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

@extends('customer-service.layout.master')
@section('ptitle','Customer Service')
@section('page_title', 'Dashboard')
@section('subpage', 'Graph & Summary Report')
@section('img_profile', asset($user->StaffDetail->user_pic))
@section('login_name', $user->StaffDetail->name )
@section('last_login', $user->last_login_at )

@section('content')
<style type="text/css">
	.i_note {color: red;}
</style>

<div class="fluid">
	@if(count($errors) > 0)
	<div class="nNote nFailure">
		@foreach($errors->all() as $error)
		<p>{{$error}}</p>
		@endforeach
	</div>
	@endif

	@if(Session::get('error_msg'))
	<div class="nNote nFailure">
		<p>Email or Password is invalid</p>
	</div>
	@elseif(Session::get('success_msg'))
	<div class="nNote nSuccess">
		<p>Add new WO successful</p>
	</div>
	@endif
</div>

<div class="wrapper">
	<!-- 6 + 6 -->
	<div class="fluid">
		<div class="grid12">
			<fieldset>
				<div class="widget grid2 widgetH"></div>
				<div class="widget grid8">
					<div class="whead"><h6>Subscriber / Customer Detail</h6></div>
					
					<div class="formRow cussPayment">
						<div class="grid3"><label><b>Select customer / subscriber detail: </b></label></div>
						<div class="grid9">
							<select class="styled" id="type_customer" name="type_customer">
								<option value=''>Please Customer / Subscriber Detail</option>
								<option value="formR">Fill The New Form ( Rectification )</option>
								<option value="formSD">Fill The New Form ( Secured Development )</option>
								<option value="formNFSP">Fill The New Form ( NFCP )</option>
							</select>
						</div>
					</div>
					
					<div class="formRow noBorderB">
						<div class="grid12">
							<input type="submit" name="refresh" id="refresh" class="buttonM bPurple" value="Refresh Selection">
						</div>
					</div>
					
				</div>
				<div class="widget grid2 widgetH"></div>
			</fieldset>
		</div>
		
		<div id="formR">
			<form action="{{ url ('/customer-service/business/create-rectification') }}" class="main cussPayment" method="POST" enctype="multipart/form-data" id="rectificationForm" name="rectificationForm">
				<input type="hidden" name="_token" value="{{ csrf_token() }}">
				<input type="hidden" name="formT" value="R">
				<input type="hidden" name="app" value="Rectification">
				<fieldset>
					<div class="widget grid2 widgetH"></div>
					<div class="widget grid8">
						<div class="whead"><h6>Customer Details</h6></div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Full Name<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6"><input type="text" name="name" id="name" required /></div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<!-- <div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>NRIC<small style="color: red">  </small>: </b></label></div>
							<div class="grid6"><input type="text" name="ic" id="ic" /></div>
							<div class="grid2">&nbsp;</div>
						</div> -->
						
						<!-- <div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Race<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="race" name="race">
									<option value="malay">Malay</option>
									<option value="chinese">Chinese</option>
									<option value="indian">Indian</option>
									<option value="others">Others</option>
								</select>
							</div>
							<div class="grid4">
								<label><b>Gender<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="gender" name="gender">';
									<option value="Male">Male</option>
									<option value="Female">Female</option>
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div> -->

						<!-- <div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Email<small style="color: red">  </small>: </b></label></div>
							<div class="grid6"><input type="email" name="email" id="email" /></div>
							<div class="grid2">&nbsp;</div>
						</div> -->
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4"><label><b>Primary Number<small style="color: red"> * </small>: </b></label><input type="text" name="phone1" id="phone1" required /></div>
							<div class="grid4"><label><b>Secondary Number : </b></label><input type="text" name="phone2" id="phone2" /></div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<!-- <div class="formRow">
							<div class="grid2">&nbsp;</div>';
							<div class="grid2"><label><b>Citizen<small style="color: red"> </small>: </b></label></div>
							<div class="grid6">
								<select class="styled" id="citizenss" name="citizenss">
									<option value="">Choose citizen</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div> -->

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Unit No.<small style="color: red"> * </small>: </b></label>
								<input type="text" name="unit_no" id="unit_no" required />
							</div>
							<div class="grid4">
								<label><b>Building<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="buildingsss" name="buildingsss" required>
									<option value="">Choose building</option>
									@foreach($coverage as $c)						
										<option value="{{ $c->building_name }}">{{ $c->building_name }}</option>
									@endforeach
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid8">
								<label><b>Street<small style="color: red"> * </small>: </b></label>
								<select id="street" name="street" class="styled" required aria-required="true">
									<option value>Select Street</option>					
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Package<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6">
								<select class="styled" id="package" name="package" required>
									<option value="">Choose package</option>
									<option value="NA">NA</option>
									<option value="30">30Mbps</option>
									@foreach($product as $c)
									<option value="{{ $c->speed }}">{{ $c->package_name }}</option>
									@endforeach
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Customer Category<small style="color: red"> * </small></b></label></div>
							<div class="grid6">
								<select class="styled" id="cust_category" name="cust_category" required>
									<option value="">Choose customer category</option>
									<option value="Allo">Allo</option>
									<option value="Astro">Astro</option>
									<option value="Maxis">Maxis</option>
									<option value="Digi">Digi</option>
									<option value="Celcom">Celcom</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow noBorderB">
							<div class="grid12">
								<input type="submit" name="rectification" id="rectification" class="buttonM bPurple formSubmit" value="Add New Customer Detail">
							</div>
						</div>
					</div>
					<div class="widget grid2 widgetH"></div>
				</fieldset>
			</form>
		</div>
		

