@extends('layouts.backend.app')

@section("content")
<div class="page page-forms-wizard">

    <div class="pageheader">

        <h2>Créer un Dévis<span></span></h2>

        <div class="page-bar">

            <ul class="page-breadcrumb">
                <li>
                <a href="{{route('spaceDashboard')}}"><i class="fa fa-home"></i> AROLI ASSURANCE</a>
                </li>
                <li>
                    <a href="#">Créer un Dévis</a>
                </li>
                
            </ul>
            
        </div>

    </div>

    <!-- page content -->
    <div class="pagecontent">
      <!-- tile -->
      <section class="tile tile-simple">

          <!-- tile body -->
          <div class="tile-body p-0">

              <div role="tabpanel">

                  <!-- Nav tabs -->
                  <ul class="nav nav-tabs tabs-dark" role="tablist">
                      <li role="presentation" class="active"><a href="#auto" aria-controls="settingsTab" role="tab" data-toggle="tab">Automobile</a></li>
                      <li><a href="{{route('devis.moto.creer')}}">Moto</a></li>
                      <li><a href="{{route('devis.voyage.creer')}}">Voyage</a></li>
                  </ul>

                  <!-- Tab panes -->
                  <div class="tab-content">

                      <div role="tabpanel" class="tab-pane active" id="auto">

                          <div class="wrap-reset">
      
                            <form method="post" action="{{route('devis.auto.post')}}" name="devis" class="quoteForm">
                              <div id="rootwizard" class="tab-container tab-wizard">
                                  @if (session('error'))
                                    <div class="alert alert-danger">
                                       {{ session('error') }}
                                    </div>
                                  @endif
                                  <ul class="nav nav-tabs nav-justified">
                                      <li><a href="#tab1" data-toggle="tab">Identité <span class="badge badge-default pull-right wizard-step">1</span></a></li>
                                      <li><a href="#tab2" data-toggle="tab">Assurance <span class="badge badge-default pull-right wizard-step">2</span></a></li>
                                      <li><a href="#tab3" data-toggle="tab">Information du Véhicule <span class="badge badge-default pull-right wizard-step">3</span></a></li>
                                      <li><a href="#tab4" data-toggle="tab">Profil de l'assuré <span class="badge badge-default pull-right wizard-step">4</span></a></li>
                                      <li><a href="#tab5" data-toggle="tab">Services optionnels <span class="badge badge-default pull-right wizard-step">5</span></a></li>
                                      
                                  </ul>
                                  <div class="tab-content">
                                       
                                          {{ csrf_field() }}
                                          <input type="hidden" name="_form_type_" id="_form_type_" value="{{encrypt('AUTO')}}">
                                      <div class="tab-pane" id="tab1">
                                        <div name="step1">
                                          <h3>Vous êtes</h3>
                                          <div class="row" id="div_proprio_veh">
                                            <div class="col-md-12 text-center">
                                                <div class="form-group">
                                                    <label for="gender">Pour qui est fait le dévis :</label><br>
                                                    <label class="checkbox-inline checkbox-custom">
                                                        <input id="particulier" name="proprio_veh" required value="P" data-parsley-group="block1" type="radio" ><i></i> Lui même
                                                    </label>
                                                    <label class="checkbox-inline checkbox-custom">
                                                        <input id="particulier" name="proprio_veh" required value="A" data-parsley-group="block1" type="radio" ><i></i> Quelqu'un d'autre
                                                    </label>
                                                    <label class="checkbox-inline checkbox-custom">
                                                        <input d="entreprise" data-parsley-group="block1" name="proprio_veh"  value="E" type="radio"><i></i> Une Entreprise
                                                    </label>
                                                </div>
                                            </div>
                                          </div>
                                          <div class="souscripteur_field" style="display:none; padding:15px;margin:10px" >
                                            <div class="form-group">
                                              <div class="col-md-6">
                                                <label class="control-label input-label" for="souscripteur_name">Votre nom*</label>
                                                <input type="text" data-parsley-group="block1" class="form-control" required  name="souscripteur_name" id="souscripteur_name" placeholder="Nom et prénom de la personne qui effectue le dévis">
                                              </div>
                                               <div class="col-md-6">
                                                 <label class="control-label input-label" for="phone_souscr">Votre Numéro de téléphone*</label>
                                                 <input data-parsley-group="block1" placeholder="Ex: 01020304" type="text" class="form-control" required name="phone_souscr" id="phone_souscr"> 
                                               </div> 
                                            </div>
                                          </div>

