['admin.request.update', $request->id], 'class'=>'form-horizontal row-border']); ?>

Companies Listed

'register it'] + $companies), Input::old('company_listed'), ['class'=>'form-control']); ?> first('company_listed'); ?>

Company Name

company_name), ['class'=>'form-control company_name']); ?> first('company_name'); ?>

Contact Name

contact_name), ['class'=>'form-control']); ?> first('fullname'); ?>

Company Address:

address), ['class'=>'form-control']); ?>

State

state_id), ['class'=>'form-control']); ?>

City

city_id), ['class'=>'form-control']); ?>

zipcode

zipcode), ['class'=>'form-control']); ?>

email), ['class'=>'form-control']); ?> first('email'); ?>

Primary Contact Phone

phone), ['class'=>'form-control']); ?> first('phone'); ?>

Fax

fax), ['class'=>'form-control']); ?> first('fax'); ?>

Username

'form-control']); ?> first('username'); ?>

Password

'form-control']); ?> first('password'); ?>