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allo
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allo/resources/views/customer-service/edit_work_order.blade.php

edit_work_order.blade.php 23KB
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  1. @extends('customer-service.layout.master')

  2. @section('ptitle','Customer Service')

  3. @section('page_title', 'Dashboard')

  4. @section('subpage', 'Graph & Summary Report')

  5. @section('img_profile', asset($user->StaffDetail->user_pic))

  6. @section('login_name', $user->StaffDetail->name )

  7. @section('last_login', $user->last_login_at )

  8. 

  9. @section('content')

  10. <div class="wrapper">	

  11. 	<div class="fluid">

  12. 		<div class="widget grid2 widgetH"></div>

  13. 		<div class="grid8 widgetH">

  14. 			<!-- for validation errors -->

  15. 			@if(count($errors) > 0)

  16. 			<div class="nNote nFailure">

  17. 				@foreach($errors->all() as $error)

  18. 				<p>{{$error}}</p>

  19. 				@endforeach

  20. 			</div>

  21. 			@endif

  22. 			@if(session()->has('success_msg'))

  23. 			<div class="nNote nSuccess">

  24. 				<p>{!! session()->get('success_msg') !!}</p>

  25. 			</div>

  26. 			@elseif(Session::get('error_msg'))

  27. 			<div class="nNote nFailure">

  28. 				<p>{!! session()->get('error_msg') !!}</p>

  29. 			</div>

  30. 			@endif

  31. 		</div>

  32. 		<div class="widget grid2 widgetH"></div>

  33. 	</div>

  34. 	<!-- Work Order Details -->

  35. 	<div class="fluid">

  36. 		<form action="{{ url('/customer-service/update-work-order-detail') }}" class="main cussPayment" method="POST" enctype="multipart/form-data">

  37. 			<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">

  38. 			<input type="hidden" name="work_order" value="{{ $form->WorkOrder->wo }}" required/>

  39. 			<fieldset>

  40. 				<div class="widget grid2 widgetH"></div>

  41. 				<div class="widget grid8">

  42. 					<div class="whead"><h6>Work Order's Detail</h6></div>

  43. 					

  44. 					<div class="formRow">

  45. 						<div class="grid4">

  46. 							<span class="grid12"><label><b>Work Order ID : </b></label><input type="text" name="wo" id="wo" value="{{ $form->WorkOrder->wo }}" readonly required /></span>

  47. 						</div>

  48. 						<div class="grid4">

  49. 							@if($form->WorkOrder->dateTimeStart != '') 

  50. 							<span class="grid12"><label><b>Appoint Date : </b></label><input type="text" name="date" id="date" value="{{ date('d/m/Y', strtotime($form->WorkOrder->dateTimeStart))}}" readonly="" required=""></span>

  51. 							@else

  52. 							<span class="grid12"><label><b>Appoint Date : </b></label><input type="text" name="date" id="date" value="{{ $form->WorkOrder->dateTimeStart}}" readonly="" required=""></span>

  53. 							@endif

  54. 						</div>

  55. 						<div class="grid4">

  56. 							@if($form->WorkOrder->dateTimeStart != '') 

  57. 							<span class="grid12"><label><b>Appoint Time : </b></label><input type="text" name="time" id="time" value="{{ date('h:i A', strtotime($form->WorkOrder->dateTimeStart))}}" readonly="" required=""></span>

  58. 							@else

  59. 							<span class="grid12"><label><b>Appoint Time : </b></label><input type="text" name="time" id="time" value="{{ $form->WorkOrder->dateTimeStart}}" readonly="" required=""></span>

  60. 							@endif

  61. 						</div>

  62. 					</div>

  63. 					

  64. 					<div class="formRow">

  65. 						<div class="grid6">

  66. 							<span class="grid12"><label><b>Work Order Current Status : </b></label><input type="text" name="status" id="status" value="{{ $form->WorkOrder->status}}" readonly required /></span>

  67. 						</div>

  68. 						<div class="grid6">

  69. 							@if(!empty($company))

  70. 								<span class="grid12"><label><b>Assign to Contractor : </b></label><input type="text" name="contractor" id="contractor" value="{{ $company->name }}" readonly required /></span>	

  71. 							@else

  72. 								<span class="grid12"><label><b>Assign to Contractor : </b></label><input type="text" name="contractor" id="contractor" value="-" readonly required /></span>

  73. 							@endif

  74. 						</div>

  75. 					</div>

  76. 					