                                        </div>
                                        
                                      </div>
                                      
                                      <div class="tab-pane" id="tab2">

                                          <div id="step2">                        
                                              

                                              <div id="formulae_section">
                                                <div class="row" style="margin-bottom:10px">
                                                  <div class="col-md-6">
                                                      <label class="control-label input-label" for="priseeffet">Date de prise d'effet du contrat souhaitée*</label>
                                                      <div class="input-group datepicker w-330 mt-8" >
                                                        <input type="text" data-parsley-group="block2" required name="priseeffet" id="priseeffet" class="form-control">
                                                        <span class="input-group-addon">
                                                            <span class="fa fa-calendar"></span>
                                                        </span>
                                                    </div>
                                                  </div>
                                                  <div class="col-md-6">
                                                      <label class="control-label input-label" for="priseeffet">Périodicité*</label>
                                                      <select class="form-control" data-parsley-group="block2" required id="periode" name="periode">
                                                      @foreach($periodes as $p)
                                                        <option value="{{$p->id}}">{{$p->periode}}</option>
                                                      @endforeach
                                                      </select>
                                                  </div>
                                                </div>
                                                <div class="row">
                                                  <div class="col-md-12">
                                                      <label class="control-label input-label" for="pref_comp">Avez vous une préfenrence pour une compagnie particulière?</label>
                                                      <select class="form-control" name="pref_comp" id="pref_comp">
                                                        <option value="0">NON</option>
                                                        @foreach($companies as $c)
                                                        <option value="{{$c->id}}">{{$c->compname}}</option>
                                                        @endforeach
                                                      </select>
                                                  </div>
                                                </div>
                                                <div class="col-md-12 text-center" style="margin-bottom:15px; margin-top:15px">
                                                    <label class="control-label input-label" for="">Type de souscription*</label><br/>
                                                    
                                                    <div class="radio radio-primary radio-inline">
                                                      <input type="radio" id="formuletype" value="F" name="souscription" checked>
                                                      <label for="formuletype"> Choisir une Formule prédéfinie </label>
                                                    </div>

                                                    {{--<div class="radio radio-primary radio-inline">
                                                      <input type="radio" id="guaranteetype" value="G" name="souscription">
                                                      <label for="guaranteetype"> Selectionner vos Garanties (Option avancée) </label>
                                                    </div>--}}                   
                                                </div>
                                                
                                                <div class="row">
                                                  <div class="col-md-12">                 
                                                      <div id="div-garantie" style="display:none" class="col-md-6">
                                                          <label class="control-label input-label" for="">Garanties*</label><br/>
                                                          @foreach($guarantees as $g)
                                                            <div class="col-md-6">
                                                            <div class="checkbox checkbox-primary">
                                                              <input type="checkbox"  id="{{$g->codeguar}}" value="{{$g->codeguar}}" name="guarantee[]"
                                                              @if($g->id==1)
                                                                {{'checked onclick=return&nbsp;false'}}
                                                              @endif
                                                               >
                                                              <label class="checkpopover" for="{{$g->codeguar}}"> <i title="{{$g->description}}" class="tooltips"> {{$g->titleguar}} </i></label>
                                                            </div>
                                                            </div>
                                                          @endforeach
                                                      </div>
                                                      <div id="div-formule"  class="col-md-6">               
                                                        <label class="control-label input-label" for="">Formule*</label><br/>
                                                        <div class="row">
                                                          <div class="col-md-12">
                                                            <div class="col-md-6">
                                                              <div class="radio radio-primary">
                                                                <input type="radio" id="tsimple" value="tsimple" name="formule" checked>
                                                                <label for="tsimple" id="lb_tsimple"> <i title="L’assurance « au tiers » est la formule d’assurance auto la plus basique et la moins chère. Contrairement à la couverture optimale du contrat « tous risques », la formule « au tiers » ne dédommage que les préjudices physiques et matériels causés à un tiers en cas d’accident." class="tooltips">Tiers Simple </i></label>
                                                              </div>
                                                            </div>
                                                            <div class="col-md-6">
                                                              <div class="radio radio-primary">
                                                                <input type="radio" class="disable_mens" id="tcomplet" value="tcomplet" name="formule">
                                                                <label for="tcomplet" id="lb_tcomplet"><i title="A mi-chemin entre les formules « au tiers » et « tous risques », l’assurance auto « Tiers Complet » répond à la demande des automobilistes cherchant à souscrire un niveau de protection correct, sans pour autant augmenter leur budget auto." class="tooltips"> Tiers Complet</i> </label>
                                                              </div>
                                                            </div>
                                                          </div>
                                                        </div><br/>
                                                        <div class="row">
                                                          <div class="col-md-12">
                                                            
