@extends('header')

@section('content')

  <style type="text/css">
  div > label.control-label
  {
    font-weight: bold !important;    
    /* text-transform:uppercase; */
  }
  </style>

  {{ Former::vertical_open('payment/' . $invitationKey)->rules(array(
      'first_name' => 'required',
      'last_name' => 'required',   
      'card_number' => 'required',
      'expiration_month' => 'required',
      'expiration_year' => 'required',
      'cvv' => 'required',
      'address1' => 'required',
      'city' => 'required',
      'state' => 'required',
      'postal_code' => 'required',
      'country' => 'required',
      'phone' => 'required',
      'email' => 'required'   
  )) }}

  {{ Former::populate($client) }}
  {{ Former::populateField('first_name', $contact->first_name) }}
  {{ Former::populateField('last_name', $contact->last_name) }}
  
  <p>&nbsp;<p/>
  <p>&nbsp;<p/>

  <div class="row">
    <div class="col-md-6" style="padding-top:16px">

      <div class="row">
        <div class="col-md-6">
          {{ Former::text('first_name') }}
        </div>
        <div class="col-md-6">
          {{ Former::text('last_name') }}
        </div>
      </div>

      <div class="row">
        <div class="col-md-12">
          {{ Former::text('address1')->label('Street') }}
        </div>
      </div>

      <div class="row">
        <div class="col-md-3">
          {{ Former::text('address2')->label('Apt/Suite') }}      
        </div>
        <div class="col-md-3">
          {{ Former::text('city') }}          
        </div>
        <div class="col-md-3">
          {{ Former::text('state')->label('State/Province') }}          
        </div>
        <div class="col-md-3">
          {{ Former::text('postal_code') }}          
        </div>
      </div>

      @if(strtolower($gateway->name) == 'beanstream')
        <div class="row">
          <div class="col-md-4">
            {{ Former::text('phone') }}
          </div>
          <div class="col-md-4">
            {{ Former::text('email') }}
          </div>
          <div class="col-md-4">
            {{ Former::select('country')->addOption('','')->label('Country')
                 ->fromQuery($countries, 'name', 'iso_3166_2') }}        
          </div>
        </div>                
      @endif

    </div>

    <div class="col-md-5 col-md-offset-1" style="background-color:#DDD;padding-top:16px">

      <div class="row">
        <div class="col-md-12">
          {{ Former::text('card_number') }}  
        </div>
      </div>
      

      <div class="row">
        <div class="col-md-6">
          {{ Former::select('expiration_month')->addOption('','')
                ->addOption('01 - January', '1')
                ->addOption('02 - February', '2')
                ->addOption('03 - March', '3')
                ->addOption('04 - April', '4')
                ->addOption('05 - May', '5')
                ->addOption('06 - June', '6')
                ->addOption('07 - July', '7')
                ->addOption('08 - August', '8')
                ->addOption('09 - September', '9')
                ->addOption('10 - October', '10')
                ->addOption('11 - November', '11')
                ->addOption('12 - December', '12')
          }}
        </div>
        <div class="col-md-6">
          {{ Former::select('expiration_year')->addOption('','')
                ->addOption('2014', '2014')
                ->addOption('2015', '2015')
                ->addOption('2016', '2016')
                ->addOption('2017', '2017')
                ->addOption('2018', '2018')
                ->addOption('2019', '2019')
                ->addOption('2020', '2020')
          }}          
        </div>
      </div>

      <div class="row">
        <div class="col-md-6">
          {{ Former::text('cvv') }}        
        </div>
      </div>

    </div>

    <p>&nbsp;<p/>
    <p>&nbsp;<p/>


    <div class="row">
      <div class="col-md-12">
      
        {{ Button::block_primary_submit_lg(strtoupper(trans('texts.pay_now')) . ' - ' . Utils::formatMoney($invoice->amount, $client->currency_id) ) }}

      </div>
    </div>    

  </div>


      


  {{ Former::close() }}

@stop