  77. 					<div class="formRow">

  78. 							<div class="grid2">&nbsp;</div>

  79. 							<div class="grid2"><label><b>Category<small style="color: red"> * </small>: </b></label></div>

  80. 							<div class="grid6">

  81. 								<select class="styled" id="cust_category" name="cust_category" required>

  82. 									<option value="">Choose customer category</option>

  83. 									<option value="Allo" <?php if($form->customer_category == "Allo") { echo "selected"; } ?>>Allo</option>

  84. 									<option value="Astro"<?php if($form->customer_category == "Astro") { echo "selected"; } ?>>Astro</option>

  85. 									<option value="Maxis"<?php if($form->customer_category == "Maxis") { echo "selected"; } ?>>Maxis</option>

  86. 									<option value="Digi"<?php if($form->customer_category == "Digi") { echo "selected"; } ?>>Digi</option>

  87. 									<option value="Celcom"<?php if($form->customer_category == "Celcom") { echo "selected"; } ?>>Celcom</option>

  88. 									<option value="TIME"<?php if($form->customer_category == "TIME") { echo "selected"; } ?>>TIME</option>

  89. 									<option value="TM"<?php if($form->customer_category == "TM") { echo "selected"; } ?>>TM</option>

  90. 								</select>

  91. 							</div>	

  92. 							<div class="grid2">&nbsp;</div>

  93. 					</div>

  94. 					

  95. 					<div class="formRow">

  96. 						<div class="grid6">

  97. 							<span class="grid12">

  98. 								<label><b>Nature of Work / Task <small style="color: red">* </small>:</b></label>

  99. 								<select class="styled" name="task" id="task" required>

  100. 									<option value="">Choose type of task / nature of work</option>

  101. 									<option value="Activation" <?php if($form->WorkOrder->nature_work == "Activation") { echo "selected"; } ?>>Activation</option>

  102. 									<option value="Rectification" <?php if($form->WorkOrder->nature_work == "Rectification") { echo "selected"; } ?>>Rectification</option>

  103. 									<option value="Relocation" <?php if($form->WorkOrder->nature_work == "Relocation") { echo "selected"; } ?>>Relocation</option>

  104. 									<option value="Modification" <?php if($form->WorkOrder->nature_work == "Modification") { echo "selected"; } ?>>Modification</option>

  105. 									<option value="Cancellation" <?php if($form->WorkOrder->nature_work == "Cancellation") { echo "selected"; } ?>>Cancellation</option>

  106. 									<option value="Addition" <?php if($form->WorkOrder->nature_work == "Splitter Addition") { echo "selected"; } ?>>Splitter Addition</option>

  107. 									<option value="Fiber" <?php if($form->WorkOrder->nature_work == "Fiber Optic Cable Installation") { echo "selected"; } ?>>Fiber Optic Cable Installation</option>

  108. 								</select>

  109. 							</span>

  110. 						</div>

  111. 						<div class="grid6">

  112. 							<span class="grid12">

  113. 								@if($form->WorkOrder->pppoe_username != '')

  114. 								<span class="grid12"><label><b>PPPOE - Username  : </b></label><input type="text" name="pppoe_username" id="pppoe_username" value="{{ $form->WorkOrder->pppoe_username }}"/></span>

  115. 								@else

  116. 								<span class="grid12"><label><b>PPPOE - Username  : </b></label><input type="text" name="pppoe_username" id="pppoe_username" value=""/></span>

  117. 								@endif

  118. 							</span>

  119. 						</div>

  120. 					</div>

  121. 					

