@extends ('helpers.base')

@section('jsPage')
{{ HTML::script('admin/template/js/cancel.js')}}
@stop

@section ('jsPageBottom')
<script type="text/javascript">var logout = {{ (Session::has('logout'))?1:0}}</script>
<script type="text/javascript">var requireLogin = {{ (Session::has('requireLogin'))?1:0}}</script>
<script type="text/javascript">var modal = {{ (Session::has('modal'))?1:0}}</script>
{{ HTML::script('admin/template/js/jquery.bxslider.js')}}
{{ HTML::script('admin/template/js/home.js')}}

@stop

@section ('jsPage')
@stop

@section ('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">
            @if($errors->count()>0)
            <div class="alert alert-danger" id="alert">
                <ul>
                    @foreach($errors->all() as $error)
                    <li>
                        {{ $error }}
                    </li>
                    @endforeach
                </ul>
            </div>
            @endif
            @if(Session::has('failed'))
            <div class="alert alert-danger align-right" id="alert">
                <p>{{ Session::get('failed') }}</p>
            </div>
            @endif
            @if(Session::has('msg'))
            <div class="alert alert-success align-right" id="alert">
                <p>{{ Session::get('msg') }}</p>
            </div>
            @endif
            <div id="basic-information">
                {{ Form::open(['route'=>'order.lien.postcancel'])}}
                <div id="form-basic-information-registration" style="height: 180px">
                    <!-- INICIO 1er fila de inputs -->
                    <div id="column" class="row">
                        <div class="col-md-4">
                            <p>File Number: <span id='required'>*</span></p>
                            {{ Form::text('file_number', Input::old('file_number', isset($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>
                            {{ 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>
                            {{ 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>
                            {{ 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>
            {{Form::close()}}
        </div>
    </div>
    @include('site.modal-windows.cancel')
    @include ('helpers.footer')
</div>
@stop