90 lines
4.8 KiB
PHP
90 lines
4.8 KiB
PHP
<div class="modal fade" id="financePaymentsForm" tabindex="-1" role="dialog" aria-labelledby="paymentModalLabel" aria-hidden="true">
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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">Payment Details</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 class="hidden" id="financeNotifyArea"></div>
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<form class="form-vertical" method="POST" id="financeForm" action="{{ url('clients/finance_store') }}">
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{{ csrf_field() }}
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<input type="hidden" name="client_id" id="clientID" value="{{ $showclient->id }}">
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<div class="row">
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<div class="form-group">
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<div class="col-md-12">
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<label for="financeServicesStore">Services *</label>
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{!! Form::select('services[]', $service_type_names , old('services'), ['class' => 'form-control' , 'id' => 'financeServicesStore', 'required' => 'required', 'multiple'=> 'true', 'style' => 'width: 100%']) !!}
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</div>
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</div>
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<div class="form-group hidden" id="ShortCodeFormGrp" >
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<div class="col-md-12" style="padding-bottom: 5px;">
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<label for="shortCode">Short Code</label>
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<input type="text" class="form-control" name="short_code" id="shortCode" required >
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<p class="text-warning">Enter Short related to the selected service</p>
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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="invoiceNumber">Invoice Number *</label>
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<input type="text" class="form-control" name="invoice_number" id="invoiceNumber" 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="invoiceAmount">Invoice Amount</label>
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<input type="text" class="form-control" name="invoice_amount" id="invoiceAmount" required >
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<div class="help-block text-warning">Enter Amount without commas</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">
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<div class='input-group date' id='myDatepicker2' style="padding-bottom: 5px;">
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<label for="invoiceDate">Invoice Date *</label>
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<!-- <input type='text' class="form-control" /> -->
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<input type="text" class="form-control" name="invoice_date" id="invoiceDate" 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="invoiceStatus">Status *</label>
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{!! Form::select('invoice_status', [ 'PAID' => 'PAID', 'UNPAID' => 'UNPAID'] , old('services'), ['class' => 'form-control' , 'id' => 'invoiceStatus', 'required' => 'required', 'placeholder' => '', '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="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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