308 lines
16 KiB
PHP
308 lines
16 KiB
PHP
@extends('layouts.admin')
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@section('content')
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<div class="row">
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<div class="col-xs-12 col-sm-12 column col-sm-offset-0 ">
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<div class="panel panel-default panel-frm">
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<div class="panel-heading">
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<div class="row" style="padding-left: 20px;padding-right: 15px">
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<h3 class="pull-left"> Client Registration</h3>
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@if(isShowContent('get.clients'))
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<a href="{{route('get.clients')}}" class="btn btn2 btn-success btn-flat pull-right">
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<i class="fa fa-list" aria-hidden="true"></i>
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Client List
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</a>
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@endif
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</div>
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</div>
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<div class="panel-body">
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<div class="clearfix"></div>
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<div class="row">
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<div class="col-md-12 col-sm-12 col-xs-12">
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<div class="x_panel">
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<form method="post" action="{{route('client.insert')}}" id="client_form" autocomplete="off"
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class="input-form-section">
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@csrf
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<div class="x_content">
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<div class="col-md-12">
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="firstname">First Name</label>
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<input class="form-control" name="first_name" type="text" placeholder=" First Name" >
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="Last Name">Last Name</label>
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<input class="form-control" name="last_name" type="text" placeholder=" Last Name">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="dob">Email</label>
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<input class="form-control" name="email"
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type="text" placeholder=" Email" >
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="dob">Password</label>
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<div class="input-group" id="manage_client_show_hide_password">
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<input class="form-control" name="password"
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type="password" placeholder=" Password">
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<div class="input-group-addon">
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<a href=""><i class="fa fa-eye-slash" aria-hidden="true"></i></a>
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</div>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="Phone">Phone</label>
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<input class="form-control" name="phone" type="text" placeholder=" Phone Number">
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="Street Number">Street Number</label>
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<input class="form-control" name="street_no" type="text" placeholder="Street No">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="Street Name">Street Name</label>
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<input class="form-control" name="street_name" type="text" placeholder="Street Name">
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="City">City</label>
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<input class="form-control" name="city" type="text" placeholder="City" >
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="State">State</label>
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<input class="form-control" name="state" type="text" placeholder="State" >
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="zip_code">Zip</label>
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<input class="form-control" name="zip_code" type="text" placeholder="Zip Code">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="dob">Date of Birth</label>
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<input class="form-control" name="birth_date" id="birth_date" type="text" maxlength="10" onkeyup="birthDateCompleted()" placeholder="mm/dd/yyyy" >
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</div>
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</div>
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="ssn">Social Security Number</label>
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<input class="form-control" name="ssn" maxlength="4"
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type="text" placeholder="Last 4 digit of ssn">
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</div>
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</div>
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</div>
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<div class="row">
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{{-- <div class="form-group col-md-6 col-xs-12 text-left" >--}}
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{{-- <input class="form-check-input" type="checkbox" name="report_provider_info"--}}
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{{-- value="1" id="report_provider_info">--}}
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{{-- <label class="form-check-label" data-toggle="tooltip" data-placement="right" title="">--}}
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{{-- Credit Report Provider Information--}}
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{{-- </label>--}}
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{{-- </div>--}}
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<div class="col-md-6 col-xs-12">
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<div class="form-group">
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<label for="">Source Type</label>
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@php
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$source_types = config('constant.sourceType');
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@endphp
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<select name="source_type" class="form-control">
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@foreach($source_types as $key=>$value)
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<option value="{{$value}}"> {{$key}}</option>
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@endforeach
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</select>
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</div>
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</div>
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</div>
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</div>
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<div class="col-sm-12 c" style="margin-top: 10px; text-align: center; ">
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<input class="btn btn-success btn2" type="submit" onclick="return client_form_submit(this)" value="Save Changes">
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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<div class="modal fade" id="common_confirmation_modal" style="margin-top: 50px" tabindex="-1" aria-hidden="true">
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<div class="modal-dialog modal-md" id="modal-dialog-panel">
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<div class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" data-dismiss="modal">×</button>
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</div>
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<div class="modal-body">
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<h4 class="mb-2 text-center" style="color: red" id="common_message_text">
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</h4>
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</div>
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<div class="modal-footer" style="text-align: center">
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<button type="button" class="btn btn-secondary btn-lg" data-dismiss="modal">Close</button>
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</div>
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</div>
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</div>
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</div>
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@endsection
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@push('script')
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<script>
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$(function(){
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common_helper.datePicker('#birth_date','mm/dd/yyyy',true,null);
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});
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$("#manage_client_show_hide_password a").on('click', function(event) {
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common_helper.globalPasswordView('#manage_client_show_hide_password',event);
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});
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const birthDateCompleted=()=>{
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let birth_date=$("[name='birth_date']").val();
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if(birth_date.length===2){
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birth_date+='/';
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}
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else if(birth_date.length===5){
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birth_date+='/';
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}
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$("[name='birth_date']").val(birth_date);
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}
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const client_form_submit =(e)=>{
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$search_provider_info = $('#report_provider_info').prop("checked");
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$('#client_form').validate({
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rules: {
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'first_name': 'required',
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'last_name': 'required',
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'email' : 'required',
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'password' : 'required',
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'street_no' : 'required',
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'street_name' : 'required',
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'city' : 'required',
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'state' : 'required',
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'zip_code' : 'required',
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'phone' : 'required',
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'birth_date': 'required',
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'ssn' : 'required',
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'source_type' : 'required',
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},
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messages: {
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'first_name': {
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required: "Please enter first name"
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},
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'last_name': {
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required: "Please enter last name"
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}, 'email': {
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required: "Please enter email"
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}, 'password': {
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required: "Please enter password"
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},
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'street_no': {
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required: "Please enter street number"
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},
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'street_name': {
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required: "Please enter street name"
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},
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'state': {
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required: "Please enter state"
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},
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'city': {
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required: "Please enter city"
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},
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'zip_code': {
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required: "Please enter zip code"
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},
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'phone': {
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required: "Please enter phone number"
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},
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'birth_date': {
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required: "Please enter birth date",
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},
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'ssn': {
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required: "Please enter last 4 digit of your ssn"
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},
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'source_type': {
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required: "Please enter source type"
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},
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},
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highlight: function (element) {
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$(element).parent().addClass("has-error");
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},
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// submitHandler: function (form) {
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// form.submit();
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// }
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});
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if($('#client_form').valid()) {
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let url = '{{ route('admin.ajax.get.process') }}';
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let email = $('#client_form').find('input[name=email]').val();
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let password = $('[name="password"]').val();
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let source_type = $('[name="source_type"]').val();
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let ssn = $('[name="ssn"]').val();
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let data = {
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action: 'GET_SUBSCRIPTION_STATUS_CREDIT_REPORT_PROVIDER',
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email: email,
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password: password,
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source_type: source_type,
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ssn: ssn
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};
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common_helper.globalAjaxRequestAsync(url, 'get', data, callbackfromreportprovider);
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}
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return false;
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};
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const callbackfromreportprovider =(response)=>{
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if(response.status) {
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$('#client_form').submit();
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}else {
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let html = response.message;
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$('#common_message_text').text(html);
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$('#common_confirmation_modal').modal('show');
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}
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}
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</script>
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@endpush
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