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											<li id="menu-item-16" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16"><a title="Residential" href="https://www.citybroadband.my/residential/">Residential</a></li>
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						<div class="container">
							<h1 class="black text-center">Residential Application</h1>
							<p class="text-center">
								Please follow the steps below to complete your application. We will get back to you shortly.
							</p>
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																<li style="width: 25%;"><a href="#address" class="nf-breadcrumb" data-toggle="tab" data-index="0" aria-expanded="true">Installation Address</a></li>
																<li style="width: 25%;"><a href="#information" class="nf-breadcrumb" data-toggle="tab" data-index="1">Application Information</a></li>
																<li class="active" style="width: 25%;"><a href="#service" class="nf-breadcrumb" data-toggle="tab" data-index="2">Service and Package Details</a></li>
																<li style="width: 25%;"><a href="#signaturess" class="nf-breadcrumb" data-toggle="tab" data-index="3">Preview</a></li>
															</ul>
														</div>
													</div>

													@foreach($data as $a)
													<form action="{{url('/residential/'.$a['package'].'/application-form/upload_preview')}}" method="post" ectype="multipart/form-data" name="registerForm" novalidate="novalidate">
														<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">
														<input type="hidden" name="dealer_id" value="{{ $dealer_id }}">
														<input type="hidden" name="nama_form" value="third">
														<input type="hidden" name="coverage" value="{{$a['coverage']}}">
														<input type="hidden" name="unit" value="{{$a['unit']}}">
														<input type="hidden" name="street" value="{{$a['street']}}">
														<input type="hidden" name="package" value="{{ $a['package'] }}">
														<input type="hidden" name="application" value="{{$a['application']}}">
														<input type="hidden" name="name" value="{{$a['name']}}">
														<input type="hidden" name="nric_passport" value="{{$a['nric_passport']}}">
														<input type="hidden" name="race" value="{{$a['race']}}">
														<input type="hidden" name="contact_primary" value="{{$a['contact_primary']}}">
														<input type="hidden" name="contact_secondary" value="{{$a['contact_secondary']}}">
														<input type="hidden" name="citizenship" value="{{$a['citizenship']}}">
														<input type="hidden" name="email" value="{{$a['email']}}">
														<input type="hidden" name="gender" value="{{$a['gender']}}">

														<div class="tracking-process" ></div>

														<div>
															<div class="inner-pane">
																<div class="row">
																	<div class="col-md-12">
																		<label>You have selected:</label>
																		<p>Resident package - 50Mbps</p>
																	</div>
																</div>

																<!-- Contract -->
																<div class="row">
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Subscription / Contract Period </b> <small style="color: red">*</small></label>

																			<div>
																				<label class="radio-inline">
																					<input type="radio" name="subscription" value="12">12 Months
																				</label>
																				<label class="radio-inline">
																					<input type="radio" name="subscription" value="24" checked="">24 Months
																				</label>
																			</div>
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Billing Cycle</b> <small style="color: red">*</small></label>

																			<div>
																				<label class="radio-inline">
																					<input type="radio" name="billing" value="monthly" checked="" readonly="">Monthly
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- Voice -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="form-group">
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="voice" id="voice" value="Yes"> <p>Would you like to subscribe for Voice ( Rm 20) ?</p>
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- RFS -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="form-group">
																			<label><b>Checking and Evaluation, Date</b> <small style="color: red">*</small></label>

																			<div class="input-group date" id="sDate">
																				<input type="text" name="thedate" id="thedate" class="form-control" required="" aria-required="true">
																				<span class="input-group-addon">
																					<i class="fas fa-calendar-alt"></i>
																				</span>
																			</div>
																		</div>
																	</div>
																</div>

																<!-- Important -->
																<div class="row">
																	<div class="col-md-12">
																		<div class="important_notes">
																			<label><b>Notes: </b></label>
																			<div class="text">
																				<p class="text">1. Standard contract period is 24 months unless otherwise stated.</p>
																				<p class="text">2. Checking and Evaluation date is subject to the availability of required infrastructure and/ or equipment.</p>
																				<p class="text">3. Early termination will subject to RM500 penalty.</p>
																			</div>
																		</div>
																	</div>
																</div>

															</div>
														</div>

														<!-- Wizard Footer -->
														<div class="wizard-footer height-wizard">
															<div class="wizard-footer-inner">
																<div class="pull-right">
																	<!-- <a href="{{url('Residential/form2')}}"> -->
																	<button type="submit" class="btn btn-next" name="next" value="Next" style="background-color: orangered; display: inline-block;">Next</button>
																	<input type="button" id="save-data" class="btn btn-finish" data-loading-text="Please Wait..." name="finish" value="Submit" style="display: none;">
																		<!-- </a> -->
																</div>
																	
																	<!-- <div class="pull-left">
																		<a href="{{url('/application-form/residential/address/step1')}}">
																			<input type="button" class="btn btn-previous" name="previous" value="Previous" style="background-color: grey;">
																		</a>
																	</div> -->
																<div class="clearfix"></div>
															</div>
														</div>
													</form>
													@endforeach
												</div>
											</div>
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