@extends('layouts.frontend')
@section('title', 'Bank Details')
@section('content')
<div class="clearfix"></div>
<section class="inner-content">
  <div class="clearfix"></div>
  <div class="container">
    <div class="form-block col-md-9 padding-left-none">
      <h2 class="product-title">{{ $product_details->ProductName}}</h2>
      @if(Session::get('success'))
        <div class="alert alert-success">
          {{Session::get('success')}}
        </div>
      @endif
        @if(Session::get('failure'))
          <div class="alert alert-danger">
            {{Session::get('failure')}}
          </div>
      @endif
      @if (count($errors) > 0)
        <div class="alert alert-danger">
          <strong>Whoops!</strong> All field are required..<br><br>
            <ul>
              @foreach ($errors->all() as $error)
                <li>{{ $error }}</li>
              @endforeach
            </ul>
        </div>
      @endif
      <form name="frmbankdetails" id="frmbankdetails" method="post" class="form-horizontal" action="{{url('webline-products/bank-details/1/'.$status)}}">
        <input type="hidden" name="_token" value="{{ csrf_token() }}">
        <div class="bg">
          <div class="steps-tabs">
            <ul >
              <li >Personal Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li>Cover <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li class="active">Bank Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li >Confirmation <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
            </ul>
          </div>
          <div class="text">
            <p class="blue">You have opted to pay your insurance premium/s by monthly Direct Debit.<br /><br />Please read the following notes before completing the Direct Debit Instruction form.

              <br><br>I confirm that: <br><br>
              <ul >
                <li>I am the account holder</li>
                <li>This account does not need more than one signature to authorise this direct debit</li>
                <li>This is not a business account</li>
                <li>I confirm that my average monthly income less average monthly expenditure exceeds the monthly instalment amount</li>
              </ul>
              If you cannot confirm the above, please choose one of the options from Need Help?<br><br>

                            The details of your Direct Debit Instruction will be sent to you within 3 working days or no later than 7 working days before the first collection.<br><br>
                            The company name which will appear on your bank statement against the Direct Debit will be Best Insurance.
            </p>
            <br><br>

              <div class="clearfix"></div>
          </div> <!-- end text -->

          <div class="form-group">
            <label class="control-label col-sm-4"><span class="asterisk">* </span>1. Name(s) of account holder(s) </label>
            <div class="col-sm-4 padding-right-none">
              <input name="accountname1"  id="accountname1"  class="form-control required" title="Please Enter Name of Account Holder" value="{{ (isset($personal_data->accountname) ? $personal_data->accountname:"") }}" maxLength=300 style="width:280px;" />
            </div>
          </div>
          <div class="form-group">
            <label class="control-label col-sm-4 col-xs-12"><span class="asterisk">* </span>2. Bank or Building Society account Number</label>
            <div class="col-sm-8 padding-right-none ac-number col-xs-12">
              <input  name="accountnumber1" id="accountnumber1" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -8, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber2)" >
              <input  name="accountnumber2" id="accountnumber2" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -7, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber3)">
              <input  name="accountnumber3" id="accountnumber3" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -6, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber4)">
              <input  name="accountnumber4" id="accountnumber4" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -5, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber5)">
              <input  name="accountnumber5" id="accountnumber5" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -4, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber6)">
              <input  name="accountnumber6" id="accountnumber6" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -3, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber7)">
              <input  name="accountnumber7" id="accountnumber7" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -2, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" onKeyup="autotab(this,document.frmbankdetails.accountnumber8)">
              <input  name="accountnumber8" id="accountnumber8" class="form-control required" value="{{ (isset($personal_data->accountnumber) ? substr($personal_data->accountnumber, -1, 1):"") }}" maxLength=1 size="1" title="Please Enter Your Account Number" >
            </div>
            <label for="accountnumber" class="error"></label>
          </div>
          <div class="form-group">
            <label class="control-label col-sm-4"><span class="asterisk">* </span>3. Branch sort Code</label>
            <div class="col-sm-8 padding-right-none ac-number col-xs-12">
              <input name="sortcode1" class="form-control required" id="sortcode1" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -6, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode2)">
              <input name="sortcode2" class="form-control required" id="sortcode2" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -5, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode3)">
              <input name="sortcode3" class="form-control required" id="sortcode3" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -4, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode4)">
              <input name="sortcode4" class="form-control required" id="sortcode4" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -3, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode5)">
              <input name="sortcode5" class="form-control required" id="sortcode5" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -2, 1):"") }}" maxLength=1 size="1" onKeyup="autotab(this,document.frmbankdetails.sortcode6)">
              <input name="sortcode6" class="form-control required" id="sortcode6" title="Please Enter Sort Code" value="{{ (isset($personal_data->sortcode) ? substr($personal_data->sortcode, -1, 1):"") }}" maxLength=1 size="1">
              <br>
              <label for="sortcode" class="error"></label>
            </div>