  122. 					<div class="formRow">

  123. 						<span class="grid6">

  124. 							<label><b>ONU / ONT <small style="color: red">* </small>:</b></label>

  125. 							<select class="styled" name="onu_ont" id="onu_ont" required>

  126. 								<option value="">Choose Modern Type</option>

  127. 								<option value="N/A" <?php if($form->WorkOrder->onu == "N/A") { echo "selected"; } ?>>N/A</option>

  128. 								<option value="Calix 801 G" <?php if($form->WorkOrder->onu == "Calix 801 G") { echo "selected"; } ?>>Calix 801 G</option>

  129. 								<option value="Calix 812 G" <?php if($form->WorkOrder->onu == "Calix 812 G") { echo "selected"; } ?>>Calix 812 G</option>

  130. 								<option value="Calix 813 G" <?php if($form->WorkOrder->onu == "Calix 813 G") { echo "selected"; } ?>>Calix 813 G</option>

  131. 								<option value="Calix 813 GV 2" <?php if($form->WorkOrder->onu == "Calix 813 GV 2") { echo "selected"; } ?>>Calix 813 GV 2</option>

  132. 								<option value="Calix 844 G" <?php if($form->WorkOrder->onu == "Calix 844 Ge") { echo "selected"; } ?>>Calix 844 G</option>

  133. 								<option value="Calix 844 E" <?php if($form->WorkOrder->onu == "Calix 844 E") { echo "selected"; } ?>>Calix 844 E</option>

  134. 								<option value="Calix 804 Mesh" <?php if($form->WorkOrder->onu == "Calix 804 Mesh") { echo "selected"; } ?>>Calix 804 Mesh</option>

  135. 								<option value="Core Cess" <?php if($form->WorkOrder->onu == "Core Cess") { echo "selected"; } ?>>Core Cess</option>

  136. 								<option value="Zyxell" <?php if($form->WorkOrder->onu== "Zyxell") { echo "selected"; } ?>>Zyxell</option>

  137. 								<option value="Huawei - EG8010H" <?php if($form->WorkOrder->onu== "Huawei - EG8010H") { echo "selected"; } ?>>Huawei - EG8010H</option>

  138. 								<option value="Huawei - EG8040H5" <?php if($form->WorkOrder->onu== "Huawei - EG8040H5") { echo "selected"; } ?>>Huawei - EG8040H5</option>

  139. 								<option value="Nokia - G010GQ" <?php if($form->WorkOrder->onu== "Nokia - G010GQ") { echo "selected"; } ?>>Nokia - G010GQ</option>

  140. 								<option value="Nokia - G240GE" <?php if($form->WorkOrder->onu== "Nokia - G240GE") { echo "selected"; } ?>>Nokia - G240GE</option>

  141. 							</select>

  142. 						</span>

  143. 						

  144. 						<span class="grid6">

  145. 							<label><b>Router <small style="color: red">* </small>:</b></label>

  146. 							<select class="styled" name="router" id="router" required>

  147. 								<option value="">Choose Router</option>

  148. 								<option value="Tenda AC1200" <?php if($form->WorkOrder->router == "Tenda AC1200") { echo "selected"; } ?>>Tenda AC1200</option>

  149. 								<option value="TPlink 1750" <?php if($form->WorkOrder->router == "TPlink 1750") { echo "selected"; } ?>>TPlink 1750</option>

  150. 								<option value="DLink AC1200" <?php if($form->WorkOrder->router == "DLink AC1200") { echo "selected"; } ?>>DLink AC1200</option>

  151. 								<option value="Tenda AP4 Wireless & AP" <?php if($form->WorkOrder->router == "Tenda AP4 Wireless & AP") { echo "selected"; } ?>>Tenda AP4 Wireless & AP</option>

  152. 								<option value="Cisco AC1200" <?php if($form->WorkOrder->router == "Cisco AC1200") { echo "selected"; } ?>>Cisco AC1200</option>

  153. 								<option value="TPLink AC1200" <?php if($form->WorkOrder->router == "TPLink AC1200") { echo "selected"; } ?>>TPLink AC1200</option>

  154. 								<option value="Mercusys AC12G" <?php if($form->WorkOrder->router == "Mercusys AC12G") { echo "selected"; } ?>>Mercusys AC12G</option>

  155. 								<option value="N/A" <?php if($form->WorkOrder->router == "N/A") { echo "selected"; } ?>>N/A</option>

  156. 							</select>

  157. 						</span>

  158. 					</div>

  159. 					