		<div id="formSD">
			<form action="{{ url('/customer-service/submit-form-secured-developement') }}" class="main cussPayment" method="POST" enctype="multipart/form-data" id="securedForm" name="securedForm">
				<input type="hidden" name="_token" value="{{ csrf_token() }}">
				<fieldset>
					<div class="widget grid2 widgetH"></div>
					<div class="widget grid8">
						<div class="whead"><h6>Customer Details</h6></div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2">
								<label><b>Type Application<small style="color: red"> * </small>: </b></label>
							</div>
							<div class="grid6">
								<select class="styled" id="app" name="app" required>
									<option value="New">New</option>
									<option value="Upgrade">Upgrade</option>
									<option value="Relocation">Relocation</option>
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Customer Category<small style="color: red"> * </small> </b></label></div>
							<div class="grid6">
								<select class="styled" id="cust_category" name="cust_category" required>
									<option value="">Choose customer category</option>
									<option value="Allo">Allo</option>
									<option value="Astro">Astro</option>
									<option value="Maxis">Maxis</option>
									<option value="Digi">Digi</option>
									<option value="Celcom">Celcom</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Full Name<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6"><input type="text" name="name" id="name" required /></div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4"><label><b>Race<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="race" name="race" required>
									<option value="malay">Malay</option>
									<option value="chinese">Chinese</option>
									<option value="indian">Indian</option>
									<option value="others">Others</option>
								</select>
							</div>
							<div class="grid4"><label><b>Gender<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="gender" name="gender" required>
									<option value="Male">Male</option>
									<option value="Female">Female</option>
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Primary Number<small style="color: red"> * </small>: </b></label>
								<input type="text" name="phone1" id="phone1" required />
							</div>
							<div class="grid4">
								<label><b>Secondary Number : </b></label>
								<input type="text" name="phone2" id="phone2" value=""/>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2">
								<label><b>Citizen<small style="color: red"> * </small>: </b></label>
							</div>
							<div class="grid6">
								<select class="styled" id="citizensss" name="citizensss" required>
									<option value="">Choose citizen</option>
									<option value="" selected="selected">Select Country</option>
									<option value="Afghanistan">Afghanistan</option>
									<option value="Albania">Albania</option>
									<option value="Algeria">Algeria</option>
									<option value="American Samoa">American Samoa</option>
									<option value="Andorra">Andorra</option>
									<option value="Angola">Angola</option>
									<option value="Anguilla">Anguilla</option>
									<option value="Antarctica">Antarctica</option>
									<option value="Antigua and Barbuda">Antigua and Barbuda</option>
									<option value="Argentina">Argentina</option>
									<option value="Armenia">Armenia</option>
									<option value="Aruba">Aruba</option>
									<option value="Australia">Australia</option>
									<option value="Austria">Austria</option>
									<option value="Azerbaijan">Azerbaijan</option>
									<option value="Bahamas">Bahamas</option>
									<option value="Bahrain">Bahrain</option>
									<option value="Bangladesh">Bangladesh</option>
									<option value="Barbados">Barbados</option>
									<option value="Belarus">Belarus</option>
									<option value="Belgium">Belgium</option>
									<option value="Belize">Belize</option>
									<option value="Benin">Benin</option>
									<option value="Bermuda">Bermuda</option>
									<option value="Bhutan">Bhutan</option>
									<option value="Bolivia">Bolivia</option>
									<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
									<option value="Botswana">Botswana</option>
									<option value="Bouvet Island">Bouvet Island</option>
									<option value="Brazil">Brazil</option>
									<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
									<option value="Brunei Darussalam">Brunei Darussalam</option>
									<option value="Bulgaria">Bulgaria</option>
									<option value="Burkina Faso">Burkina Faso</option>
									<option value="Burundi">Burundi</option>
									<option value="Cambodia">Cambodia</option>
									<option value="Cameroon">Cameroon</option>
									<option value="Canada">Canada</option>
									<option value="Cape Verde">Cape Verde</option>
									<option value="Cayman Islands">Cayman Islands</option>
									<option value="Central African Republic">Central African Republic</option>
									<option value="Chad">Chad</option>
									<option value="Chile">Chile</option>
									<option value="China">China</option>
									<option value="Christmas Island">Christmas Island</option>
									<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
									<option value="Colombia">Colombia</option>
									<option value="Comoros">Comoros</option>
									<option value="Congo">Congo</option>
									<option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option>
									<option value="Cook Islands">Cook Islands</option>
									<option value="Costa Rica">Costa Rica</option>
									<option value="Cote D'ivoire">Cote D'ivoire</option>
									<option value="Croatia">Croatia</option>
									<option value="Cuba">Cuba</option>
									<option value="Cyprus">Cyprus</option>
									<option value="Czech Republic">Czech Republic</option>
									<option value="Denmark">Denmark</option>
									<option value="Djibouti">Djibouti</option>
									<option value="Dominica">Dominica</option>
