@extends('layouts.app')

@section('content')
    <div class="container-fluid">
        <div class="page-title">
            <div class="row project-list">
                <div class="col-sm-6">
                    <h3>{{__('messages.create_folder')}}</h3>
                </div>
            </div>
        </div>
    </div>
    <div class="container-fluid">
        @if (session('error'))
            <div class="alert alert-danger" id="message" role="alert">
                <p> {{ session('error') }}</p>
            </div>
        @endif

        <div class="row">
            <div class="col-sm-12">
                <form class="needs-validation" novalidate="" method="POST" action="{{route('folders.store')}}" enctype="multipart/form-data">
                    @csrf
                    <div class="card">
                        <div class="card-header pb-0 d-flex justify-content-between align-items-center">
                            <h4 class="mb-0">{{__('messages.info_client')}}</h4>
                        </div>
                        <div class="card-body">
                            <div class="row g-3 mb-3">
                                <div class="col-md-3">
                                    <label class="form-label" for="role">{{__('messages.civilite')}}</label>
                                        <select class="form-select" id="civilite"  name="civilite" required="">
                                            <option></option>
                                            <option value="Mr">Mr</option>
                                            <option value="Mme">Mme</option>
                                            <option value="Mlle">Mlle</option>
                                        </select>
                                    @error('civilite')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="name">{{__('messages.name')}}</label>
                                    <input class="form-control" id="name" name="first_name" type="text" placeholder="{{__('messages.name')}}" required="" value="{{old('name')}}">
                                    @error('name')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="last_name">{{__('messages.last_name')}}</label>
                                    <input class="form-control" id="last_name" name="last_name" type="text" placeholder="{{__('messages.last_name')}}" required="" value="{{old('last_name')}}">
                                    @error('username')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="email">{{__('messages.cp')}}</label>
                                    <div class="input-group left-radius">
                                        <input class="form-control" id="cp" name="cp" type="number"  placeholder="{{__('messages.cp')}}" required="" value="{{old('cp')}}">
                                    </div>
                                    @error('email')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                            </div>
                            <div class="row g-3 mb-3">
                                <div class="col-md-3">
                                    <label class="form-label" for="city">{{__('messages.city')}}</label>
                                    <div class="input-group left-radius">
                                        <input class="form-control" id="city" name="city" type="text" placeholder="{{__('messages.city')}}" required="" value="{{old('city')}}">
                                    </div>
                                    @error('email')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="phone">{{__('messages.phone')}}</label>
                                    <input class="form-control" id="phone" name="phone" type="text" required="" placeholder="0612345678" value="{{old('phone')}}">

                                    @error('phone')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-6">
                                    <label class="form-label" for="address">{{__('messages.address')}}</label>
                                    <textarea class="form-control" id="address" name="address" required="" placeholder="{{__('messages.address')}}">{{old('address')}}</textarea>

                                    @error('address')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                            </div>
{{--                            <div class="row g-3 mb-3">--}}
{{--                                <div class="col-md-12">--}}
{{--                                    <label class="form-label" for="avatar">{{__('messages.photo_garde')}}</label>--}}
{{--                                    <input class="form-control" id="avatar" name="avatar" type="file" value="{{old('avatar')}}">--}}

{{--                                    @error('avatar')--}}
{{--                                    <div class="invalid-feedback d-block">{{ $message }}</div>--}}
{{--                                    @enderror--}}
{{--                                </div>--}}
{{--                            </div>--}}
                        </div>
                    </div>

                    <div class="card">
                        <div class="card-header pb-0 d-flex justify-content-between align-items-center">
                            <h4 class="mb-0">{{__('messages.intervention')}}</h4>
                            <div class="form-check checkbox checkbox-primary mb-0">
                                <input class="form-check-input" id="checkbox-primary-1" type="checkbox">
                                <label class="form-check-label" for="checkbox-primary-1">Identiques</label>
                            </div>
                        </div>

                        <div class="card-body">

                            <div class="row g-3 mb-3">
                                <div class="col-md-3">
                                    <label class="form-label" for="role">{{__('messages.civilite')}}</label>
                                    <select class="form-select" id="civiliteIntervenant"  name="title" required="">
                                        <option></option>
                                        <option value="Mr">Mr</option>
                                        <option value="Mme">Mme</option>
                                        <option value="Mlle">Mlle</option>
                                    </select>
                                    @error('title')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
{{--                                <div class="col-md-3">--}}
{{--                                    <label class="form-label" for="title">{{__('messages.title')}}</label>--}}
{{--                                    <input class="form-control" id="title" name="title" type="text" placeholder="{{__('messages.title')}}" required="" value="{{old('title')}}">--}}
{{--                                    @error('title')--}}
{{--                                    <div class="invalid-feedback d-block">{{ $message }}</div>--}}
{{--                                    @enderror--}}
{{--                                </div>--}}
                                <div class="col-md-3">
                                    <label class="form-label" for="name">{{__('messages.name')}}</label>
                                    <input class="form-control" id="first_name_intervenant" name="first_name_intervenant" type="text" placeholder="{{__('messages.name')}}" required="" value="{{old('name')}}">
                                    @error('first_name_intervenant')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="last_name">{{__('messages.last_name')}}</label>
                                    <input class="form-control" id="last_name_intervenant" name="last_name_intervenant" type="text" placeholder="{{__('messages.last_name')}}" required="" value="{{old('last_name')}}">
                                    @error('last_name_intervenant')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="email">{{__('messages.cp')}}</label>
                                    <div class="input-group left-radius">
                                        <input class="form-control" id="code_postal_intervenant" name="code_postal_intervenant" type="text"  placeholder="{{__('messages.cp')}}" required="" value="{{old('cp')}}">
                                    </div>
                                    @error('cp')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                            </div>
                            <div class="row g-3 mb-3">
                                <div class="col-md-3">
                                    <label class="form-label" for="city">{{__('messages.city')}}</label>
                                    <div class="input-group left-radius">
                                        <input class="form-control" id="city_intervenant" name="city_intervenant" type="text" placeholder="{{__('messages.city')}}" required="" value="{{old('city')}}">
                                    </div>
                                    @error('city')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-3">
                                    <label class="form-label" for="phone">{{__('messages.phone')}}</label>
                                    <input class="form-control" id="phone_intervenant" name="phone_intervenant" type="text" required="" placeholder="0612345678" value="{{old('phone')}}">