                                                            <div class="col-md-6">
                                                              <div class="radio radio-primary">
                                                                <input type="radio" class="disable_mens" id="trisque" value="toutrisque" name="formule">
                                                                <label for="trisque" id="lb_trisque"><i title="L’assurance « tous risques » est la formule d’assurance voiture la plus complète, mais aussi la plus chère. Elle s’adresse aux automobilistes qui souhaitent circuler l’esprit tranquille, en étant certains de bénéficier de la meilleure couverture possible contre les risques." class="tooltips"> Tout risque </i></label>
                                                              </div>
                                                            </div>
                                                          </div>
                                                        </div>
                                                        

                                                        
                                                      </div>   
                                                      <div class="col-md-6">
                                                      <br/>
                                                          <div class="alert alert-info alert-dismissable" id="info">
                                                          
                                                             
                                                               <img src="{{asset('images/help.png')}}" width="24x24"> <div id="info1">
                                         L'assurance au tiers simple est la formule Auto la plus basique et obligatoire.<br/>
                                         <p>Elle renferme les garanties suivantes : </p>
                                         <p><strong>-La responsabilité civile : </strong>Elle ne couvre que les dommages matériels et corporels causés aux tiers, en cas d’accident dont vous êtes responsable. Elle ne couvre pas ceux que vous-même et votre véhicule subissez.</p>
                                          <p><strong>-Défense et recours : </strong>Cette garantie impose à votre assureur au titre de la défense, à pourvoir, à ses frais, à votre défense devant les juridictions compétentes si vous êtes poursuivi à la suite d’un sinistre couvert.<br/> Le recours oblige votre assureur à réclamer à la partie adverse la réparation des préjudices subis à l’occasion d’un accident dont vous êtes victime. 
                                          </p>
                                          <p><strong>-La sécurité routière ou personne transportée : </strong> L’assureur accorde sa garantie pour uniquement à ceux que vous transportez dans votre véhicule à titre gratuit. 
                                          </p>
                                        </div>
                                         <strong id="info2">Les garanties peuvent varier d'une compagnie à une autre!</strong>
                                                              
                                                                
                                                          </div>
                                                      </div>                
                                                  </div>
                                                </div>