									<option value="Dominican Republic">Dominican Republic</option>
									<option value="Ecuador">Ecuador</option>
									<option value="Egypt">Egypt</option>
									<option value="El Salvador">El Salvador</option>
									<option value="Equatorial Guinea">Equatorial Guinea</option>
									<option value="Eritrea">Eritrea</option>
									<option value="Estonia">Estonia</option>
									<option value="Ethiopia">Ethiopia</option>
									<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
									<option value="Faroe Islands">Faroe Islands</option>
									<option value="Fiji">Fiji</option>
									<option value="Finland">Finland</option>
									<option value="France">France</option>
									<option value="French Guiana">French Guiana</option>
									<option value="French Polynesia">French Polynesia</option>
									<option value="French Southern Territories">French Southern Territories</option>
									<option value="Gabon">Gabon</option>
									<option value="Gambia">Gambia</option>
									<option value="Georgia">Georgia</option>
									<option value="Germany">Germany</option>
									<option value="Ghana">Ghana</option>
									<option value="Gibraltar">Gibraltar</option>
									<option value="Greece">Greece</option>
									<option value="Greenland">Greenland</option>
									<option value="Grenada">Grenada</option>
									<option value="Guadeloupe">Guadeloupe</option>
									<option value="Guam">Guam</option>
									<option value="Guatemala">Guatemala</option>
									<option value="Guinea">Guinea</option>
									<option value="Guinea-bissau">Guinea-bissau</option>
									<option value="Guyana">Guyana</option>
									<option value="Haiti">Haiti</option>
									<option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option>
									<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
									<option value="Honduras">Honduras</option>
									<option value="Hong Kong">Hong Kong</option>
									<option value="Hungary">Hungary</option>
									<option value="Iceland">Iceland</option>
									<option value="India">India</option>
									<option value="Indonesia">Indonesia</option>
									<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
									<option value="Iraq">Iraq</option>
									<option value="Ireland">Ireland</option>
									<option value="Israel">Israel</option>
									<option value="Italy">Italy</option>
									<option value="Jamaica">Jamaica</option>
									<option value="Japan">Japan</option>
									<option value="Jordan">Jordan</option>
									<option value="Kazakhstan">Kazakhstan</option>
									<option value="Kenya">Kenya</option>
									<option value="Kiribati">Kiribati</option>
									<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
									<option value="Korea, Republic of">Korea, Republic of</option>
									<option value="Kuwait">Kuwait</option>
									<option value="Kyrgyzstan">Kyrgyzstan</option>
									<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
									<option value="Latvia">Latvia</option>
									<option value="Lebanon">Lebanon</option>
									<option value="Lesotho">Lesotho</option>
									<option value="Liberia">Liberia</option>
									<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
									<option value="Liechtenstein">Liechtenstein</option>
									<option value="Lithuania">Lithuania</option>
									<option value="Luxembourg">Luxembourg</option>
									<option value="Macao">Macao</option>
									<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
									<option value="Madagascar">Madagascar</option>
									<option value="Malawi">Malawi</option>
									<option value="Malaysia">Malaysia</option>
									<option value="Maldives">Maldives</option>
									<option value="Mali">Mali</option>
									<option value="Malta">Malta</option>
									<option value="Marshall Islands">Marshall Islands</option>
									<option value="Martinique">Martinique</option>
									<option value="Mauritania">Mauritania</option>
									<option value="Mauritius">Mauritius</option>
									<option value="Mayotte">Mayotte</option>
									<option value="Mexico">Mexico</option>
									<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
									<option value="Moldova, Republic of">Moldova, Republic of</option>
									<option value="Monaco">Monaco</option>
									<option value="Mongolia">Mongolia</option>
									<option value="Montserrat">Montserrat</option>
									<option value="Morocco">Morocco</option>
									<option value="Mozambique">Mozambique</option>
									<option value="Myanmar">Myanmar</option>
									<option value="Namibia">Namibia</option>
									<option value="Nauru">Nauru</option>
									<option value="Nepal">Nepal</option>
									<option value="Netherlands">Netherlands</option>
									<option value="Netherlands Antilles">Netherlands Antilles</option>
									<option value="New Caledonia">New Caledonia</option>
									<option value="New Zealand">New Zealand</option>
									<option value="Nicaragua">Nicaragua</option>
									<option value="Niger">Niger</option>
									<option value="Nigeria">Nigeria</option>
									<option value="Niue">Niue</option>
									<option value="Norfolk Island">Norfolk Island</option>
									<option value="Northern Mariana Islands">Northern Mariana Islands</option>
									<option value="Norway">Norway</option>
									<option value="Oman">Oman</option>
									<option value="Pakistan">Pakistan</option>
									<option value="Palau">Palau</option>
									<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
									<option value="Panama">Panama</option>
									<option value="Papua New Guinea">Papua New Guinea</option>
									<option value="Paraguay">Paraguay</option>
									<option value="Peru">Peru</option>
									<option value="Philippines">Philippines</option>
									<option value="Pitcairn">Pitcairn</option>
									<option value="Poland">Poland</option>
									<option value="Portugal">Portugal</option>
									<option value="Puerto Rico">Puerto Rico</option>
