118 lines
6.0 KiB
PHP
118 lines
6.0 KiB
PHP
<div class="modal fade" id="newShortCodeFormModal" tabindex="-1" role="dialog" aria-labelledby="createShortCodeModalLabel" aria-hidden="false">
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<div class="modal-dialog">
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<div class="modal-content">
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<div class="modal-header">
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<!-- <h4 class="modal-title">Default Modal</h4> -->
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<h5 class="modal-title text-center" id="paymentModalLabelHeading">New Short Code Form</h5>
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<button type="button" class="close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<div class="modal-body">
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<div id="notifyArea" class="alert alert-danger hidden"></div>
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<form class="form-vertical" method="POST" id="shortCodeForm" action="{{ url('ussdshortcodes/store') }}">
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{{ csrf_field() }}
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<input type="hidden" name="code_type" id="shortCodeType">
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<div class="row">
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<div class="form-group" >
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<div class="col-md-12" style="padding-bottom: 5px;">
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<label for="shortCode">Code *</label>
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<input type="number" class="form-control" name="shortcode" id="shortCode" required >
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</div>
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</div>
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<div class="form-group" >
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<div class="col-md-12" style="padding-bottom: 5px;">
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<label for="name">Friendly Name *</label>
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<input type="text" class="form-control" name="name" id="name" required >
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-12" style="padding-bottom: 5px">
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<label for="clientID">Client *</label>
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{!! Form::select('client_id', $client_arr, null, ['class' => 'form-control' , 'id' => 'clientID', 'placeholder'=>'Select Client ' , 'required' => 'required' , 'style' => 'width: 100%']) !!}
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-12" style="padding-bottom: 5px">
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<label for="networks">Network *</label>
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{!! Form::select('network', $country_network_arr, null, ['class' => 'form-control' , 'id' => 'networks', 'placeholder'=>'Select Network ' , 'required' => 'required' , 'style' => 'width: 100%']) !!}
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-12" style="padding-bottom: 5px">
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<label for="tollFree">Toll Free</label>
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<select name="toll_free" id="tollFree" class="form-control" required style="width: 100%;">
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<option value="YES">YES</option>
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<option value="NO">NO</option>
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</select>
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-12" style="padding-bottom: 5px">
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<label for="monthlyFee">Monthly Fee</label>
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<input type="number" class="form-control" name="monthly_fee" id="monthlyFee" >
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</div>
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</div>
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<div class="form-group">
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<div class="col-md-6">
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<div class='input-group date' id='myDatepicker22' style="padding-bottom: 5px;">
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<label for="launchDate">Launch Date</label>
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<input type="text" class="form-control scdates" name="launch_date" id="launchDate" required >
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<div class="input-group-addon">
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<span class="fa fa-calendar"></span>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<div class='input-group date' id='myDatepicker223' style="padding-bottom: 5px;">
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<label for="expiryDate">Expiry Date</label>
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<input type="text" class="form-control scdates" name="expiry_date" id="expiryDate" required >
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<div class="input-group-addon">
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<span class="fa fa-calendar"></span>
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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="form-group">
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<div class="col-md-12" style="padding-bottom: 5px">
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<label for="codeStatus">Status</label>
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<select id="codeStatus" name="status" class="form-control" required style="width: 100%;">
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<option value="LIVE">Live</option>
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<option value="PENDING">Pending</option>
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<option value="TESTING">Testing</option>
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<option value="INACTIVE">Inactive </option>
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</select>
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</div>
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</div>
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<div class="form-group" >
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<div class="col-md-12" style="padding-bottom: 5px;">
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<label for="remarks">Remarks</label>
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<input type="text" class="form-control" name="remarks" id="remarks"></textarea>
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</div>
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</div>
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<div class="form-group" style="margin-bottom: 0.2rem; padding-bottom: 5px; padding-top: 5px;">
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<div class="col-md-12" style="padding-bottom: 10px;">
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<button type="submit" class="btn btn-success btn-block updateBtn"> <i class="fa fa-send"></i> Submit</button>
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</div>
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</div>
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<div class="form-group" style="margin-bottom: 0.5rem; padding-bottom: 5px; padding-top: 5px;">
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<div class="col-md-12">
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<button type="button" class="btn btn-dark btn-block" data-dismiss="modal"><i class="fa fa-close"></i> Close</button>
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</div>
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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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<!-- /.modal-content -->
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</div>
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<!-- /.modal-dialog -->
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</div>
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<!-- /.modal -->
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