                                                
                                              </div>
                                            
                                          </div>
                                      </div>
                                      <div class="tab-pane" id="tab3">
                                          <div name="step3">
                                                  <div class="row">                                         
                                                      <div class="form-group col-md-11 {{ $errors->has('immat') ? ' has-error' : '' }}">
                                                          <label for="energie">Immatriculation*</label>
                                                            <input type="text" name="immat" id="immat" class="form-control" onkeyup ="this.value = this.value.toUpperCase();" required value="{{old('immat')}}" data-parsley-group="block3">
                                                            @if ($errors->has('immat'))
                                                                <span class="help-block ">
                                                                    <strong>{{ $errors->first('immat') }}</strong>
                                                                </span>
                                                            @endif
                                                            <span id="immat-result" style="position:relative;top:-30px;float:right;width:2%"></span>
                                                            <span class="help-block" style="color:green"><strong id="mat_help-block"></strong></span>
                                                      </div>
                                                      <div class="col-md-1">
                                                        <button type="button" id="searchmat" style="background-color:#5bc0de;margin-top:25px" class="btn btn-info"><i class="fa fa-search"></i></button>
                                                      </div>
                                                  </div>
                                                  <div class="row">
                                                      <div class="form-group col-md-6 {{ $errors->has('name_cg') ? ' has-error' : '' }}">
                                                          <label for="name_cg">Nom sur carte grise* </label>
                                                          <input type="text" value="{{ old('name_cg')}}" name="name_cg" id="name_cg" required data-parsley-group="block3" class="form-control">
                                                          @if ($errors->has('name_cg'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('name_cg') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                       <div class="form-group col-md-6 {{ $errors->has('marque') ? ' has-error' : '' }}">
                                                       <label for="marque">Marque du véhicule* </label>
                                                      <select id="marque" name="marque" data-parsley-group="block3" class="form-control" required>
                                                           <option></option>
                                                          @foreach($makes as $make)
                                                             <option value="{{$make->id}}" {{ (old("marque") == $make->id) ? "selected":""}}>{{$make->title}} </option>           
                                                             @endforeach 
                                                       </select>
                                                       @if ($errors->has('marque'))
                                                           <span class="help-block ">
                                                               <strong>{{ $errors->first('marque') }}</strong>
                                                           </span>
                                                       @endif
                                                       </div>
                                                  </div>
                                                  <div class="row">
                                                       <div class="form-group col-md-6 {{ $errors->has('genre') ? ' has-error' : '' }}">
                                                           <label for="genre">Genre du vehicule* </label>
                                                      <select id="genre" name="genre" class="form-control" data-parsley-group="block3" required>
                                                           <option></option>
                                                            @foreach($car_types as $type)
                                                             <option value="{{ $type->id_type }}">{{ $type->car_type_desc }}</option>
                                                             @endforeach 
                                                       </select>
                                                       @if ($errors->has('genre'))
                                                           <span class="help-block ">
                                                               <strong>{{ $errors->first('genre') }}</strong>
                                                           </span>
                                                       @endif
                                                       </div>
                                                        <div class="form-group col-md-6 {{ $errors->has('category') ? ' has-error' : '' }}">
                                                            <label for="category">Categorie / Usage du véhicule* </label>
                                                            <select id="category" disabled name="category" class="form-control" required data-parsley-group="block3">
                                                                  <option></option>
                                                                  @foreach($categories as $cat)
                                                                  <option value="{{$cat->id}}" {{ (old("category") == $cat->id) ? "selected":""}}>({{$cat->id}}) {{$cat->shortdesc}}</option>
                                                                  @endforeach 
                                                            </select>
                                                        </div>
                                                      
                                                  </div>
                                                  
                                                  <div class="row">
                                                      
                                                      <div class="form-group col-md-3 {{ $errors->has('puissance') ? ' has-error' : '' }}">
                                                          <label for="pf">Puissance Fiscale*: </label>
                                                          <select class="form-control form-step1" name="puissance" id="puissance" required data-parsley-group="block3">

                                                         <option></option>
                                                                                                                  <option value="1" {{ (old("puissance") == $i) ? "selected":""}}>1 CV</option>  
                                                                                                                  <option value="2" {{ (old("puissance") == $i) ? "selected":""}}>2 CV</option>  
                                                                                                                  <option value="3" {{ (old("puissance") == $i) ? "selected":""}}>3 CV</option>  
                                                                                                                  <option value="4" {{ (old("puissance") == $i) ? "selected":""}}>4 CV</option>  
                                                                                                                  <option value="5" {{ (old("puissance") == $i) ? "selected":""}}>5 CV</option>  
                                                                                                                  <option value="6" {{ (old("puissance") == $i) ? "selected":""}}>6 CV</option>  
                                                                                                                  <option value="7" {{ (old("puissance") == $i) ? "selected":""}}>7 CV</option>  
                                                                                                                  <option value="8" {{ (old("puissance") == $i) ? "selected":""}}>8 CV</option>  
                                                                                                                  <option value="9" {{ (old("puissance") == $i) ? "selected":""}}>9 CV</option>  
                                                                                                                  <option value="10" {{ (old("puissance") == $i) ? "selected":""}}>10 CV</option>  
                                                                                                                  <option value="11" {{ (old("puissance") == $i) ? "selected":""}}>11 CV</option>  
                                                                                                                  <option value="12" {{ (old("puissance") == $i) ? "selected":""}}>12 CV</option>  
                                                                                                                  <option value="13">Plus de 12</option>