									<option value="Qatar">Qatar</option>
									<option value="Reunion">Reunion</option>
									<option value="Romania">Romania</option>
									<option value="Russian Federation">Russian Federation</option>
									<option value="Rwanda">Rwanda</option>
									<option value="Saint Helena">Saint Helena</option>
									<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
									<option value="Saint Lucia">Saint Lucia</option>
									<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
									<option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option>
									<option value="Samoa">Samoa</option>
									<option value="San Marino">San Marino</option>
									<option value="Sao Tome and Principe">Sao Tome and Principe</option>
									<option value="Saudi Arabia">Saudi Arabia</option>
									<option value="Senegal">Senegal</option>
									<option value="Serbia and Montenegro">Serbia and Montenegro</option>
									<option value="Seychelles">Seychelles</option>
									<option value="Sierra Leone">Sierra Leone</option>
									<option value="Singapore">Singapore</option>
									<option value="Slovakia">Slovakia</option>
									<option value="Slovenia">Slovenia</option>
									<option value="Solomon Islands">Solomon Islands</option>
									<option value="Somalia">Somalia</option>
									<option value="South Africa">South Africa</option>
									<option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option>
									<option value="Spain">Spain</option>
									<option value="Sri Lanka">Sri Lanka</option>
									<option value="Sudan">Sudan</option>
									<option value="Suriname">Suriname</option>
									<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
									<option value="Swaziland">Swaziland</option>
									<option value="Sweden">Sweden</option>
									<option value="Switzerland">Switzerland</option>
									<option value="Syrian Arab Republic">Syrian Arab Republic</option>
									<option value="Taiwan, Province of China">Taiwan, Province of China</option>
									<option value="Tajikistan">Tajikistan</option>
									<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
									<option value="Thailand">Thailand</option>
									<option value="Timor-leste">Timor-leste</option>
									<option value="Togo">Togo</option>
									<option value="Tokelau">Tokelau</option>
									<option value="Tonga">Tonga</option>
									<option value="Trinidad and Tobago">Trinidad and Tobago</option>
									<option value="Tunisia">Tunisia</option>
									<option value="Turkey">Turkey</option>
									<option value="Turkmenistan">Turkmenistan</option>
									<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
									<option value="Tuvalu">Tuvalu</option>
									<option value="Uganda">Uganda</option>
									<option value="Ukraine">Ukraine</option>
									<option value="United Arab Emirates">United Arab Emirates</option>
									<option value="United Kingdom">United Kingdom</option>
									<option value="United States">United States</option>
									<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
									<option value="Uruguay">Uruguay</option>
									<option value="Uzbekistan">Uzbekistan</option>
									<option value="Vanuatu">Vanuatu</option>
									<option value="Venezuela">Venezuela</option>
									<option value="Viet Nam">Viet Nam</option>
									<option value="Virgin Islands, British">Virgin Islands, British</option>
									<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
									<option value="Wallis and Futuna">Wallis and Futuna</option>
									<option value="Western Sahara">Western Sahara</option>
									<option value="Yemen">Yemen</option>
									<option value="Zambia">Zambia</option>
									<option value="Zimbabwe">Zimbabwe</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Unit No.<small style="color: red"> * </small>: </b></label>
								<input type="text" name="unit_no" id="unit_no" required />
							</div>
							<div class="grid4">
								<label><b>Building<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="buildingssss" name="buildingssss" required>
									<option value="">Choose building</option>
									@foreach($coverage as $c)						
										<option value="{{ $c->building_name }}">{{ $c->building_name }}</option>
									@endforeach
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid8">
								<label><b>Street<small style="color: red"> * </small>: </b></label>
								<select id="streets" name="streets" class="styled" required aria-required="true">
									<option value>Select Street</option>					
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Package<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6">
								<select class="styled" id="package" name="package" required>
									<option value="">Choose package</option>
									<option value="NA">NA</option>
									<option value="30">30Mbps</option>
									@foreach($product as $c)
									<option value="{{ $c->speed }}">{{ $c->package_name }}</option>
									@endforeach
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Subscription/ Contract Period : </b></label></div>
							<div class="grid2">
								<div class="checker" id="uniform-check1">
									<span class="checked"><input type="checkbox" id="period" name="period" style="opacity: 0;" checked="checked"></span>
								</div>
								<label for="check1" class="mr20">24 Month</label>
							</div>
							<div class="grid2"><label><b>Billing Cycle: </b></label></div>
							<div class="grid2">
								<div class="checker" id="uniform-check2">
									<span>
										<input type="checkbox" id="billing" name="billing" style="opacity: 0;" checked="checked">
									</span>
								</div>
								<label for="check2" class="mr20">Monthly</label>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow noBorderB">
							<div class="grid12">
								<input type="submit" name="secured" id="secured" class="buttonM bPurple formSubmit" value="Add New Customer Detail">
							</div>
						</div>
						