  160. 					<div class="formRow">

  161. 						<span class="grid6">

  162. 							<label><b>Phone <small style="color: red">* </small>:</b></label>

  163. 							<select class="styled" name="n_phone" id="n_phone" required>

  164. 								<option value="">Need Phone?</option>

  165. 								<option value="Yes" <?php if($form->WorkOrder->n_phone == "Yes") { echo "selected"; } ?>>Yes</option>

  166. 								<option value="No" <?php if($form->WorkOrder->n_phone == "No") { echo "selected"; } ?>>No</option>

  167. 							</select>

  168. 						</span>

  169. 						

  170. 						<span class="grid6" id="noPhone">

  171. 							<label><b>No. Phone <small style="color: red">* </small>:</b></label>

  172. 							<select class="styled" name="no_phone" id="no_phone">

  173. 								@if($form->type_application == 'R')

  174. 								<option value="1">1</option>

  175. 								<option value="2">2</option>

  176. 								@elseif($form->type_application == 'B')

  177. 								<option value="1">1</option>

  178. 								<option value="2">2</option>

  179. 								@endif

  180. 							</select>

  181. 						</span>

  182. 					</div>

  183. 					

  184. 					<div class="formRow">

  185. 						<span class="grid12">

  186. 							<label><b>Remarks : </b></label>

  187. 							<textarea rows="3" cols="" name="remark" id="remark" class="auto" style="overflow: hidden; word-wrap: break-word; resize: horizontal; height: 70px;">{{ $form->WorkOrder->remarks_custservice }}</textarea>

  188. 						</span>

  189. 					</div>

  190. 					

  191. 					<div class="formRow noBorderB">

  192. 						<div class="grid4">

  193. 							<a href="{{ url('/customer-service/work-order/list') }}" name="cancel" id="cancel" class="buttonM bRed">Cancel</a>

  194. 						</div>

  195. 						<div class="grid8">

  196. 							<input type="submit" name="updateWk" id="updateWk" value="Update Work Order" class="buttonM bPurple formSubmit">

  197. 						</div>

  198. 					</div>

  199. 					

  200. 				</div>

  201. 				<div class="widget grid2 widgetH"></div>

  202. 			</fieldset>

  203. 		</form>

  204. 

  205. 		@if($form->type_application == 'R')

  206. 		<form action="{{ url('/customer-service/update-customer-detail') }}" class="main cussPayment" method="POST" enctype="multipart/form-data" id="updateFormR" name="updateFormR">

  207. 			<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">

  208. 			<input type="hidden" name="subscriber_id" value="{{ $form->Subscriber->subscriber_id }}" required/>

  209. 			<fieldset>

  210. 				<div class="widget grid2 widgetH"></div>

  211. 				<div class="widget grid8">

  212. 					<div class="whead"><h6>Customer's Details</h6></div>

  213. 

  214. 					<div class="formRow">

  215. 						<div class="grid2">&nbsp;</div>

  216. 						<div class="grid2"><label><b>Type Application : </b></label></div>

  217. 						<div class="grid6"><input type="text" name="app" id="app" value="{{ $form->type_application }}" readonly required /></div>

  218. 						<div class="grid2">&nbsp;</div>

  219. 					</div>

  220. 					

  221. 					<div class="formRow">

  222. 						<div class="grid2">&nbsp;</div>

  223. 						<div class="grid2"><label><b>Full Name : </b></label></div>

  224. 						<div class="grid6"><input type="text" name="name" id="name" value="{{ $form->Subscriber->name }}" required /></div>

  225. 						<div class="grid2">&nbsp;</div>

  226. 					</div>

  227. 

  228. 					<div class="formRow">

  229. 						<div class="grid2">&nbsp;</div>

  230. 						<div class="grid2"><label><b>NRIC : </b></label></div>

  231. 						<div class="grid6">

  232. 							@if($form->Subscriber->ic == "<b>Package Development</b>") 

  233. 							<input type="text" name="ic" id="ic"  value="{{ $form->Subscriber->ic }}" required />

  234. 							@else

  235. 							<input type="text" name="ic" id="ic"  value="{{ $form->Subscriber->ic }}" required />

  236. 							@endif

  237. 						</div>

  238. 						<div class="grid2">&nbsp;</div>

  239. 					</div>

  240. 

