<?php $__env->startSection('jsPage'); ?>
<?php echo HTML::script('admin/template/js/cancel.js'); ?>

<?php $__env->stopSection(); ?>

<?php $__env->startSection('jsPageBottom'); ?>
<script type="text/javascript">var logout = <?php echo (Session::has('logout'))?1:0; ?></script>
<script type="text/javascript">var requireLogin = <?php echo (Session::has('requireLogin'))?1:0; ?></script>
<script type="text/javascript">var modal = <?php echo (Session::has('modal'))?1:0; ?></script>
<?php echo HTML::script('admin/template/js/jquery.bxslider.js'); ?>

<?php echo HTML::script('admin/template/js/home.js'); ?>


<?php $__env->stopSection(); ?>

<?php $__env->startSection('jsPage'); ?>
<?php $__env->stopSection(); ?>

<?php $__env->startSection('pageContent'); ?>
<div id="center-body">
    <div id="title-background">
        <div id="title-body-registration">
            <p id="text-left-body-registration">CANCEL LIEN ORDER FORM</p>
            &nbsp;&nbsp;&nbsp;You can include some descriptive text right here, just let me know
        </div>
    </div>
    <div id="slider-central-registration" class="cancel-form">
        <div id="form-container-registration">
            <?php if($errors->count()>0): ?>
            <div class="alert alert-danger" id="alert">
                <ul>
                    <?php foreach($errors->all() as $error): ?>
                    <li>
                        <?php echo $error; ?>

                    </li>
                    <?php endforeach; ?>
                </ul>
            </div>
            <?php endif; ?>
            <?php if(Session::has('failed')): ?>
            <div class="alert alert-danger align-right" id="alert">
                <p><?php echo Session::get('failed'); ?></p>
            </div>
            <?php endif; ?>
            <?php if(Session::has('msg')): ?>
            <div class="alert alert-success align-right" id="alert">
                <p><?php echo Session::get('msg'); ?></p>
            </div>
            <?php endif; ?>
            <div id="basic-information">
                <?php echo Form::open(['route'=>'order.lien.postcancel']); ?>

                <div id="form-basic-information-registration" style="height: 180px">
                    <!-- INICIO 1er fila de inputs -->
                    <div id="column" class="row">
                        <div class="col-md-4">
                            <p>File Number: <span id='required'>*</span></p>
                            <?php echo Form::text('file_number', Input::old('file_number', isset($order->FileNo)? $order->FileNo:''), ['id'=>'file_number', 'class' => 'form-control center', 'required' => 'required']); ?>

                        </div>
                        <div class="col-md-4">
                            <p>Name: <span id='required'>*</span></p>
                            <?php echo Form::text('your_name', null, ['id'=>'your_name', 'class' => 'form-control center', 'required' => 'required']); ?>

                        </div>
                        <div class="col-md-4">
                            <p>Email: <span id='required'>*</span></p>
                            <?php echo Form::text('email', null, ['id'=>'email', 'class' => 'form-control center', 'required' => 'required']); ?>

                        </div>
                    </div>
                    <!-- FIN 1er fila de inputs -->
                    <!-- INICIO 2o fila de inputs -->
                    <div id="column" class="row">
                        <div class="col-xs-12">
                            <p>Reason for Cancelling? <span id='required'>*</span></p>
                            <?php echo Form::textarea('reason', null, ['id'=>'reason', 'class'=>'form-control', 'size' => '20x3', 'required' => 'required']); ?>

                        </div>
                    </div>
                    <!-- FIN 2o fila de inputs -->
                </div>
                <div id="form-submit">
                    <div class="row">
                        <div class="col-md-4">&nbsp;</div>
                        <div class="col-md-2">
                            <div class="btn-group">
                                <button id="button-submit-form" name="button-submit-form" type="button" class="btn btn-default proceed-btn">Submit</button>
                            </div>
                        </div>
                        <div class="col-md-2">
                            <td id="" width="97"><a href="/orders/lien/index/" id="button-submit-form" class="btn btn-default">Back</a></td>
                            
                            <!--<button id="button-submit-form" name="button-cancel-form" type="reset" class="btn btn-default">Cancel</button>-->
                        </div>
                        <div class="col-md-4">&nbsp;</div>
                    </div>
                </div>
            </div>
            <?php echo Form::close(); ?>

        </div>
    </div>
    <?php echo $__env->make('site.modal-windows.cancel', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
    <?php echo $__env->make('helpers.footer', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
</div>
<?php $__env->stopSection(); ?>
<?php echo $__env->make('helpers.base', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>