					</div>
					<div class="widget grid2 widgetH"></div>
				</fieldset>
			</form>
		</div>	
		<!-- //////////// jiha tambah formNFSP on 20 mei 2020//////// -->
		<div id="formNFSP">
			<form action="{{ url('/customer-service/submit-form-secured-developement') }}" class="main cussPayment" method="POST" enctype="multipart/form-data" id="securedForm" name="securedForm">
				<input type="hidden" name="_token" value="{{ csrf_token() }}">
				{{-- <input type="hidden" name="buildingssss" value="-"> --}}
				<input type="hidden" name="citizensss" value="-">
				<fieldset>
					<div class="widget grid2 widgetH"></div>
					<div class="widget grid8">
						<div class="whead"><h6>Customer Details</h6></div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2">
								<label><b>Type Application<small style="color: red"> * </small>: </b></label>
							</div>
							<div class="grid6">
								<select class="styled" id="app" name="app" required>
									<option value="New">New</option>
									<option value="Upgrade">Upgrade</option>
									<option value="Relocation">Relocation</option>
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>

						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Customer Category<small style="color: red"> * </small> </b></label></div>
							<div class="grid6">
								<select class="styled" id="cust_category" name="cust_category" required>
									<option value="">Choose customer category</option>
									<option value="Allo">Allo</option>
									<option value="Astro">Astro</option>
									<option value="Maxis">Maxis</option>
									<option value="Digi">Digi</option>
									<option value="Celcom">Celcom</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Full Name<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6"><input type="text" name="name" id="name" required /></div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4"><label><b>Race<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="race" name="race" required>
									<option value="malay">Malay</option>
									<option value="chinese">Chinese</option>
									<option value="indian">Indian</option>
									<option value="others">Others</option>
								</select>
							</div>
							<div class="grid4"><label><b>Gender<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="gender" name="gender" required>
									<option value="Male">Male</option>
									<option value="Female">Female</option>
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Primary Number<small style="color: red"> * </small>: </b></label>
								<input type="text" name="phone1" id="phone1" required />
							</div>
							<div class="grid4">
								<label><b>Secondary Number : </b></label>
								<input type="text" name="phone2" id="phone2" value=""/>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<!-- <div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2">
								<label><b>Citizen<small style="color: red"> * </small>: </b></label>
							</div>
							<div class="grid6">
								<select class="styled" id="citizensss" name="citizensss" required>
									<option value="">Choose citizen</option>
									<option value="" selected="selected">Select Country</option>
									<option value="Afghanistan">Afghanistan</option>
									<option value="Albania">Albania</option>
									<option value="Algeria">Algeria</option>
									<option value="American Samoa">American Samoa</option>
									<option value="Andorra">Andorra</option>
									<option value="Angola">Angola</option>
									<option value="Anguilla">Anguilla</option>
									<option value="Antarctica">Antarctica</option>
									<option value="Antigua and Barbuda">Antigua and Barbuda</option>
									<option value="Argentina">Argentina</option>
									<option value="Armenia">Armenia</option>
									<option value="Aruba">Aruba</option>
									<option value="Australia">Australia</option>
									<option value="Austria">Austria</option>
									<option value="Azerbaijan">Azerbaijan</option>
									<option value="Bahamas">Bahamas</option>
									<option value="Bahrain">Bahrain</option>
									<option value="Bangladesh">Bangladesh</option>
									<option value="Barbados">Barbados</option>
									<option value="Belarus">Belarus</option>
									<option value="Belgium">Belgium</option>
									<option value="Belize">Belize</option>
									<option value="Benin">Benin</option>
									<option value="Bermuda">Bermuda</option>
									<option value="Bhutan">Bhutan</option>
									<option value="Bolivia">Bolivia</option>
									<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
									<option value="Botswana">Botswana</option>
									<option value="Bouvet Island">Bouvet Island</option>
									<option value="Brazil">Brazil</option>
									<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
									<option value="Brunei Darussalam">Brunei Darussalam</option>
									<option value="Bulgaria">Bulgaria</option>
									<option value="Burkina Faso">Burkina Faso</option>
									<option value="Burundi">Burundi</option>
									<option value="Cambodia">Cambodia</option>
									<option value="Cameroon">Cameroon</option>
									<option value="Canada">Canada</option>
									<option value="Cape Verde">Cape Verde</option>
									<option value="Cayman Islands">Cayman Islands</option>
									<option value="Central African Republic">Central African Republic</option>
									<option value="Chad">Chad</option>
									<option value="Chile">Chile</option>
									<option value="China">China</option>
									<option value="Christmas Island">Christmas Island</option>
									<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
									<option value="Colombia">Colombia</option>
									<option value="Comoros">Comoros</option>
									<option value="Congo">Congo</option>
									<option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option>
									<option value="Cook Islands">Cook Islands</option>
									<option value="Costa Rica">Costa Rica</option>
									<option value="Cote D'ivoire">Cote D'ivoire</option>
									<option value="Croatia">Croatia</option>
									<option value="Cuba">Cuba</option>
									<option value="Cyprus">Cyprus</option>
