@extends('layouts.firstuse')
@section('content')
<div class="row">
  <div class="col-sm-offset-1 col-sm-10 firstContain">
    <div class="panel panel-alternative">
      <div class="panel-heading">
        <div class="row">
          <div class="col-sm-12 col-md-12 text-center">
            <h3>{{__('messages.steptwo')}}</h3>
          </div>
        </div>
      </div>
      <div class="panel-body">
        <div class="col-sm-12">
          <p>{{__('messages.steptwo_text_1')}}</p>
        </div>
        <div class="col-sm-12 col-md-12">
          <form id="adminForm">
            <div class="form-group">
              <div class="col-md-6{{ $errors->has('fname') ? ' has-error' : '' }}" >
                <label for="fname" class="col-md-4 control-label">{{__('messages.first')}} {{__('messages.name')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="fname" type="text" class="form-control" name="fname" value="{{ old('fname') }}" required autofocus>
                  @if ($errors->has('fname'))
                  <span class="help-block">
                    <strong>{{ $errors->first('fname') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('sname') ? ' has-error' : '' }}">
                <label for="sname" class="col-md-4 control-label">{{__('messages.second')}} {{__('messages.name')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="sname" type="text" class="form-control" name="sname" value="{{ old('sname') }}" >
                  @if ($errors->has('sname'))
                  <span class="help-block">
                    <strong>{{ $errors->first('sname') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
            </div>
            <div class="form-group">
              <div class="col-md-6{{ $errors->has('flastname') ? ' has-error' : '' }}" >
                <label for="flastname" class="col-md-4 control-label">{{__('messages.first')}} {{__('messages.lastname')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="flastname" type="text" class="form-control" name="flastname" value="{{ old('flastname') }}" required autofocus>
                  @if ($errors->has('flastname'))
                  <span class="help-block">
                    <strong>{{ $errors->first('flastname') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('slastname') ? ' has-error' : '' }}" >
                <label for="slastname" class="col-md-4 control-label">{{__('messages.second')}} {{__('messages.lastname')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="slastname" type="text" class="form-control" name="slastname" value="{{ old('slastname') }}" required autofocus>
                  @if ($errors->has('slastname'))
                  <span class="help-block">
                    <strong>{{ $errors->first('slastname') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
            </div>
            <div class="form-group">
              <div class="col-md-6{{ $errors->has('email') ? ' has-error' : '' }}" >
                <label for="email" class="col-md-4 control-label">{{__('messages.email')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="email" type="email" class="form-control" name="email" value="{{ old('email') }}" required>
                  @if ($errors->has('email'))
                  <span class="help-block">
                    <strong>{{ $errors->first('email') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <!-- <div class="col-md-6{{ $errors->has('country') ? ' has-error' : '' }}" >
                <label for="Country" class="col-md-4 control-label">{{__('messages.country')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <div class="countryinput">
                    <select class="form-control" name="country" id="country" >
                    </select>
                  </div>
                  @if ($errors->has('country'))
                  <span class="help-block">
                    <strong>{{ $errors->first('country') }}</strong>
                  </span>
                  @endif
                </div>
              </div> -->
            </div>
            <!-- <div class="form-group">
              <div class="col-md-6{{ $errors->has('state') ? ' has-error' : '' }}" >
                <label for="state" class="col-md-4 control-label">{{__('messages.state')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <div class="stateinput">
                    <select class="form-control" name="state" id="state" >
                    </select>
                  </div>
                  @if ($errors->has('state'))
                  <span class="help-block">
                    <strong>{{ $errors->first('state') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('city') ? ' has-error' : '' }}" >
                <label for="city" class="col-md-4 control-label">{{__('messages.city')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <div class="cityinput">
                    <select class="form-control" name="city" id="city" >
                    </select>
                  </div>
                  @if ($errors->has('state'))
                  <span class="help-block">
                    <strong>{{ $errors->first('state') }}</strong>
                  </span>
                  @endif
                </div>
              </div>

