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	<title>Business Application</title>

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		input[type="text"], .tab-pane input[type="search"], input[type="email"], input[type="tel"], input[type="file"] {
		    height: 40px !important;
		    border: 1px solid #ccc !important;
		    border-radius: 4px;
		    margin-bottom: 0px;
		    background: #f5f5f5;
		}
	    footer {
		    padding: 40px 0 !important;
		}

		.inner-pane-white{
			background-color: #fff !important;
			border: 1px solid #ccc;
			padding: 20px;
		}
		#preview{
			padding: 0px !important;
		}
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<body>
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		<a class="skip-link screen-reader-text" href="#content">Skip to content</a>


		<header id="masthead" class="site-header" role="banner">
			<div class="fixed-portal-login"><a href="http://userportal.citybroadband.my/login" target="_blank">User Portal Login</a></div></div>

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				<nav id="site-navigation" class="main-navigation" role="navigation">
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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://cbb.allo.my/residential/">Residential</a></li>
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		</header><!-- #masthead -->

		<div id="content" class="main-container">
			<section class="content-area">
				<div id="main" role="main">
					<div class="bg-white splash-text" style="padding-bottom: 0">
						<div class="container">
							<h1 class="black text-center">Business Application</h1>
							<p class="text-center">
								Please follow the steps below to complete your application. We will get back to you shortly.
							</p>
						</div>
					</div>
					<div class="container">
						<div class="row">
							<div class="col-md-8 col-md-offset-2">
								<section class="form-box">
									<div class="row">
										<div class="col-md-12">

											<!--      Wizard container        -->
											<div class="wizard-container">

												<div class="card wizard-card">
													<div class="wizard-navigation">
														<div>
															<ul class="nf-breadcrumbs nav nav-pills">
																<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 style="width: 25%;"><a href="#service" class="nf-breadcrumb" data-toggle="tab" data-index="2">Service and Package Details</a></li>
																<li class="active" style="width: 25%;"><a href="#signaturess" class="nf-breadcrumb" data-toggle="tab" data-index="3">Preview</a></li>
															</ul>
														</div>
													</div>

													@foreach($data as $a)
													<form method="post" action="{{ url('/business/application-form/store/'.$a['dealer_id']) }}" enctype="multipart/form-data" name="registerForm" novalidate="novalidate">

														<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">
														<input type="hidden" name="dealer_id" value="{{ $a['dealer_id'] }}">
														<input type="hidden" name="unit_no" value="{{$a['unit_no']}}">
														<input type="hidden" name="caddress" value="{{$a['caddress']}}">
														<input type="hidden" name="ccity" value="{{$a['ccity']}}">
														<input type="hidden" name="cstate" value="{{$a['cstate']}}">
														<input type="hidden" name="postcode" value="{{$a['postcode']}}">
														<input type="hidden" name="package" value="{{ $a['package'] }}">
														<input type="hidden" name="application" value="{{$a['application']}}">
														<input type="hidden" name="company_name" value="{{$a['company_name']}}">
														<input type="hidden" name="company_register" value="{{$a['company_register']}}">
														<input type="hidden" name="company_number" value="{{$a['company_number']}}">
														<input type="hidden" name="company_fax" value="{{$a['company_fax']}}">
														<input type="hidden" name="full_name" value="{{$a['full_name']}}">
														<input type="hidden" name="nric_passport" value="{{$a['nric_passport']}}">
														<input type="hidden" name="designation" value="{{$a['designation']}}">
														<input type="hidden" name="contact_primary" value="{{$a['contact_primary']}}">
														<input type="hidden" name="contact_secondary" value="{{$a['contact_secondary']}}">
														<input type="hidden" name="email" value="{{$a['email']}}">
														<input type="hidden" name="subscription" value="{{$a['subscription']}}">
														<input type="hidden" name="voice" value="{{$a['voice']}}">
														<input type="hidden" name="ip" value="{{$a['ip']}}">
														<input type="hidden" name="rfs" value="{{$a['thedate']}}">
														<input type="hidden" name="deposit" value="{{ $deposit }}">
														<input type="hidden" name="otc" value="{{ $otc }}">
														<input type="hidden" name="gst" value="{{ $gst }}">
														<input type="hidden" name="total" value="{{ $total }}">