									<option value="Czech Republic">Czech Republic</option>
									<option value="Denmark">Denmark</option>
									<option value="Djibouti">Djibouti</option>
									<option value="Dominica">Dominica</option>
									<option value="Dominican Republic">Dominican Republic</option>
									<option value="Ecuador">Ecuador</option>
									<option value="Egypt">Egypt</option>
									<option value="El Salvador">El Salvador</option>
									<option value="Equatorial Guinea">Equatorial Guinea</option>
									<option value="Eritrea">Eritrea</option>
									<option value="Estonia">Estonia</option>
									<option value="Ethiopia">Ethiopia</option>
									<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
									<option value="Faroe Islands">Faroe Islands</option>
									<option value="Fiji">Fiji</option>
									<option value="Finland">Finland</option>
									<option value="France">France</option>
									<option value="French Guiana">French Guiana</option>
									<option value="French Polynesia">French Polynesia</option>
									<option value="French Southern Territories">French Southern Territories</option>
									<option value="Gabon">Gabon</option>
									<option value="Gambia">Gambia</option>
									<option value="Georgia">Georgia</option>
									<option value="Germany">Germany</option>
									<option value="Ghana">Ghana</option>
									<option value="Gibraltar">Gibraltar</option>
									<option value="Greece">Greece</option>
									<option value="Greenland">Greenland</option>
									<option value="Grenada">Grenada</option>
									<option value="Guadeloupe">Guadeloupe</option>
									<option value="Guam">Guam</option>
									<option value="Guatemala">Guatemala</option>
									<option value="Guinea">Guinea</option>
									<option value="Guinea-bissau">Guinea-bissau</option>
									<option value="Guyana">Guyana</option>
									<option value="Haiti">Haiti</option>
									<option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option>
									<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
									<option value="Honduras">Honduras</option>
									<option value="Hong Kong">Hong Kong</option>
									<option value="Hungary">Hungary</option>
									<option value="Iceland">Iceland</option>
									<option value="India">India</option>
									<option value="Indonesia">Indonesia</option>
									<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
									<option value="Iraq">Iraq</option>
									<option value="Ireland">Ireland</option>
									<option value="Israel">Israel</option>
									<option value="Italy">Italy</option>
									<option value="Jamaica">Jamaica</option>
									<option value="Japan">Japan</option>
									<option value="Jordan">Jordan</option>
									<option value="Kazakhstan">Kazakhstan</option>
									<option value="Kenya">Kenya</option>
									<option value="Kiribati">Kiribati</option>
									<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
									<option value="Korea, Republic of">Korea, Republic of</option>
									<option value="Kuwait">Kuwait</option>
									<option value="Kyrgyzstan">Kyrgyzstan</option>
									<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
									<option value="Latvia">Latvia</option>
									<option value="Lebanon">Lebanon</option>
									<option value="Lesotho">Lesotho</option>
									<option value="Liberia">Liberia</option>
									<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
									<option value="Liechtenstein">Liechtenstein</option>
									<option value="Lithuania">Lithuania</option>
									<option value="Luxembourg">Luxembourg</option>
									<option value="Macao">Macao</option>
									<option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
									<option value="Madagascar">Madagascar</option>
									<option value="Malawi">Malawi</option>
									<option value="Malaysia">Malaysia</option>
									<option value="Maldives">Maldives</option>
									<option value="Mali">Mali</option>
									<option value="Malta">Malta</option>
									<option value="Marshall Islands">Marshall Islands</option>
									<option value="Martinique">Martinique</option>
									<option value="Mauritania">Mauritania</option>
									<option value="Mauritius">Mauritius</option>
									<option value="Mayotte">Mayotte</option>
									<option value="Mexico">Mexico</option>
									<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
									<option value="Moldova, Republic of">Moldova, Republic of</option>
									<option value="Monaco">Monaco</option>
									<option value="Mongolia">Mongolia</option>
									<option value="Montserrat">Montserrat</option>
									<option value="Morocco">Morocco</option>
									<option value="Mozambique">Mozambique</option>
									<option value="Myanmar">Myanmar</option>
									<option value="Namibia">Namibia</option>
									<option value="Nauru">Nauru</option>
									<option value="Nepal">Nepal</option>
									<option value="Netherlands">Netherlands</option>
									<option value="Netherlands Antilles">Netherlands Antilles</option>
									<option value="New Caledonia">New Caledonia</option>
									<option value="New Zealand">New Zealand</option>
									<option value="Nicaragua">Nicaragua</option>
									<option value="Niger">Niger</option>
									<option value="Nigeria">Nigeria</option>
									<option value="Niue">Niue</option>
									<option value="Norfolk Island">Norfolk Island</option>
									<option value="Northern Mariana Islands">Northern Mariana Islands</option>
									<option value="Norway">Norway</option>
									<option value="Oman">Oman</option>
									<option value="Pakistan">Pakistan</option>
									<option value="Palau">Palau</option>
									<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
									<option value="Panama">Panama</option>
									<option value="Papua New Guinea">Papua New Guinea</option>
									<option value="Paraguay">Paraguay</option>
									<option value="Peru">Peru</option>
									<option value="Philippines">Philippines</option>
									<option value="Pitcairn">Pitcairn</option>
									<option value="Poland">Poland</option>
									<option value="Portugal">Portugal</option>
