@extends('layouts.applicant')
@section('content')
    <div class="row">
        <div class="page-header">
            <h4> Application Fee Payements </h4>

        </div>
        <!-- /.row -->

        <!-- /.row -->
        <form action="{{$postParameters['queryApiUrl']}}" method="post">
            {{csrf_field()}}
            <div class="row">
                <!-- /.col-lg-6 -->
                <div class="col-lg-12">
                    <div class="panel panel-default">
                        <div class="panel-heading">
                            Proceed To Make Payments
                        </div>
                        <!-- /.panel-heading -->
                        <div class="panel-body">
                            <div class="row hidden">
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="apiClientID" type="text" value="{{$postParameters['apiClientID']}}" {{old($postParameters['apiClientID']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="secureHash" type="text" value="{{$postParameters['secureHash']}}" {{old($postParameters['secureHash']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="currency" type="text" value="{{$postParameters['currency']}}" {{old($postParameters['currency']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="serviceID" type="text" value="{{$postParameters['serviceID']}}" {{old($postParameters['serviceID']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="callBackURLOnSuccess" type="text" value="{{$postParameters['callBackURLOnSuccess']}}" {{old($postParameters['callBackURLOnSuccess']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-2">
                                    <div class="form-group">
                                        <input class="form-control" name="notificationURL" type="text" value="{{$postParameters['notificationURL']}}" {{old($postParameters['notificationURL']??'')}}>
                                    </div>

                                </div>
                            </div>
                            <div class="row">
                                <div class="col-lg-3">
                                    <div class="form-group">
                                        <label>Name</label>
                                        <input class="form-control" name="clientName" type="text" value="{{$postParameters['clientName']}}" {{old($postParameters['clientName']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-3">
                                    <div class="form-group">
                                        <label>Phone</label>
                                        <input class="form-control" name="clientMSISDN" type="text" value="{{$postParameters['clientMSISDN']}}" {{old($postParameters['clientMSISDN']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-3">
                                    <div class="form-group">
                                        <label>Id Number</label>
                                        <input class="form-control" name="clientIDNumber" type="text" value="{{$postParameters['clientIDNumber']}}" {{old($postParameters['clientIDNumber']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-3">
                                    <div class="form-group">
                                        <label>Email</label>
                                        <input class="form-control" name="clientEmail" type="text" value="{{$postParameters['clientEmail']}}" {{old($postParameters['clientEmail']??'')}}>
                                    </div>

                                </div>
                            </div>
                            <div class="row">
                                <div class="col-lg-4">
                                    <div class="form-group">
                                        <label>Bill Ref</label>
                                        <input class="form-control" name="billRefNumber" type="text" value="{{$postParameters['billRefNumber']}}" {{old($postParameters['billRefNumber']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-4">
                                    <div class="form-group">
                                        <label>Description</label>
                                        <input class="form-control" name="billDesc" type="text" value="{{$postParameters['billDesc']}}" {{old($postParameters['billDesc']??'')}}>
                                    </div>

                                </div>
                                <div class="col-lg-4">
                                    <div class="form-group">
                                        <label>Amount ({{$postParameters['currency']}})</label>
                                        <input class="form-control" name="amountExpected" type="number" min="0" step="10" value="{{$postParameters['amountExpected']}}" {{old($postParameters['amountExpected']??'')}}>
                                    </div>

                                </div>
                            </div>
                        </div>
                        <div class="panel-footer">
                            <button type="submit" class="btn btn-sm btn-primary">Submit</button>
                        </div>
                    </div>
                    <!-- /.panel -->
                </div>
                <!-- /.col-lg-6 -->

            </div>

        </form>

    </div>

@stop