														<div class="tracking-process"></div>
													
														<div>
															<div class="inner-pane-white">
																<!-- Preview -->
																<div class="row">
																	<div class="col-md-12">
																		<div id="preview">
																			<label><b>Subscription Details</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Type Application</th>
																						<td>{{$a['application']}}</td>
																					</tr>
																					<tr><th width="50%">Business Package</th>
																						<td>{{$a['package']}}</td>
																					</tr>
																					<tr><th width="50%">Contract Term</th>
																						<td>{{$a['subscription']}}Months</td>
																					</tr>
																					<tr><th width="50%">Checking and Evaluation, Date</th>
																						<td>{{$a['thedate']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Add-On(s)</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Subscribe for Voice</th>
																						<td>{{$a['voice']}}</td>
																					</tr>
																					<tr><th width="50%">IP</th>
																						<td>{{$a['ip']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Personal Details</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Full Name</th>
																						<td>{{$a['full_name']}}</td>
																					</tr>
																					<tr><th width="50%">MyKad/Passport</th>
																						<td>{{$a['nric_passport']}}</td>
																					</tr>
																					<tr><th width="50%">Designation</th>
																						<td>{{$a['designation']}}</td>
																					</tr>
																					<tr><th width="50%">Primary Phone Number</th>
																						<td>{{$a['contact_primary']}}</td>
																					</tr>
																					<tr><th width="50%">Secondary Phone Number</th>
																						<td>{{$a['contact_secondary']}}</td>
																					</tr>
																					<tr><th width="50%">Email Address</th>
																						<td>{{$a['email']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Service Installation Address</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Unit Number</th>
																						<td>{{$a['unit_no']}}</td>
																					</tr>
																					<tr><th width="50%">Company Name</th>
																						<td>{{$a['company_name']}}</td>
																					</tr>
																					<tr><th width="50%">Address</th>
																						<td>{{$a['caddress']}}</td>
																					</tr>
																					<tr><th width="50%">Postcode</th>
																						<td>{{$a['postcode']}}</td>
																					</tr>
																					<tr><th width="50%">City</th>
																						<td>{{$a['ccity']}}</td>
																					</tr>
																					<tr><th width="50%">State</th>
																						<td>{{$a['cstate']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Montly Recurring Fee</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr>
																						<th>Description</th>
																						<th>Price excl. ST</th>
																						<th>With ST (6%)</th>
																					</tr>
																					<tr><th>Broadband Fee</th>
																						<td>{{ $product->retail_price }}</td>
																						<td>{{ $gst }}</td>
																					</tr>
																					<tr><th colspan="2">Deposit</th>
																						<td>
																							{{ $deposit }}
																						</td>
																					</tr>
																					<tr><th colspan="2">OTC</th>
																						<td>{{ $otc }}</td>
																					</tr>
																					<tr><th colspan="2">Total Charges</th>
																						<td>{{ $total }}</td>
																					</tr>
																				</tbody>
																			</table>
																		</div>
																	</div>
																</div>
															</div>
															
