@extends('layouts.master')

@section('pagetitle')
    Nouveau établissement - ADMIN ALTER IPSO
@endsection

@section('topband')
    @include('partials.topband_con')
@endsection

@section('sidebar')
    @include('partials.sidebar_admin', ['open' => 'newetab'])
@endsection

@section('content')
    <div class="content-wrapper">
        <div class="container-fluid">

            <div class="row">
                <div class="col-md-12">
                
                    <h2 class="page-title text-center">NOUVEAU ÉTABLISSEMENT</h2>

                    @include('partials.errors')
                    
                    <div class="row">
                            <div class="col-md-6">
                                <div class="panel panel-default">
                                    <div class="panel-heading">Coordonnées de l'établissement</div>
                                    <div class="panel-body">
                                        <form method="POST" action="{{ url('/etabs/registeruser') }}" class="form-horizontal" >
                                            {{ csrf_field() }}
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Nom</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" name="nom" autofocus value="{{ old('nom') }}" placeholder="Nom de l'établissement" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Adresse</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" value="{{ old('adresse') }}" name="adresse" placeholder="Adresse complète" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Pays</label>
                                                    <div class="col-sm-9">
                                                        <select class="form-control" name="pays">
                                                            <option value="France">France</option>
                                                        </select>
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Ville</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" id="villeTextView" name="ville" value="{{ old('ville') }}" autocomplete="on" placeholder="Ville de l'établissement" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Code Postal</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" name="code_postal" value="{{ old('code_postal') }}" placeholder="Code postal de la ville" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Numéro De Tél.</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" name="tel" value="{{ old('tel') }}" placeholder="+33000000000" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Site Web</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" name="site_web" value="{{ old('site_web') }}" placeholder="http:\\www.monetablissement.fr" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="hr-dashed"></div>
                                                <div class="form-group">
                                                    <label class="col-sm-3 control-label">Numéro SIREN</label>
                                                    <div class="col-sm-9">
                                                        <input type="text" name="num_siren" id="siren" value="{{ old('num_siren') }}" placeholder="Numéro d'identification SIREN" class="form-control">
                                                    </div>
                                                </div>

                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="panel panel-default">
                                    <div class="panel-heading">Coordonnées utilisateur</div>
                                        <div class="panel-body">
                                        
                                            <div class="form-horizontal">
                                            
                                                <div class="form-group">
                                                    <label class="col-sm-2 control-label">E-mail<span style="color: red;"> *</span></label>
                                                    <div class="col-sm-10">
                                                        <input type="text" name="email" value="{{ old('email') }}" placeholder="E-mail de l'utilisateur de l'établissement" class="form-control">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="panel panel-default">
                                    <div class="panel-heading">Identification</div>
                                        <div class="panel-body">
                                        
                                            <div class="form-horizontal">
                                            
                                                <div class="form-group">
                                                    <label class="col-sm-4 control-label">Code d'identification</label>
                                                    <div class="col-sm-8">
                                                        <input type="text" name="code_identif" value="{{ old('code_identif') }}" placeholder="Code d'identification de l'établissement" class="form-control">
                                                    </div>
                                                </div>
                                                <div class="form-group">
                                                    <label class="col-sm-4 control-label">Serveur Local</label>
                                                    <div class="col-sm-8">
                                                        <input type="text" name="serveur_local" value="{{ old('serveur_local') }}" placeholder="@ IP/Port du serveur local (Sans HTTP)" class="form-control">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                </div>
                            </div>
                        </div>
                    </div>

                    <script src="https://maps.googleapis.com/maps/api/js?libraries=places&key=AIzaSyAyymKTjrRe2dYJkSHXOAWS648f1ZX4mSM"></script>

                    <!-- script de l'auto-completion des villes --> 
                    <script type="text/javascript">
                        function init() {
                            var options = {
                              types: ['(cities)'],
                              componentRestrictions: {country: 'fr'}
                            };
                            var input = document.getElementById('villeTextView');
                            var autocomplete = new google.maps.places.Autocomplete(input, options);
                        }
                        google.maps.event.addDomListener(window, 'load', init);
                    </script>

                    <div class="row col-md-8 col-md-push-2">
                        <button style="font-size:15px;" class="btn btn-primary btn-block" type="submit">ENREGISTRER</button>
                        <h5 class="text-info text-center">Au clic sur <strong>Enregister</strong>, les coordonnées de connexion seront immédiatement envoyées à l'adresse mail specifiée</h5>
                    </div>
                </form>
            </div>
        
        @include('partials.footer')
            
        </div>
    </div>
@endsection