@extends('layouts.paybase')

@section('form-name')
<form method="post" id="form" action="{{ action('UbahsuaiPremisController@update') }}" data-parsley-validate>
@endsection

@section('pay-details')
  <div class="fdb-box py-3 mb-3">
    <div class="row justify-content-left">
      <div class="col-md-9 text-left">
        <h2>Deposit Ubah Suai Premis</h2>
      </div>
    </div>
    <div class="row pt-2">
      <div class="col small text-justify text-danger">
        NOTIS: Sila isikan butiran berikut sebelum meneruskan pembayaran. Sila pastikan butiran yang diisi beserta nilai bayaran adalah tepat.
      </div>
    </div>
    <div class="row py-2 px-1">
      <div class="col col-md col-sm-12 mt-2 mt-md-0">
          <label class="required" for="negeri">Negeri</label>
          <select id="negeri" name="negeri" class="form-control" data-parsley-required="true">
            <option selected disabled>Sila pilih</option>
            @foreach($states as $s)
              <option value="{{ $s->id }}">
                {{ $s->shortname }}
              </option>
            @endforeach
          </select>
      </div>
      <div class="col col-md col-sm-12 mt-2 mt-md-0">
      <label class="required" for="lot">No. Lot</label>
      <input name="lot" id="lot" type="text" class="form-control" value="{{ old('lot') }}"
        data-parsley-trigger="change"
        data-parsley-maxlength="255"
        required>
      </div>
    </div>
    <div class="row py-2 px-1">
      <div class="col col-md col-sm-12 mt-2 mt-md-0">
        <label class="required" for="projek">Projek</label>
        <input name="projek" id="projek" type="text" class="form-control" value="{{ old('projek') }}"
          data-parsley-trigger="change"
          data-parsley-maxlength="255"
          required>
      </div>
    </div>
    <div class="row py-2 px-1">
      <div class="col-3 col-md-3 col-sm-12 mt-2 mt-md-0">
        <label class="required" for="nilai_bayaran">Nilai (RM)</label>
        <input type="number" step="0.01" class="form-control" name="nilai_bayaran" id="nilai_bayaran" value="{{ old('nilai_bayaran') }}"
        data-parsley-min='1'
        required>
      </div>
    </div>
  </div>

@endsection