                                                       </select>
                                                       @if ($errors->has('puissance'))
                                                           <span class="help-block ">
                                                               <strong>{{ $errors->first('puissance') }}</strong>
                                                           </span>
                                                       @endif
                                                      </div>
                                                      <div class="form-group col-md-3 {{ $errors->has('cu') ? ' has-error' : '' }}" id="div_cu" style="display:none">
                                                          <label for="cu">Charge utilse*: </label>
                                                          <select class="form-control form-step1" name="cu" id="cu">

                                                         <option></option>
                                                                                                                  <option value="1" {{ (old("cu") == $i) ? "selected":""}}>1 T</option>  
                                                                                                                  <option value="2" {{ (old("cu") == $i) ? "selected":""}}>2 T</option>  
                                                                                                                  <option value="3" {{ (old("cu") == $i) ? "selected":""}}>3 T</option>  
                                                                                                                  <option value="4" {{ (old("cu") == $i) ? "selected":""}}>4 T</option>  
                                                                                                                  <option value="5" {{ (old("cu") == $i) ? "selected":""}}>5 T</option>  
                                                                                                                  <option value="6" {{ (old("cu") == $i) ? "selected":""}}>6 T</option>  
                                                                                                                  <option value="7" {{ (old("cu") == $i) ? "selected":""}}>7 T</option>  
                                                                                                                  <option value="8" {{ (old("cu") == $i) ? "selected":""}}>8 T</option>  
                                                                                                                  <option value="9" {{ (old("cu") == $i) ? "selected":""}}>9 T</option>  
                                                                                                                  <option value="10" {{ (old("cu") == $i) ? "selected":""}}>10 T</option>  
                                                                                                                  <option value="11" {{ (old("cu") == $i) ? "selected":""}}>11 T</option>  
                                                                                                                  <option value="12" {{ (old("cu") == $i) ? "selected":""}}>12 T</option>  
                                                                                                                  <option value="13" {{ (old("cu") == $i) ? "selected":""}}>13 T</option>  
                                                                                                                  <option value="14" {{ (old("cu") == $i) ? "selected":""}}>14 T</option>  
                                                                                                                  <option value="15" {{ (old("cu") == $i) ? "selected":""}}>15 T</option>  
                                                                                                                  <option value="13">Plus de 15</option>

                                                       </select>
                                                       @if ($errors->has('cu'))
                                                           <span class="help-block ">
                                                               <strong>{{ $errors->first('cu') }}</strong>
                                                           </span>
                                                       @endif
                                                      </div>
                                                      <div class="form-group col-md-3 {{ $errors->has('ennergie') ? ' has-error' : '' }}">
                                                          <label for="ennergie">Energie* </label>
                                                          <select id="ennergie" class="form-control" name="ennergie" required data-parsley-group="block3">
                                                              <option value="E" {{ (old("ennergie") == 'E') ? "selected":""}}>ESSENCE</option>
                                                              <option value="D" {{ (old("ennergie") == 'D') ? "selected":""}}>DIESEL</option>
                                                             
                                                          </select>
                                                          @if ($errors->has('ennergie'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('ennergie') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                  </div>
                                              
                                                  

                                                  <div class="row if_not_tiers_simple" style="display:none">
                                                      <div class="form-group col-md-6 {{ $errors->has('vneuve') ? ' has-error' : '' }}">
                                                          <label for="vneuve">Valeur Neuve* </label>
                                                          <input type="number" value="{{ old('vneuve')}}" name="vneuve" id="vneuve" class="form-control">
                                                          @if ($errors->has('vneuve'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('vneuve') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                      <div class="form-group col-md-6 {{ $errors->has('vvenale') ? ' has-error' : '' }}">
                                                          <label for="vvenale">Valeur Venale* : </label>
                                                          <input type="number" value="{{ old('vvenale')}}" name="vvenale" id="vvenale" class="form-control">
                                                                @if ($errors->has('vvenale'))
                                                                    <span class="help-block ">
                                                                        <strong>{{ $errors->first('vvenale') }}</strong>
                                                                    </span>
                                                                @endif
                                                      </div>
                                                  </div>
                                                  <div class="row">
                                                      <div class="form-group col-md-3 {{ $errors->has('dateMiseCirc') ? ' has-error' : '' }}">
                                                        <label for="city">Date 1ère mise en circulation* </label>
                                                          <div class='input-group datetimepicker_dateMiseCirc'>
                                                            <input type='text' class="form-control dateMiseCirc" required data-parsley-group="block3" name="dateMiseCirc" id="dateMiseCirc" placeholder="JJ/MM/AAAA" />
                                                            <span class="input-group-addon">
                                                                <span class="glyphicon glyphicon-calendar"></span>
                                                            </span>
                                                      </div>
                                                      </div>

