<?php $__env->startSection('title'); ?>
    AVSR Request
<?php $__env->stopSection(); ?>

<?php $__env->startSection('styles'); ?>

<?php $__env->stopSection(); ?>

<?php $__env->startSection('content'); ?>

<h1>AVSR Request</h1>

        <?php echo Form::open(); ?>


            <div class="row">
                <div class="large-6 columns">
                    <label>Initials</label>
                    <?php echo Form::text('initials'); ?>

                </div>
                <div class="large-6 columns">
                    <label>Surname</label>
                    <?php echo Form::text('surname'); ?>

                </div>
            </div>
			<div class="row">
			    <div class="large-6 columns">
			        <label>ID Number</label>
			        <?php echo Form::text('idNumber'); ?>

			    </div>
			    <div class="large-6 columns">
                	 <label>Account Number</label>
                	 <?php echo Form::text('accountNumber'); ?>

                </div>
			</div>

			<div class="row">
			    <div class="large-6 columns">
                	 <label>Brach Code</label>
                	 <?php echo Form::text('branchCode'); ?>

                </div>
			    <div class="large-6 columns">
                     <label>Bank Account Type</label>
                         <?php echo Form::select('accountType', [
                                         '' => 'Please Select',
                                         '1' => 'current',
                                         '2' => 'savings',
                                         '3' => 'bond',
                                         '4' => 'credit card',
                                         '5' => 'subscription share',
                                         '6' => 'not known'
                                         ]
                                                            ); ?>

                </div>
			</div>

		<button class="myButton" type="submit">Submit</button>

		<?php echo Form::close(); ?>

	</div>


<?php $__env->stopSection(); ?>

<?php $__env->startSection('scripts'); ?>

<?php $__env->stopSection(); ?>


<?php echo $__env->make('master', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>