            </div> -->
            <!-- <div class="form-group">
              <div class="col-md-6{{ $errors->has('street') ? ' has-error' : '' }}" >
                <label for="street" class="col-md-4 control-label">{{__('messages.street')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="street" type="input" class="form-control" name="street" value="{{ old('street') }}" required>
                  @if ($errors->has('street'))
                  <span class="help-block">
                    <strong>{{ $errors->first('street') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('house') ? ' has-error' : '' }}" >
                <label for="house" class="col-md-4 control-label">{{__('messages.house')}} #</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="house" type="input" class="form-control" name="house" required>
                  @if ($errors->has('house'))
                  <span class="help-block">
                    <strong>{{ $errors->first('house') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
            </div> -->
            <!-- <div class="form-group">
              <div class="col-md-6{{ $errors->has('postal') ? ' has-error' : '' }}" >
                <label for="postal" class="col-md-4 control-label">{{__('messages.postal')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <input id="postal" type="text" class="form-control" name="postal" value="{{ old('postal') }}" required>
                  @if ($errors->has('postal'))
                  <span class="help-block">
                    <strong>{{ $errors->first('postal') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('phone') ? ' has-error' : '' }}" >
                <label for="phone" class="col-md-4 control-label">{{__('messages.phone')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <div class="phoneinput">
                    <input type="text" name="phone" id="phone" class="form-control input-medium bfh-phone" data-format="+1 (ddd) ddd-dddd">
                  </div>
                  @if ($errors->has('phone'))
                  <span class="help-block">
                    <strong>{{ $errors->first('phone') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
            </div> -->
            <!-- <div class="form-group">
              <div class="col-md-6{{ $errors->has('bornDate') ? ' has-error' : '' }}" >
                <label for="bornDate" class="col-md-4 control-label">{{__('messages.birthdate')}}</label>
                <div class="col-md-8" style="padding: 0px;">

                  <input id="bornDate" type="date" class="form-control" name="bornDate" value="{{ old('bornDate') }}" required>
                  @if ($errors->has('bornDate'))
                  <span class="help-block">
                    <strong>{{ $errors->first('bornDate') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
              <div class="col-md-6{{ $errors->has('bornCity') ? ' has-error' : '' }}">
                <label for="bornCity" class="col-md-4 control-label">{{__('messages.born')}}</label>
                <div class="col-md-8" style="padding: 0px;">
                  <div class="borninput">
                    <select class="form-control" name="bornCity" id="bornCity" >
                    </select>
                  </div>
                  @if ($errors->has('bornCity'))
                  <span class="help-block">
                    <strong>{{ $errors->first('bornCity') }}</strong>
                  </span>
                  @endif
                </div>
              </div>
            </div> -->
          <div class="form-group">
            <div class="col-md-6{{ $errors->has('password') ? ' has-error' : '' }}">
              <label for="password" class="col-md-4 control-label">{{__('messages.password')}}</label>
              <div class="col-md-8" style="padding: 0px;">
                <input id="password" type="password" class="form-control" name="password" required>
                @if ($errors->has('password'))
                <span class="help-block">
                  <strong>{{ $errors->first('password') }}</strong>
                </span>
                @endif
              </div>
            </div>
            <div class="col-md-6">
              <label for="password-confirm" class="col-md-4 control-label">{{__('messages.confirm')}} {{__('messages.password')}}</label>
              <div class="col-md-8" style="padding: 0px;">
                <input id="password_confirmation" type="password" class="form-control" name="password_confirmation" required>
              </div>
            </div>
          </div>
          <div class="form-group">
            <div class="col-md-6 col-md-offset-4">
              {!! NoCaptcha::display(['data-theme' => 'dark']) !!}
              @if ($errors->has('g-recaptcha-response'))
              <span class="help-block">
                <strong>{{ $errors->first('g-recaptcha-response') }}</strong>
              </span>
              @endif
            </div>
          </div>
        </form>
        </div>
      </div>
      <div class="panel-footer">
        <button type="button" class="btn btn-alternative" id="continue" name="button">{{__('system.continue')}}</button>
      </div>
    </div>
  </div>
</div>

@endsection