@extends ('helpers.base') @section ('jsPageBottom') {{ HTML::style('admin/template/plugin/bootstrap-datepicker/css/datepicker.css')}} {{ HTML::script('admin/template/plugin/bootstrap-datepicker/js/bootstrap-datepicker.js')}} @stop @section ('cssPage') {{ HTML::style('admin/template/css/order-forms-both-lien-hoa.css'); }} @stop @section ('pageContent')
 

ORDER FORMS / BOTH LIEN AND HOA

@if($errors->count()>0)
    @foreach($errors->all() as $error)
  • {{ $error }}
  • @endforeach
@endif @if(Session::has('failed'))

{{ Session::get('failed') }}

@endif
{{ Form::open(['route'=>['order.lienhoaboth.store'], 'files'=>true, 'class'=>'form-horizontal row-border'])}}
Basic Information

Requested By:

{{ Form::text('RequestedBy', Input::old('RequestedBy', Auth::user()->fullname), ['id'=>'requested-by-both', 'class'=>"form-control", 'maxlength'=>"50"]) }} {{Form::hidden('ClientID', Auth::user()->lien_client_id)}}

File Number:

{{ Form::text('FileNo', Input::old('FileNo'), ['id'=>'file-number-both', 'class'=>"form-control center", 'maxlength'=>"50"]) }}

Closing Date:

{{-- Form::input('date', 'ClosingDate', Input::old('ClosingDate'), ['id'=>'closing-date-both', 'class'=>"form-control center", 'placeholder'=>"MM/DD/YYYY"]) --}}
{{ Form::text('ClosingDate', Input::old('ClosingDate'), ['id'=>'closing-date-both', 'class'=>"form-control center", 'placeholder'=>"MM/DD/YYYY"]) }}
Property Information

Number:

{{ Form::text('StreetNo',false, ['class'=>'form-control-especial center', 'maxlength'=>"50"] )}}

 

{{ Form::select('StreetDirectionID',($select + $streetDirection), Input::old('StreetDirectionID'), ['class'=>'form-control center-especial StreetDirectionID']) }}

Street Name:

{{ Form::text('StreetName',false, ['class'=>'form-control center', 'maxlength'=>"100"] )}}

Type:

{{ Form::select('StreetTypeID',(['-1'=>'Select'] + $streetType), Input::old('StreetTypeID'), ['class'=>'form-control center StreetTypeID']) }}

Unit Number:

{{ Form::text('StreetUnitNo',false, ['class'=>'form-control center', 'maxlength'=>"50"] )}}

City:

{{ Form::select('CityID',($select + $cities), Input::old('CityID'), ['id'=>'city-lien', 'class'=>'form-control center']) }}

Zip:

{{ Form::text('ZipCode',Input::get('ZipCode'), ['class'=>'form-control center', 'maxlength'=>"10"] )}}

County:

{{ Form::select('CountyID',($select + $counties), Input::old('CountyID'), ['id'=>'county-lien', 'class'=>'form-control center']) }}

Folio Number:

{{ Form::text('FolioNo',Input::get('FolioNo'), ['class'=>'form-control center', 'maxlength'=>"100"] )}}

Legal Description:

{{ Form::textarea('LegalDescription',Input::get('LegalDescription'), ['class'=>'form-control', 'size'=>'3x5', 'maxlength'=>"1000"] )}}

Buyer:

{{ Form::text('BuyerName',Input::get('BuyerName'), ['class'=>'form-control center', 'maxlength'=>"100"] )}}

Seller:

{{ Form::text('SellerName',Input::get('SellerName'), ['class'=>'form-control center', 'maxlength'=>"100"] )}}

Specific Instructions:

{{ Form::textarea('SpecialInstruction',Input::get('SpecialInstruction'), ['class'=>'form-control','size'=>'3x5', 'maxlength'=>"2000"] )}}
@include ('helpers.lienSelections')
HOA Information

HOA Name:

{{ Form::text('HOAName',Input::old('HOAName'), ['class'=>'form-control center', 'maxlength'=>"255"] )}}

Phone:

{{ Form::text('hoa_tel[0]',Input::get('hoa_tel.0'), ['class'=>'form-control-especial', 'id'=>'tel1', 'size'=>'3', 'maxlength'=>'3']) }}

 

{{ Form::text('hoa_tel[1]',Input::get('hoa_tel.1'), ['class'=>'form-control-especial', 'id'=>'tel2', 'size'=>'3', 'maxlength'=>'3']) }}

 

{{ Form::text('hoa_tel[2]',Input::get('hoa_tel.2'), ['class'=>'form-control-especial', 'id'=>'tel3', 'size'=>'4', 'maxlength'=>'4']) }}

Listing Agent/ Realtor:

{{ Form::text('ListingAgentName',Input::get('ListingAgentName'), ['class'=>'form-control center', 'maxlength'=>"255"] )}}

Phone:

{{ Form::text('agent_tel[0]',Input::get('agent_tel.0'), ['class'=>'form-control-especial', 'id'=>'tel1', 'size'=>'3', 'maxlength'=>'3'] )}}

 

{{ Form::text('agent_tel[1]',Input::get('agent_tel.0'), ['class'=>'form-control-especial', 'id'=>'tel2', 'size'=>'3', 'maxlength'=>'3'] )}}

 

{{ Form::text('agent_tel[2]',Input::get('agent_tel.0'), ['class'=>'form-control-especial', 'id'=>'tel2', 'size'=>'4', 'maxlength'=>'4'] )}}
@include ('helpers.uploadDoc')
Search Response Delivery
@include('site.EmailFax') @include('site.buttonsSubmit') @if(Session::has('message'))
{{ Session::get('message')}}
@endif
@include ('helpers.footer') @stop