                                                      <div class="form-group col-md-3 {{ $errors->has('city') ? ' has-error' : '' }}">
                                                          <label for="city">Zone de stationnement* </label>
                                                           <select id="city" name="city" class="form-control" data-parsley-group="block3" required>
                                                              @foreach($zones as $zone)
                                                                  <option value="{{$zone->id}}" {{ (old("city") == $zone->id) ? "selected":""}}>{{$zone->city}}</option>
                                                              @endforeach  
                                                          </select>
                                                          @if ($errors->has('city'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('city') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                      <div class="form-group col-md-3 {{ $errors->has('nbplace') ? ' has-error' : '' }}">
                                                          <label for="nbplace">Nombre de place* : </label>
                                                          <input type="number" min="1" value="{{ old('nbplace')}}" name="nbplace" id="nbplace" class="form-control" data-parsley-group="block3" required>
                                                          @if ($errors->has('nbplace'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('nbplace') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                      
                                                      <div class="form-group col-md-3 {{ $errors->has('nbplace') ? ' has-error' : '' }}">
                                                          <label for="nbplace">Couleur*: </label>
                                                          <select class="form-control" data-parsley-group="block3" required name="color" id="color" data-placeholder="Couleur du véhicule">
                                                            <option value="1">Blanc</option>
                                                            <option value="2">Bleu</option>
                                                            <option value="3">Gris</option>
                                                            <option value="4">Jaune</option>
                                                            <option value="5">Maron</option>
                                                            <option value="6">Noir</option>
                                                            <option value="7">Orange</option>
                                                            <option value="8">Rouge</option>
                                                            <option value="9">Vert</option>
                                                            <option value="10">Violet</option>
                                                            <option value="11">Autres</option>
                                                          </select> 
                                                          @if ($errors->has('color'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('color') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                  </div>
                                          </div>
                                      </div>
                                      <div class="tab-pane" id="tab4">
                                          <div name="step4">

                                                  <div class="row particulier_field">
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('lastname') ? ' has-error' : '' }}">
                                                          <label for="lastname">Nom*: </label>
                                                          <input type="text" value="{{ old('lastname') }}" name="lastname" id="lastname" class="form-control" data-parsley-group="block4" required>
                                                          @if ($errors->has('lastname'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('lastname') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('firstname') ? ' has-error' : '' }}">
                                                          <label for="firstname">Prénoms*: </label>
                                                          <input type="text" data-parsley-group="block4" value="{{ old('firstname') }}" name="firstname" id="firstname" class="form-control" required>
                                                          @if ($errors->has('firstname'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('firstname') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                  </div>
                                                  <div class="form-group entreprise_field" style="display:none">
                                                    <div class="col-md-6">
                                                      <label class="control-label input-label" for="company_name">Nom de l'entreprise*</label>
                                                      <input type="text" data-parsley-group="block4" class="form-control repeat" required data-parsley-group="block4"  name="company_name" id="company_name">
                                                    </div>
                                                    <div class="col-md-6">
                                                      <label class="control-label input-label" for="name_manager">Nom du gérant</label>
                                                      <input type="text" class="form-control" name="manager_name" id="manager_name">
                                                    </div>
                                                  </div>
                                                  <br/>
                                                  
                                                  
                                                    <div class="row">
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('email') ? ' has-error' : '' }}">
                                                          <label for="email">E-mail: </label>
                                                          <input type="email" value="{{ old('email') }}" name="email" id="email" class="form-control" >
                                                          @if ($errors->has('email'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('email') }}</strong>
                                                              </span>
                                                          @endif

                                                      </div>
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('phone') ? ' has-error' : '' }}">
                                                          <label for="phone">Contact*: </label>
                                                          <input type="text" name="phone" id="phone" class="form-control" value="{{old('phone')}}" required data-parsley-group="block4">
                                                          @if ($errors->has('phone'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('phone') }}</strong>
                                                              </span>
                                                          @endif
                                                      </div>
                                                  </div>
                                                  