  241. 					<div class="formRow">

  242. 						<div class="grid3">&nbsp;</div>

  243. 						<div class="grid2">

  244. 							<label><b>Citizen : </b></label>

  245. 							<input type="text" name="citizen" id="citizen"  value="{{ $form->Subscriber->citizen }}" readonly required />

  246. 						</div>

  247. 						<div class="grid2">

  248. 							<label><b>Gender : </b></label>

  249. 							<input type="text" name="gender" id="gender"  value="{{ $form->Subscriber->gender }}" readonly required />

  250. 						</div>

  251. 						<div class="grid2">

  252. 							<label><b>Race : </b></label>

  253. 							<input type="text" name="race" id="race"  value="{{ $form->Subscriber->race }}" readonly required />

  254. 						</div>

  255. 						<div class="grid3">&nbsp;</div>

  256. 					</div>

  257. 

  258. 					<div class="formRow">

  259. 						<div class="grid2">&nbsp;</div>

  260. 						<div class="grid2"><label><b>Email : </b></label></div>

  261. 						<div class="grid6">

  262. 							@if($form->Subscriber->email == "<b>Package Development</b>")

  263. 							<input type="text" name="email" id="email" value="{{ $form->Subscriber->email }}" required />

  264. 							@else

  265. 							<input type="email" name="email" id="email" value="{{ $form->Subscriber->email }}" required />

  266. 							@endif

  267. 						</div>

  268. 						<div class="grid2">&nbsp;</div>

  269. 					</div>

  270. 

  271. 					<div class="formRow">

  272. 						<div class="grid2">&nbsp;</div>

  273. 						<div class="grid4">

  274. 							<label><b>Primary Number : </b></label>

  275. 							<input type="text" name="phone1" id="phone1" value="{{ $form->Subscriber->phone1 }}" required />

  276. 						</div>

  277. 						<div class="grid4">

  278. 							<label><b>Secondary Number: </b></label>

  279. 							<input type="text" name="phone2" id="phone2"  value="{{ $form->Subscriber->phone2 }}"/>

  280. 						</div>

  281. 						<div class="grid2">&nbsp;</div>

  282. 					</div>

  283. 

  284. 					<div class="formRow">

  285. 						<div class="grid2">&nbsp;</div>

  286. 						<div class="grid2"><label><b>Building : </b></label></div>

  287. 						<div class="grid6">

  288. 							<select class="styled" name="building" id="building" required>

  289. 								<option value='-'>Please Select Building</option>	

  290. 								@foreach ($coverage as $c)

  291. 								@if($c->building_name == $form->Subscriber->building_name)

  292. 								<option value='{{$c->building_name}}' selected>{{$c->building_name}}</option>

  293. 								@else {

  294. 								<option value='{{$c->building_name}}'>{{$c->building_name}}</option>

  295. 								@endif

  296. 								@endforeach

  297. 							</select>

  298. 						</div>

  299. 						<div class="grid2">&nbsp;</div>

  300. 					</div>

  301. 

  302. 					<div class="formRow">

  303. 						<div class="grid2">&nbsp;</div>

  304. 						<div class="grid4">

  305. 							<label><b>Unit No : </b></label>

  306. 							<input type="text" name="unit_no" id="unit_no" value="{{ $form->Subscriber->unit_no }}" required />

  307. 						</div>

  308. 						<div class="grid4">

  309. 							<label><b>Street : </b></label>

  310. 							<input type="text" name="street" id="street" value="{{ $form->Subscriber->street }}" />

  311. 						</div>

  312. 						<div class="grid2">&nbsp;</div>

  313. 					</div>

  314. 