          </div>

          <div class="clearfix"></div>
          <div class="small-btn2">
            <a id="sortValidate" title="Please click on validate" onclick="javascript:showbankdetails()" style="cursor:pointer;" >Validate</a>
          </div>

          <td class="fornRow"  id="bankdetails" style="padding-left:0px;">
            <table class="bank-validate-form" width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td width="10%" align="left" valign="middle"><strong>IBAN:<br /></strong>
                  <INPUT  name=iban class="form-control" id="iban" value="{{ (isset($personal_data->iban) ? $personal_data->iban:"") }}"  >
                </td>
                <td width="10%" align="left" valign="middle"><strong>Bank:<br /></strong>
                  <INPUT  name=bank class="form-control" id="bank" value="{{ (isset($personal_data->bank) ? $personal_data->bank:"") }}"  >
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Bank BIC:<br /></strong>
                  <input  name="bankbic" class="form-control" id="bankbic" value="{{ (isset($personal_data->bankbic) ? $personal_data->bankbic:"") }}" />
                </td>
                <td align="left" valign="middle"><strong>Branch:<br /></strong>
                  <input  name="branch" class="form-control" id="branch" value="{{ (isset($personal_data->branch) ? $personal_data->branch:"") }}"  />
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Branch BIC:<br /></strong>
                  <input  name="branchbic" class="form-control" id="branchbic" value="{{ (isset($personal_data->branchbic) ? $personal_data->branchbic:"") }}" />
                </td>
                <td align="left" valign="middle"><strong>Town:<br /></strong>
                  <input  name="town" class="form-control" id="town" value="{{ (isset($personal_data->town) ? $personal_data->town:"") }}"/>
                </td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Post Code<br /></strong>
                  <input  name="postcode" class="form-control" id="postcode" value="{{ (isset($personal_data->bank_postcode) ? $personal_data->bank_postcode:"") }}"  /></td>
                <td align="left" valign="middle"><strong>Phone:<br /></strong>
                  <input  name="phone" class="form-control" id="phone" value="{{ (isset($personal_data->bank_phone) ? $personal_data->bank_phone:"") }}"  /></td>
              </tr>

              <tr>
                <td align="left" valign="middle"><strong>Address:<br /></strong>
                  <textarea  name="address" class="form-control input input-middle" id="address" >{{ (isset($personal_data->branch_address) ? $personal_data->branch_address:"") }}</textarea></td>
                <td align="left" valign="middle">&nbsp;</td>
              </tr>
            </table>
          </td>
          <input type="hidden" name="directdebits" id="directdebits" value="{{ (isset($personal_data->directdebits) ? $personal_data->directdebits:"") }}" />
          <!--end account details section -->
          <!--direct debit date section -->


          <!--end originator section -->
          <!--instructions to bank section -->
          


        </div> <!-- bg cover-questions end -->
        <!-- redirection section -->
        <div class="form-btns">
            <div class="medium-btn2 pull-left"><a href="{{ url('/webline-products/cover') }}/{{ encryptUrl($personal_data->quote_id) }}/{{ $personal_data->product_id }}/{{$status}}">Back</a></div>
            <button type="submit" class="medium-btn btn-default pull-right" >Continue</button>
        </div>
        <!--end redirection section -->

        <input type="hidden" id="hidden_product_id" name="hidden_product_id" value="{{ $personal_data->product_id }}">
        <input type="hidden" id="hidden_quote_id" name="hidden_quote_id" value="{{ $personal_data->quote_id }}">


      </form>
      <br clear="all" />
    </div> <!-- Left side content -->

    <div class="col-md-3 padding-none right-col border-left-none">
      @include('slices.frontend.get-a-quot.web-api-pages.right_bottom')

    </div>

  </div>
</section>

<div class="clearfix"></div>
@endsection
@section('page-script')
<script type="text/javascript" src="https://code.jquery.com/jquery-2.0.0.js"></script>
<script src="https://ajax.aspnetcdn.com/ajax/jquery.validate/1.11.1/jquery.validate.js"></script>
<script src="{{ URL::asset('assets/js/get-a-quote/bank_details.js') }}"></script>
<script src="{{ URL::asset('assets/js/get-a-quote/bank_details_validation.js') }}"></script>
<style type="text/css">
  .blue_form{
    color: #2ea4c5;
  }
  .asterisk{
    color: red;
  }
</style>
@stop