                                    @error('phone')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                                <div class="col-md-6">
                                    <label class="form-label" for="address">{{__('messages.address')}}</label>
                                    <textarea class="form-control" id="address_intervenant" name="address_intervenant" required="" placeholder="{{__('messages.address')}}">{{old('address')}}</textarea>

                                    @error('address')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>

                                <div class="col-md-3">
                                    <label class="form-label" for="phone">{{__('messages.contact_first')}}</label>
                                    <input class="form-control" id="premier_contact_date" name="premier_contact_date" type="date" required="" placeholder="{{__('messages.premier_contact_date')}}" value="{{old('premier_contact_date')}}">
                                    @error('contact_first')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>

                                <div class="col-md-3">
                                    <label class="form-label" for="phone">{{__('messages.date_intervention')}}</label>
                                    <input class="form-control" id="date_intervention" name="date_intervention" type="date" required="" placeholder="{{__('messages.date_intervention')}}" value="{{old('date_intervention')}}">
                                    @error('date_intervention')
                                    <div class="invalid-feedback d-block">{{ $message }}</div>
                                    @enderror
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="card">
                        <div class="card-header pb-0">
                            <h4>{{__('messages.information_assurance')}}</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="row g-3 mb-3">
                                        <div class="col-md-12">
                                            <label class="form-label" for="title">{{__('messages.donneur_order')}}</label>
                                            <input class="form-control" id="donneur_order" name="donneur_order" type="text" placeholder="{{__('messages.donneur_order')}}" required="" value="{{old('donneur_order')}}">
                                            @error('title')
                                            <div class="invalid-feedback d-block">{{ $message }}</div>
                                            @enderror
                                        </div>
                                        <div class="col-md-12">
                                            <label class="form-label" for="assurance">{{__('messages.assurance')}}</label>
                                            <input class="form-control" id="assurance" name="assurance" type="text" placeholder="{{__('messages.assurance')}}" required="" value="{{old('assurance')}}">
                                            @error('assurance')
                                            <div class="invalid-feedback d-block">{{ $message }}</div>
                                            @enderror
                                        </div>
                                        <div class="col-md-12">
                                            <label class="form-label" for="expert">{{__('messages.expert')}}</label>
                                            <input class="form-control" id="expert" name="expert" type="text" placeholder="{{__('messages.expert')}}" required="" value="{{old('expert')}}">
                                            @error('expert')
                                            <div class="invalid-feedback d-block">{{ $message }}</div>
                                            @enderror
                                        </div>
                                    </div>
                                </div>
                                <div class="col-md-6">
                                    <div class="row g-3 mb-3">
{{--                                        <div class="col-md-12">--}}
{{--                                            <label class="form-label" for="ref_dossier">{{__('messages.ref_dossier')}}</label>--}}
{{--                                            <input class="form-control" id="ref_dossier" name="ref_dossier" type="text" placeholder="{{__('messages.ref_dossier')}}" required="" value="{{old('ref_dossier')}}">--}}
{{--                                            @error('ref_dossier')--}}
{{--                                            <div class="invalid-feedback d-block">{{ $message }}</div>--}}
{{--                                            @enderror--}}
{{--                                        </div>--}}
                                        <div class="col-md-12">
                                            <label class="form-label" for="ref_sinistre">{{__('messages.ref_sinistre')}}</label>
                                            <input class="form-control" id="ref_sinistre" name="ref_sinistre" type="text" placeholder="{{__('messages.ref_sinistre')}}" required="" value="{{old('ref_sinistre')}}">
                                            @error('ref_sinistre')
                                            <div class="invalid-feedback d-block">{{ $message }}</div>
                                            @enderror
                                        </div>
                                        <div class="col-md-12">
                                            <label class="form-label" for="ref_expert">{{__('messages.ref_expert')}}</label>
                                            <input class="form-control" id="ref_expert" name="ref_expert" type="text" placeholder="{{__('messages.ref_expert')}}" required="" value="{{old('ref_expert')}}">
                                            @error('ref_expert')
                                            <div class="invalid-feedback d-block">{{ $message }}</div>
                                            @enderror
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <button class="btn btn-primary f-right" type="submit">{{__('messages.add_folder')}}</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
@endsection