									<option value="Puerto Rico">Puerto Rico</option>
									<option value="Qatar">Qatar</option>
									<option value="Reunion">Reunion</option>
									<option value="Romania">Romania</option>
									<option value="Russian Federation">Russian Federation</option>
									<option value="Rwanda">Rwanda</option>
									<option value="Saint Helena">Saint Helena</option>
									<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
									<option value="Saint Lucia">Saint Lucia</option>
									<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
									<option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option>
									<option value="Samoa">Samoa</option>
									<option value="San Marino">San Marino</option>
									<option value="Sao Tome and Principe">Sao Tome and Principe</option>
									<option value="Saudi Arabia">Saudi Arabia</option>
									<option value="Senegal">Senegal</option>
									<option value="Serbia and Montenegro">Serbia and Montenegro</option>
									<option value="Seychelles">Seychelles</option>
									<option value="Sierra Leone">Sierra Leone</option>
									<option value="Singapore">Singapore</option>
									<option value="Slovakia">Slovakia</option>
									<option value="Slovenia">Slovenia</option>
									<option value="Solomon Islands">Solomon Islands</option>
									<option value="Somalia">Somalia</option>
									<option value="South Africa">South Africa</option>
									<option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option>
									<option value="Spain">Spain</option>
									<option value="Sri Lanka">Sri Lanka</option>
									<option value="Sudan">Sudan</option>
									<option value="Suriname">Suriname</option>
									<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
									<option value="Swaziland">Swaziland</option>
									<option value="Sweden">Sweden</option>
									<option value="Switzerland">Switzerland</option>
									<option value="Syrian Arab Republic">Syrian Arab Republic</option>
									<option value="Taiwan, Province of China">Taiwan, Province of China</option>
									<option value="Tajikistan">Tajikistan</option>
									<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
									<option value="Thailand">Thailand</option>
									<option value="Timor-leste">Timor-leste</option>
									<option value="Togo">Togo</option>
									<option value="Tokelau">Tokelau</option>
									<option value="Tonga">Tonga</option>
									<option value="Trinidad and Tobago">Trinidad and Tobago</option>
									<option value="Tunisia">Tunisia</option>
									<option value="Turkey">Turkey</option>
									<option value="Turkmenistan">Turkmenistan</option>
									<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
									<option value="Tuvalu">Tuvalu</option>
									<option value="Uganda">Uganda</option>
									<option value="Ukraine">Ukraine</option>
									<option value="United Arab Emirates">United Arab Emirates</option>
									<option value="United Kingdom">United Kingdom</option>
									<option value="United States">United States</option>
									<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
									<option value="Uruguay">Uruguay</option>
									<option value="Uzbekistan">Uzbekistan</option>
									<option value="Vanuatu">Vanuatu</option>
									<option value="Venezuela">Venezuela</option>
									<option value="Viet Nam">Viet Nam</option>
									<option value="Virgin Islands, British">Virgin Islands, British</option>
									<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
									<option value="Wallis and Futuna">Wallis and Futuna</option>
									<option value="Western Sahara">Western Sahara</option>
									<option value="Yemen">Yemen</option>
									<option value="Zambia">Zambia</option>
									<option value="Zimbabwe">Zimbabwe</option>
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div> -->
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid4">
								<label><b>Unit No.<small style="color: red"> * </small>: </b></label>
								<input type="text" name="unit_no" id="unit_no" required />
							</div>
							<div class="grid4">
								<label><b>Building<small style="color: red"> * </small>: </b></label>
								<select class="styled" id="buildingsssss" name="buildingsssss" required>
									<option value="">Choose building</option>
									@foreach($coverage as $c)						
										<option value="{{ $c->building_name }}">{{ $c->building_name }}</option>
									@endforeach
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid8">
								<label><b>Street<small style="color: red"> * </small>: </b></label>
								<select id="streetss" name="streetss" class="styled" required aria-required="true">
									<option value>Select Street</option>					
								</select>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Package<small style="color: red"> * </small>: </b></label></div>
							<div class="grid6">
								<select class="styled" id="package" name="package" required>
									<option value="">Choose package</option>
									<option value="NA">NA</option>
									<option value="30">30Mbps</option>
									@foreach($product as $c)
									<option value="{{ $c->speed }}">{{ $c->package_name }}</option>
									@endforeach
								</select>
							</div>	
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow">
							<div class="grid2">&nbsp;</div>
							<div class="grid2"><label><b>Subscription/ Contract Period : </b></label></div>
							<div class="grid2">
								<div class="checker" id="uniform-check1">
									<span class="checked"><input type="checkbox" id="period" name="period" style="opacity: 0;" checked="checked"></span>
								</div>
								<label for="check1" class="mr20">24 Month</label>
							</div>
							<div class="grid2"><label><b>Billing Cycle: </b></label></div>
							<div class="grid2">
								<div class="checker" id="uniform-check2">
									<span>
										<input type="checkbox" id="billing" name="billing" style="opacity: 0;" checked="checked">
									</span>
								</div>
								<label for="check2" class="mr20">Monthly</label>
							</div>
							<div class="grid2">&nbsp;</div>
						</div>
						
