needed for auto orienting image files OR when restoring exif data in resized images and when you
wish to resize images before upload. This must be loaded before fileinput.min.js -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/js/plugins/piexif.min.js" type="text/javascript"></script>
<!-- sortable.min.js is only needed if you wish to sort / rearrange files in initial preview.
This must be loaded before fileinput.min.js -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/js/plugins/sortable.min.js" type="text/javascript"></script>
<!-- purify.min.js is only needed if you wish to purify HTML content in your preview for
HTML files. This must be loaded before fileinput.min.js -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/js/plugins/purify.min.js" type="text/javascript"></script>
<!-- popper.min.js below is needed if you use bootstrap 4.x. You can also use the bootstrap js
3.3.x versions without popper.min.js. -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.7/umd/popper.min.js"></script>
<!-- bootstrap.min.js below is needed if you wish to zoom and preview file content in a detail modal
dialog. bootstrap 4.x is supported. You can also use the bootstrap js 3.3.x versions. -->
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js" type="text/javascript"></script>
<!-- the main fileinput plugin file -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/js/fileinput.min.js"></script>
<!-- optionally if you need a theme like font awesome theme you can include it as mentioned below -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-fileinput/5.1.2/themes/fa/theme.js"></script>
<!-- optionally if you need translation for your language then include locale file as mentioned below -->
@endsection
@section('content')
<style>
.btn-success {
color: #fff;
background-color: #9933cc;
border-color: #9C27B0;
}
</style>
<div class="container-fluid">
<div class="fade-in">
<div class="row">
<div class="mx-auto col-md-6 col-sm-10">
<div class="card">
<div class="card-header text-center">
<img src="{{ asset('img/naila.png') }}" width="125" alt="naila">
<h4 style="margin-top:12px;">Naila Syafaah - Registrasi Agen</h4>
</div>
<div class="card-body">
@if( $message ?? false )
<div class="row">
<div class="col-12">
<div class="alert alert-success" role="alert">{{ $message }}</div>
</div>
</div>
@endif
@if( $error ?? false )
<div class="row">
<div class="col-12">
<div class="alert alert-warning" role="alert">{{ $error }}</div>
</div>
</div>
@endif
<div class="row">
<div class="col-12">
<form method="POST" action="{{ route('registerAgentCreate') }}">
@csrf
<input name="marker" value="selectModel" type="hidden">
<div class="form-group">
<label>{{ __('Nama Depan') }}</label>
<input
type="text"
placeholder=""
name="first_name"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('Nama Belakang') }}</label>
<input
type="text"
placeholder=""
name="last_name"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('Gelar') }}</label>
<input
type="text"
placeholder="S.Kom, Spd"
name="gelar"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('Jenis Kelamin') }}</label>
<select class="input-group" name="" id="">
<option value="pria">Pria</option>
<option value="wanita">Wanita</option>
</select>
</div>
<div class="form-group">
<label>{{ __('Alamat') }}</label>
<textarea
placeholder=""
name="address"
class="form-control"
></textarea>
</div>
<div class="form-group">
<label>{{ __('No. Telp.') }}</label>
<input
type="text"
placeholder=""
name="phone"
class="form-control"
>
</div>
<hr>
<div class="form-group">
<label>{{ __('No. KTP') }}</label>
<input
type="text"
placeholder=""
name="ktp"
class="form-control"
>
<br/>
<label class="control-label">Upload Foto KTP</label>
<input id="ktp_image" name="ktp_image" type="file">
<script>
$(document).ready(function() {
$("#ktp_image").fileinput({
showUpload: false,
dropZoneEnabled: false,
maxFileCount: 1,
mainClass: "input-group"
});
});
</script>
</div>
<hr>
<div class="form-group">
<label>{{ __('No. NPWP') }}</label>
<input
type="text"
placeholder=""
name="npwp"
class="form-control"
>
<br/>
<label class="control-label">Upload Foto NPWP</label>
<input id="npwp_image" name="npwp_image" type="file">
<script>
$(document).ready(function() {
$("#npwp_image").fileinput({
showUpload: false,
dropZoneEnabled: false,
maxFileCount: 1,
mainClass: "input-group"
});
});
</script>
</div>
<hr>
<div class="form-group">
<label>{{ __('No. Kartu Keluarga') }}</label>
<input
type="text"
placeholder=""
name="kk"
class="form-control"
>
<br/>
<label class="control-label">Upload Foto KK</label>
<input id="kk_image" name="kk_image" type="file">
<script>
$(document).ready(function() {
$("#kk_image").fileinput({
showUpload: false,
dropZoneEnabled: false,
maxFileCount: 1,
mainClass: "input-group"
});
});
</script>
</div>
<hr>
<div class="form-group">
<label>{{ __('Nama Bank') }}</label>
<input
type="text"
placeholder=""
name="bank_name"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('Cabang Bank') }}</label>
<input
type="text"
placeholder=""
name="bank_name"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('No. Rekening Bank') }}</label>
<input
type="text"
placeholder=""
name="bank_account_number"
class="form-control"
>
</div>
<div class="form-group">
<label>{{ __('Nama Pemilik Rekening Bank') }}</label>
<input
type="text"
placeholder=""
name="bank_account_name"
class="form-control"
>
</div>
<hr>
<div class="form-group">
<label>{{ __('Alamat Kantor Cabang') }}</label>
<textarea
placeholder=""
name="branch_address"
class="form-control"
></textarea>
<br/>
<label class="control-label">Upload Foto Kantor Cabang</label>
<input id="branch_image" name="branch_image" type="file">
<script>
$(document).ready(function() {
$("#branch_image").fileinput({
showUpload: false,
dropZoneEnabled: false,
maxFileCount: 1,
mainClass: "input-group"
});
});
</script>
</div>
<hr>
<div class="form-group">
<label>{{ __('Rekomendasi') }}</label>
<select class="select-group" name="" id="">
<option value="0">Tanpa Rekomendasi</option>
<option value="1">Fullan 1 (no-anggota)</option>
<option value="2">Fullan 2 (no-anggota)</option>
<option value="3">Fullan 3 (no-anggota) </option>
</select>
</div>
<div class="form-group">
<label>{{ __('Tipe Pengurus') }}</label>
<select class="form-input" name="" id="">
<option value="">Cabang Wilayah Province (CWP)</option>
<option value="">Cabang Kota Kabupaten (CK) </option>
<option value="">Agen Pewakilan (AP)</option>
<option value="">Marketing Freelance (MF)</option>
</select>
</div>
<hr>
<button
type="submit"
class="btn btn-success"
>
Submit
</button>
<a
href="{{ 'http://nailasyafaah.com' }}"
class="btn btn-primary"
>
Kembali
</a>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
@endsection
@section('javascript')
@endsection
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