<?php $__env->startSection('content'); ?>
<?php echo Form::open(['route'=>'signup']); ?>


<p>
    <?php echo Form::label('Company Name:'); ?>

    <?php echo Form::text('company_name'); ?>

</p>

<p>
    <?php echo Form::label('Contact Name:'); ?>

    <?php echo Form::text('contact_name'); ?>

</p>

<p>
    <?php echo Form::label('Company Address:'); ?>

    <?php echo Form::text('address'); ?>

</p>

<p>
    <?php echo Form::label('City:'); ?>

    <?php echo Form::text('city_id'); ?>

</p>

<p>
    <?php echo Form::label('State:'); ?>

    <?php echo Form::text('state_id'); ?>

</p>

<p>
    <?php echo Form::label('Zipcode:'); ?>

    <?php echo Form::text('zipcode'); ?>

</p>

<p>
    <?php echo Form::label('Email:'); ?>

    <?php echo Form::text('email'); ?>

</p>

<p>
    <?php echo Form::label('Primary Contact Phone:      Ext:'); ?>

    <?php echo Form::text('phone[]'); ?><?php echo Form::text('phone[]'); ?><?php echo Form::text('phone[]'); ?><?php echo Form::text('phone[]'); ?>

</p>

<p>
    <?php echo Form::label('Fax:'); ?>

    <?php echo Form::text('fax'); ?>

</p>

<p>
    <?php echo Form::submit('Sign Up'); ?>

    <?php echo Form::reset('Cancel'); ?>

</p>


<?php echo Form::close(); ?>

<?php $__env->stopSection(); ?>
<?php echo $__env->make('layouts.main', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>