  315. 					<div class="formRow">

  316. 						<div class="grid2">&nbsp;</div>

  317. 						<div class="grid8">

  318. 							<span class="grid4">

  319. 								<label><b>City : </b></label>

  320. 								<input type="text" name="city" id="city" value="{{ $form->Subscriber->city }}" readonly required />

  321. 							</span>

  322. 							<span class="grid4">

  323. 								<label><b>Postcode : </b></label>

  324. 								<input type="text" name="postcode" id="postcode" value="{{ $form->Subscriber->postcode }}" readonly required />

  325. 							</span>

  326. 							<span class="grid4">

  327. 								<label><b>State : </b></label>

  328. 								<input type="text" name="state" id="state" value="{{ $form->Subscriber->state }}" readonly required />

  329. 							</span>

  330. 						</div>

  331. 						<div class="grid2">&nbsp;</div>

  332. 					</div>

  333. 

  334. 					<div class="formRow noBorderB">

  335. 						<div class="grid12">

  336. 							<input type="submit" name="update" id="update" class="buttonM bBlue formSubmit" value="Update Customer's Details">

  337. 						</div>

  338. 					</div>

  339. 					

  340. 				</div>

  341. 				<div class="widget grid2 widgetH"></div>

  342. 			</fieldset>

  343. 		</form>

  344. 		@elseif($form->type_application == 'B')

  345. 		<form action="{{ url('/customer-service/update-customer-detail') }}" class="main cussPayment" method="POST" enctype="multipart/form-data" id="updateFormB" name="updateFormB">

  346. 			<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">

  347. 			<input type="hidden" name="subscriber_id" value="{{ $form->Subscriber->subscriber_id }}" required/>

  348. 			<!-- Company Details-->

  349. 			<fieldset>

  350. 				<div class="widget grid2 widgetH"></div>

  351. 				<div class="widget grid8">

  352. 					<div class="whead"><h6>Company's Details</h6></div>

  353. 

  354. 					<div class="formRow">

  355. 						<div class="grid2">&nbsp;</div>

  356. 						<div class="grid2"><label><b>Type Application : </b></label></div>

  357. 						<div class="grid6"><input type="text" name="app" id="app" value="{{ $form->type_application }}" readonly required /></div>

  358. 						<div class="grid2">&nbsp;</div>

  359. 					</div>

  360. 

  361. 					<div class="formRow">

  362. 						<div class="grid2">&nbsp;</div>

  363. 						<div class="grid8">

  364. 							<span class="grid4">

  365. 								<label><b>Company Registration Number : </b></label>

  366. 								<input type="text" name="company_reg" id="company_reg" value="{{ $form->Subscriber->company_reg }}" />

  367. 							</span>

  368. 							<span class="grid4">

  369. 								<label><b>Company Contact Number : </b></label>

  370. 								<input type="text" name="company_num" id="company_num" value="{{ $form->Subscriber->company_num }}" />

  371. 							</span>

  372. 							<span class="grid4">

  373. 								<label><b>Company Fax Number: </b></label>

  374. 								<input type="text" name="company_fax" id="company_fax" value="{{ $form->Subscriber->fax }}" />

  375. 							</span>

  376. 						</div>

  377. 						<div class="grid2">&nbsp;</div>

  378. 					</div>

  379. 

  380. 					<div class="formRow">

  381. 						<div class="grid2">&nbsp;</div>

  382. 						<div class="grid2"><label><b>Company Name : </b></label></div>

  383. 						<div class="grid6"><input type="text" name="company_name" id="company_name" value="{{ $form->Subscriber->company_name }}" required /></div>

  384. 						<div class="grid2">&nbsp;</div>

  385. 					</div>

  386. 

  387. 					<div class="formRow">

  388. 						<div class="grid2">&nbsp;</div>

  389. 						<div class="grid2"><label><b>Unit No : </b></label></div>

  390. 						<div class="grid6"><input type="text" name="unit_no" id="unit_no" value="{{ $form->Subscriber->unit_no }}" required /></div>

  391. 						<div class="grid2">&nbsp;</div>

  392. 					</div>

  393. 					

  394. 					<div class="formRow">

  395. 						<div class="grid2">&nbsp;</div>

  396. 						<div class="grid2"><label><b>Company Address : </b></label></div>

  397. 						<div class="grid6"><textarea rows="3" cols="" name="address" id="address" class="auto" style="overflow: hidden; word-wrap: break-word; resize: horizontal; height: 70px;" required>{{ $form->Subscriber->street }}</textarea></div>

  398. 						<div class="grid2">&nbsp;</div>

  399. 					</div>

  400. 

