@extends('layouts.app')

@section('content')
<div class="page-title">
    <h3>Fill Payout form</h3>
    @include('partials._breadcrumbs')
</div>
<div id="main-wrapper">

    <div class="row">
        <form method="POST" id="form" class="" action="/payout?otp_page=true">
            @csrf

            <div class="col-md-12">
                <div class="panel panel-white">

                    <div class="panel-heading clearfix">
                        <h4 class="panel-title">Payout Form </h4>

                    </div>
                    <div class="panel-body">

                        <div class="row">
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">First Name </label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" readonly value="{{$user->name}}"
                                        id='first_name' name="first_name">

                                </div>
                            </div>
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Last name</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" readonly value="{{$user->last_name}}"
                                        id='last_name' name="last_name">
                                </div>
                            </div>

                        </div>
                        <div class="row">
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Email</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="email" readonly class="form-control" value="{{$user->email}}"
                                        id='aadhar' name="email">

                                </div>
                            </div>
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Mobile No.</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" readonly class="form-control" value="{{$user->contact}}"
                                        id='contact' name="contact">

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

                        <div class="row">
                            <div class="col-md-2">
                                <div class="form-group ">
                                    <label for="" class="control-label">GST Number</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group ">
                                    <input type="text" class="form-control" value="{{$user->gst_number}}"
                                        id='gst_number' name="gst_number">

                                </div>
                            </div>
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Account No.</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" value="{{$user->account_no}}" id='account'
                                        name="account">
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">IFSC Code </label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" value="{{$user->ifsc_code}}" id='ifsc'
                                        name="ifsc">
                                </div>
                            </div>


                        </div>
                        <div class="row">
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Shop Name</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <input type="text" class="form-control" value="{{$user->shop_name}}" id='shop_name'
                                        name="shop_name">

                                </div>
                            </div>
                            <div class="col-md-2">
                                <div class="form-group required">
                                    <label for="" class="control-label">Shop address</label>

                                </div>
                            </div>
                            <div class="col-md-3">
                                <div class="form-group">
                                    <textarea class="form-control" required style="resize:none" id='shop_address'
                                        name="shop_address">{{$user->shop_address}}</textarea>

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


                    </div>


                    <div class="panel-body">

                        <div class="row">
                            <div class="col-md-2">
                                <button class="btn btn-xs btn-success" type="submit">Submit</button>
                            </div>
                        </div>

                    </div>


                </div>

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

</div>



@endsection