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

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

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

<?php $__env->startSection('content'); ?>
<img style="max-width: 30%;display: block; margin-top: -3rem; margin-left: auto; margin-right: auto;" src="/img/Prestige_Logo.jpg" />

<h1>New Bank Code Request - (BCS)</h1>

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


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

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

                </div>
            </div>
			<div class="row">
			    <div class="large-6 columns">
			    <label>Bank</label>
			    <?php echo Form::select('bank', [
                             '' => 'Please Select',
                             'ASBA' => 'ASBA',
                             'NEDBANK' => 'NEDBANK',
                             'STANDARD' => 'STANDARD',
                             'FNB' => 'FNB',
                             'MERCANTILE' => 'MERCANTILE',
                             'BANK OF ATHENS' => 'BANK OF ATHENS',
                             'CITI BANK' => 'CITI BANK',
                             'HSBC' => 'HSBC',
                             'HBZ' => 'HBZ',
                             'HABIB BANK' => 'HABIB BANK',
                             'INVESTEC' => 'INVESTEC']
                            ); ?>

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

			    </div>
			</div>

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

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

                </div>
			</div>

			<div class="row">
			    <div class="large-6 columns">
                     <label>Transaction Type</label>
                         <?php echo Form::select('transactionType', [
                                         '' => 'Please Select',
                                         'BCE' => 'BCE - Bank Code Only',
                                         'BCD' => 'BCD - Bank Code and Date Account was Opened',
                                         'BRP' => 'BRP - Bank Code and Full Generals Results']
                                                            ); ?>

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

                </div>
			</div>

			<div class="row">
			    <div class="large-6 columns">
			    <label>Terms</label>
			    <?php echo Form::select('terms', [
                                             '' => 'Please Select',
                                             '30' => '30 Days',
                                             '60' => '60 Days',
                                             '90' => '90 Days',
                                             '120' => '120 Days',
                                             'COD' => 'Cash On Delivery',
                                             '12' => '12 Months',
                                             '24' => '24 Months',
                                             '36' => '36 Months']
                                            ); ?>

			    </div>
			    <div class="large-6 columns">
			       <label>Country</label>
			       <?php echo Form::select('country', [
                                                '' => 'Please Select',
                                                'BWA' => 'Botswana',
                                                'LSO' => 'Lesotho',
                                                'MWI' => 'Malawi',
                                                'NAM' => 'Namibia',
                                                'SWZ' => 'Swaziland',
                                                'ZAF' => 'South Africa',
                                                'ZWE' => 'Zimbabwe']
                                            ); ?>

			    </div>
			</div>

		</div>
		<div class="row">
		    <div class="large-12 columns">
		    <label>Amount</label>
		    <?php echo Form::text('amount'); ?>

		    </div>
		</div>
    <button 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(); ?>