                                                  <div class="row particulier_field">
                                                    <div class="col-md-6 {{ $errors->has('gender') ? ' has-error' : '' }} " >
                                                      <label class="control-label input-label" for="gender">Sexe*</label>
                                                     
                                                      <select data-parsley-group="block4" class="form-control"required  name="gender" id="gender">
                                                        <option value="H">Homme</option>
                                                        <option value="F">Femme</option>
                                                      </select>
                                                      @if ($errors->has('gender'))
                                                              <span class="help-block ">
                                                                  <strong>{{ $errors->first('gender') }}</strong>
                                                              </span>
                                                          @endif
                                                    </div>
                                                    <div class="col-md-6">
                                                      <label class="control-label input-label" for="dob">Date de naissance</label>
                                                        <div class="input-group datepicker w-330 mt-8" >
                                                          <input type="text"  name="dob" id="dob" class="form-control">
                                                          <span class="input-group-addon">
                                                              <span class="fa fa-calendar"></span>
                                                          </span>
                                                      </div>
                                                    </div>
                                                  </div>
                                                  
                                                  
                                                    <div class="row particulier_field">
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('job') ? ' has-error' : '' }} ">
                                                          <label for="job">Profession*: </label>
                                                         <select id="job" name="job" data-parsley-group="block4" class="form-control" required>
                                                         @foreach($jobs as $job)
                                                                  <option value="{{$job->id}}" {{ (old("job") == $job->id) ? "selected":""}}>{{$job->jobtitle}}</option>
                                                         @endforeach  
                                                      </select>
                                                      @if ($errors->has('job'))
                                                          <span class="help-block ">
                                                              <strong>{{ $errors->first('job') }}</strong>
                                                          </span>
                                                      @endif
                                                      </div>
                                                      <div class="form-group col-md-6 mb-0 {{ $errors->has('datePC') ? ' has-error' : '' }}">
                                                          <label class="control-label input-label" for="datePC">Date de delivrance permis de conduire*</label>
                                                              <div class='input-group datetimepicker_datePC'>
                                                                  <input data-parsley-group="block4" type='text' class="form-control datePC" data-parsley-group="block4" required name="datePC" id="datePC" placeholder="JJ/MM/AAAA" />
                                                                  <span class="input-group-addon">
                                                                      <span class="glyphicon glyphicon-calendar"></span>
                                                                  </span>
                                                                @if ($errors->has('datePC'))
                                                                    <span class="help-block">
                                                                        <strong>{{ $errors->first('datePC') }}</strong>
                                                                    </span>
                                                                @endif
                                                              </div>
                                                        </div>
                                          
                                                    </div>
                                                </div>
                                              </div>
                                      <div class="tab-pane" id="tab5">
                                        <div name="step5">
                                          <div class="row text-center">
                                              <div class="col-md-12">
                                                <div class="form-group">
                                              <p class="text-center" style="font-size:16px;color:red">Je souhaites souscrire à ces services supplémentaires </p>
                                              @foreach($optional_services as $serv)
                                                <div class="col-md-6">
                                                <div class="checkbox checkbox-primary">
                                                  <input type="checkbox" id="{{$serv->service}}" checked value="{{$serv->id}}" name="opt_serv[]">
                                                  <label class="checkpopover" for="{{$serv->service}}"> {{$serv->service}} ( {{$serv->amount}} FCFA/an ) </label>
                                                </div>
                                                </div>
                                              @endforeach
                                            </div>
                                            </div>
                                          </div>
                                        </div>
                                        
                                      </div>
                                      
                                      
                                      <ul class="pager wizard">

                                          <li class="previous"><a class="btn btn-default">Précédent</a></li>
                                          <li class="next"><a class="btn btn-default">Suivant</a></li>
                                          <li class="next finish" style="display:none;"><button type="submit" class="btn btn-success">Générer dévis</button></li>
                                      </ul>

                                  </div>
                              </div>
                            </form>
                          </div>

                      </div>
                  </div>

              </div>

          </div>
          <!-- /tile body -->

      </section>
      <!-- /tile --> 
        
    </div>
    <!-- /page content -->
</div>
@endsection



@section('header-script')
<link rel="stylesheet" href="{{asset('back/assets/js/vendor/datetimepicker/css/bootstrap-datetimepicker.min.css')}}">
@stop
      

@section('footer-script')
<script src="