  401. 					<div class="formRow">

  402. 						<div class="grid2">&nbsp;</div>

  403. 						<div class="grid8">

  404. 							<span class="grid4">

  405. 								<label><b>City : </b></label>

  406. 								<input type="text" name="city" id="city" value="{{ $form->Subscriber->city }}" />

  407. 							</span>

  408. 							<span class="grid4">

  409. 								<label><b>Postcode : </b></label>

  410. 								<input type="text" name="postcode" id="postcode" value="{{ $form->Subscriber->postcode }}" />

  411. 							</span>

  412. 							<span class="grid4">

  413. 								<label><b>State : </b></label>

  414. 								<input type="text" name="state" id="state" value="{{ $form->Subscriber->state }}" />

  415. 							</span>

  416. 						</div>

  417. 						<div class="grid2">&nbsp;</div>

  418. 					</div>

  419. 

  420. 				</div>

  421. 				<div class="widget grid2 widgetH"></div>

  422. 			</fieldset>

  423. 

  424. 			<!-- Customer Details-->

  425. 			<fieldset>

  426. 				<div class="widget grid2 widgetH"></div>

  427. 				<div class="widget grid8">

  428. 					<div class="whead"><h6>Technical Contact Person</h6></div>

  429. 

  430. 					<div class="formRow">

  431. 						<div class="grid2">&nbsp;</div>

  432. 						<div class="grid2"><label><b>Name : </b></label></div>

  433. 						<div class="grid6"><input type="text" name="name" id="name"  value="{{ $form->Subscriber->name }}" required /></div>

  434. 						<div class="grid2">&nbsp;</div>

  435. 					</div>

  436. 

  437. 					<div class="formRow">

  438. 						<div class="grid2">&nbsp;</div>

  439. 						<div class="grid2"><label><b>NRIC : </b></label></div>

  440. 						<div class="grid6"><input type="text" name="ic" id="ic"  value="{{ $form->Subscriber->ic }}" /></div>

  441. 						<div class="grid2">&nbsp;</div>

  442. 					</div>

  443. 

  444. 					<div class="formRow">

  445. 						<div class="grid2">&nbsp;</div>

  446. 						<div class="grid2"><label><b>Designation : </b></label></div>

  447. 						<div class="grid6"><input type="text" name="designation" id="designation" value="{{ $form->Subscriber->designation }}" /></div>

  448. 						<div class="grid2">&nbsp;</div>

  449. 					</div>

  450. 

  451. 					<div class="formRow">

  452. 						<div class="grid2">&nbsp;</div>

  453. 						<div class="grid2"><label><b>Email : </b></label></div>

  454. 						<div class="grid6"><input type="email" name="email" id="email" value="{{ $form->Subscriber->email }}" /></div>

  455. 						<div class="grid2">&nbsp;</div>

  456. 					</div>

  457. 

  458. 					<div class="formRow">

  459. 						<div class="grid2">&nbsp;</div>

  460. 						<div class="grid4">

  461. 							<label><b>Primary Number : </b></label>

  462. 							<input type="text" name="phone1" id="phone1" value="{{ $form->Subscriber->phone1 }}" required />

  463. 						</div>

  464. 						<div class="grid4">

  465. 							<label><b>Secondary Number: </b></label>

  466. 							<input type="text" name="phone2" id="phone2"  value="{{ $form->Subscriber->phone2 }}"/>

  467. 						</div>

  468. 						<div class="grid2">&nbsp;</div>

  469. 					</div>

  470. 

  471. 					<div class="formRow noBorderB">

  472. 						<div class="grid12">

  473. 							<input type="submit" name="update" id="update" class="buttonM bBlue formSubmit" value="Update Customer's Details">

  474. 						</div>

  475. 					</div>

  476. 					

  477. 				</div>

  478. 				<div class="widget grid2 widgetH"></div>

  479. 			</fieldset>

  480. 		</form>

  481. 		@endif

  482. 	</div>

  483. </div>

  484. @endsection