						<div class="formRow noBorderB">
							<div class="grid12">
								<input type="submit" name="secured" id="secured" class="buttonM bPurple formSubmit" value="Add New Customer Detail">
							</div>
						</div>
						
					</div>
					<div class="widget grid2 widgetH"></div>
				</fieldset>
			</form>
		</div>	
		<!-- ///////////////////////////////// -->	
	</div>
</div>


@endsection

@section('external_js')
<script>
	$(document).ready(function() {	
		var formSD = document.getElementById("formSD");
		var formR = document.getElementById("formR");
		var formNFSP = document.getElementById("formNFSP");

		formSD.style.display = "none";
		formR.style.display = "none";
		formNFSP.style.display = "none";

		$('#type_customer').on('change',function(){

			if ($('#type_customer').val() == "formR"){

				formSD.style.display = "none";
				formR.style.display = "";

				$.getJSON('{{url("/CustomerService/wo/country-json")}}', function( data ) {
					$.each(data, function (key, entry) {
						$('#citizenss').append($('<option></option>').attr('value', entry.name).text(entry.name));
					});
				});

				$.ajax({
					type: "GET",
					url: "{{url('/CustomerService/wo/building-json')}}",
					data: { },
					dataType: "json",
					success:function(data){
						$.each(data, function (key, entry) {
							$('#buildingsss').append($('<option></option>').attr('value', entry.name).text(entry.name));
						});
					}
				});		

				$('#buildingsss').change(function(){
					if( $(this).val()==""){
						$("#street").prop("checked", false);
						$('#street').empty();
						$('#street').append('<option value="">Please choose street</option>');
					}
					else {
						$('#street').empty();
						$('#street').append('<option value="">Please choose street</option>');

							$.ajax({
								type: "GET",
								url: "{{ url('api/get-street') }}"+"/"+$(this).val(),
								success: function(result){
									$.each(result.data, function(i, d) {
										$('#street').append('<option value="' + d.street + '">' + d.street + '</option>');
										$('#street').prop('required',true);
									});
							}
							});
					}
				});
				$('#street').change(function(){
					$.ajax({
						type: "GET",
						url: "{{ url('api/get-coverage-detail') }}"+"/"+$('#coverage').val()+"/"+$('#street').val(),
						success: function(result){
							$.each(result.data, function(i, d) {
								$('#city').val(d.city);
								$('#state').val(d.state);
								$('#postcode').val(d.postcode);
							});
						}
					});
				});		

					//$(".styled, input:radio, input:checkbox, .dataTables_length select").uniform();
					
				}else if($('#type_customer').val() == "formSD"){
					
					formSD.style.display = "";
					formR.style.display = "none";
					
					$.getJSON('{{url("/CustomerService/wo/country-json")}}', function( data ) {
						$.each(data, function (key, entry) {
							$('#citizensss').append($('<option></option>').attr('value', entry.name).text(entry.name));
						});
					});
					
					$.ajax({
						type: "GET",
						url: "{{url('/CustomerService/wo/building-json')}}",
						data: { },
						dataType: "json",
						success:function(data){
							$.each(data, function (key, entry) {
								$('#buildingssss').append($('<option></option>').attr('value', entry.name).text(entry.name));
							});
						}
					});	

					$('#buildingssss').change(function(){
						if( $(this).val()==""){
							$("#streets").prop("checked", false);
							$('#streets').empty();
							$('#streets').append('<option value="">Please choose street</option>');
						}
						else {
							$('#streets').empty();
							$('#streets').append('<option value="">Please choose street</option>');

								$.ajax({
									type: "GET",
									url: "{{ url('api/get-street') }}"+"/"+$(this).val(),
									success: function(result){
										$.each(result.data, function(i, d) {
											$('#streets').append('<option value="' + d.street + '">' + d.street + '</option>');
											$('#streets').prop('required',true);
										});
								}
								});
						}
					});
					$('#streets').change(function(){
						$.ajax({
							type: "GET",
							url: "{{ url('api/get-coverage-detail') }}"+"/"+$('#coverage').val()+"/"+$('#street').val(),
							success: function(result){
								$.each(result.data, function(i, d) {
									$('#city').val(d.city);
									$('#state').val(d.state);
									$('#postcode').val(d.postcode);
								});
							}
						});
					});			

					//$(".styled, input:radio, input:checkbox, .dataTables_length select").uniform();
				}else if($('#type_customer').val() == "formNFSP"){

					formNFSP.style.display = "";
					formSD.style.display = "none";
					formR.style.display = "none";
					
					// $.getJSON('{{url("/CustomerService/wo/country-json")}}', function( data ) {
					// 	$.each(data, function (key, entry) {
					// 		$('#citizensss').append($('<option></option>').attr('value', entry.name).text(entry.name));
					// 	});
					// });
					
					// $.ajax({
					// 	type: "GET",
					// 	url: "{{url('/CustomerService/wo/building-json')}}",
					// 	data: { },
					// 	dataType: "json",
					// 	success:function(data){
					// 		$.each(data, function (key, entry) {
					// 			$('#buildingssss').append($('<option></option>').attr('value', entry.name).text(entry.name));
					// 		});
					// 	}
					// });				

					//$(".styled, input:radio, input:checkbox, .dataTables_length select").uniform();

					$('#buildingsssss').change(function(){
						if( $(this).val()==""){
							$("#streetss").prop("checked", false);
							$('#streetss').empty();
							$('#streetss').append('<option value="">Please choose street</option>');
						}
						else {
							$('#streetss').empty();
							$('#streetss').append('<option value="">Please choose street</option>');

								$.ajax({
									type: "GET",
									url: "{{ url('api/get-street') }}"+"/"+$(this).val(),
									success: function(result){
										$.each(result.data, function(i, d) {
											$('#streetss').append('<option value="' + d.street + '">' + d.street + '</option>');
											$('#streetss').prop('required',true);
										});
								}
								});
						}
					});
					$('#street').change(function(){
						$.ajax({
							type: "GET",
							url: "{{ url('api/get-coverage-detail') }}"+"/"+$('#coverage').val()+"/"+$('#street').val(),
							success: function(result){
								$.each(result.data, function(i, d) {
									$('#city').val(d.city);
									$('#state').val(d.state);
									$('#postcode').val(d.postcode);
								});
							}
						});
					});
				}
			});

		$('#refresh').on('click',function(){
			window.location.reload();
		});

	});
</script>

@endsection