															<!-- Document -->
																
															<div class="inner-pane">
																<h3>Declaration and Signature</h3>
																<div class="row">
																	<div class="col-md-12" id="document">
																		<label><b>Document &amp; Declaration </b><small style="color: red">*</small></label>
																		<div class="form-group">
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="photocopy" id="photocopy" value="24" required /> <p>Photocopy of NRIC(both side) or passport minimum (12 months validity) and visa minimum 6 months validity)</p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="formss" id="formss" value="24" required /> <p>Photocopy of Form 9, 24, 44 & 49 </p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="consent" id="consent" value="24" required /> <p>I hereby consent to the collection, use,
																						disclosure of my personal information in accordance with the <b> Privacy Policy </b> available one www.citybroadband.my.</p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="declare" id="declare" value="24" required /> <p>I hereby declare that the above information, documents, and
																						any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by <b> Terms & Condition </b>
																						as stated on the next page of this form which accompany the subscription of product(s) and/ or service(s). Allo Technology Sdn Bhd reserve the rights
																						to refuse any application  at any given time should any of the information is incorrect.
																					</p>
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<h3>Upload Documents</h3>
																<small><b>Acceptable formats: jpg , jpeg , pdf</b></small>
																<div class="row">

																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Front IC / Passport</b> <small style="color: red">*</small></label>
																			<input type="file" id="front_ic" name="front_ic" multiple onchange="validateImage1()" class="form-control" required />
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Rear IC/ Passport</b> <small style="color: red">*</small></label>
																			<input type="file" id="back_ic" name="back_ic" multiple onchange="validateImage2()" class="form-control" required />
																		</div>
																	</div>

																	<!-- <div class="col-md-6">
																		<div class="form-group">
																			<label><b>Front Visa</b> <small style="color: red">*</small></label>
																			<input type="file" id="visaF" name="visaF" multiple onchange="validateImage5()" class="form-control" required />
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Rear Visa</b> <small style="color: red">*</small></label>
																			<input type="file" id="visaB" name="visaB" multiple onchange="validateImage6()" class="form-control" required />
																		</div>
																	</div> -->

																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Company Form 24 / 49</b> <small style="color: red">*</small></label>
																			<input type="file" id="form_24" name="form_24" multiple onchange="validateImage3()" class="form-control" required />
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label><b>Company Form 9 & 44</b> <small style="color: red">*</small></label>
																			<input type="file" id="form9" name="form9" multiple onchange="validateImage4()" class="form-control" required />
																		</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;"> -->
																	<div id="showB">
																		<input type="submit" class="btn btn-finish" data-loading-text="Please Wait..." name="finish" value="Submit" style="display: none;">
																		<!-- </a> -->
																	</div>
																</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>
										</div>
									</div>	
								</section>
							</div>
						</div>
					</div>
					<div class="nonstick-footer padding bg-blue" align="center">
						<span class="medium-title text-centeryellow" style="color: yellow;">Got A Question?</span>
						<div align="center">
							<a class="nomargin btn btn-default" href="#" style="width: 230px;">
								Read FAQ
							</a>
							<a style="width:230px" href="#" class="nomargin btn btn-default">
								Write to us
							</a>
						</div>
					</div>
				</div>
			</section>
		</div>
	<div class="footer-callout"></div>
		<footer id="colophon" class="site-footer footer" role="contentinfo">
		<div class="container footer-inner">
			<div class="row">
				<div class="footer-widget-area">
					<div class="col-md-6 col-md-3 footer-widget" role="complementary">
						<div class="widget widget_nav_menu" id="nav_menu-3">
							<h2 class="widget-title">Overview</h2>
							<div class="menu-main-container">
								<ul id="menu-main" class="menu">
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16">
										<a href="https://cbb.allo.my/residential/">Residential</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-15">
										<a href="https://cbb.allo.my/business/">Business</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-14">
										<a href="https://cbb.allo.my/our-story/">Our Story</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://cbb.allo.my/support/">Support</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://cbb.allo.my/support/coverage-map/">Coverage Map</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-12">
										<a href="https://cbb.allo.my/contact-us/">Contact Us</a>
									</li>
								</ul>
							</div>
						</div>
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="nav_menu-2" class="widget widget_nav_menu">
							<h2 class="widget-title">Legal</h2>
							<div class="menu-footer-2-container">
								<ul id="menu-footer-2" class="menu">
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<style>
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		margin: 0;
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</style>