@extends('front.master.master')
@section('contect')
<!-- ======= Contact Section ======= -->
<section id="contact" class="contact mt-4">
    <div class="container" data-aos="fade-up">

    <div class="section-title">
        <h2>Insurance Forms</h2>
    </div>

    <div class="row" data-aos="fade-up" data-aos-delay="100">
        <div class="col-lg-4 col-md-4">
            <h4>Login Form</h4>
            <form action="{{ route('login') }}" method="post" role="form" class="php-email-form">
                @csrf
                <div class="col-md-12 mb-3">
                    <div class="form-group">
                        <label class="form-label" for="username">E-Mail Address</label>
                        <input id="email" type="email" class="form-control @error('email') is-invalid @enderror" name="email" placeholder="your id or email" value="{{ old('email') }}"  required autocomplete="email" autofocus>
                        <div class="invalid-feedback">No, you missed this one.</div>
                        <div class="help-block">Your unique username to app</div>

                    </div>
                </div>
                <div class="col-md-12 mb-3">
                    <div class="form-group">
                        <label class="form-label" for="password">Password</label>
                        <input type="password" id="password" name="password" class="form-control @error('password') is-invalid @enderror" placeholder="password"  value="{{ __('Password') }}" required autocomplete="current-password">
                        <div class="invalid-feedback">Sorry, you missed this one.</div>
                        <div class="help-block">Your password</div>

                        @error('password')
                            <span class="invalid-feedback" role="alert">
                                <strong>{{ $message }}</strong>
                            </span>
                        @enderror
                    </div>
                </div>
                <div class="col-md-12 mb-3">
                    <div class="form-group text-left">
                        <div class="custom-control custom-checkbox">
                            <input type="checkbox" class="custom-control-input" id="remember">
                            <label class="custom-control-label" name="remember" id="remember" {{ old('remember') ? 'checked' : '' }} for="remember"> {{ __('Remember Me') }}</label>
                        </div>
                    </div>
                </div>
                <div class="row no-gutters">
                    <div class="col-lg-12 pl-lg-1 my-2">
                        <button id="js-login-btn" type="submit" class="btn btn-primary btn-block btn-lg"> Login</button>
                    </div>
                        @if (Route::has('password.request'))
                        <a class="btn btn-link" href="">
                            {{ __('Forgot Your Password?') }}
                        </a>
                     @endif
                </div>
            </form>
        </div>
        <div class="col-lg-8 ml-auto">
            <h4>Registration From</h4>
            <form action="{{ route('insurance.register') }}" method="post" class="php-email-form">
                @csrf
                <div class="form-group row">
                    <div class="col-md-12">
                    <label for="name" >Name</label>
                        <input id="name" type="text" class="form-control" name="name" value="" required autocomplete="name" autofocus>
                         @error('name')
                            <span class="invalid-feedback" role="alert">
                                <strong>{{ $message }}</strong>
                            </span>
                        @enderror
                    </div>
                </div>
                <div class="form-group row">
                    <div class="col-md-12">
                    <label for="name" >Company Name</label>
                        <input id="name" type="text" class="form-control" name="c_name" value="" required autocomplete="name" autofocus>
                         @error('c_name')
                            <span class="invalid-feedback" role="alert">
                                <strong>{{ $message }}</strong>
                            </span>
                        @enderror
                    </div>
                </div>
                <div class="form-group row">
                    <div class="col-md-12">
                    <label for="email" >E-Mail Address</label>
                        <input id="email" type="email" class="form-control" name="email" value="" required autocomplete="email">

                         @error('email')
                            <span class="invalid-feedback" role="alert">
                                <strong>{{ $message }}</strong>
                            </span>
                        @enderror
                    </div>
                </div>
                <div class="form-group row">
                    <div class="col-md-12">
                    <label for="password">Password</label>
                        <input id="password" type="password" class="form-control" name="password" required autocomplete="new-password">
                        @error('password')
                            <span class="invalid-feedback" role="alert">
                                <strong>{{ $message }}</strong>
                            </span>
                        @enderror
                    </div>
                </div>
                <div class="form-group row">
                    <div class="col-md-12">
                    <label for="password-confirm" >Confirm Password</label>
                        <input id="password-confirm" type="password" class="form-control" name="password_confirmation" required autocomplete="new-password">
                    </div>
                </div>

                <div class="form-group row mb-0">
                    <div class="col-md-12 ">
                        <button type="submit" class="btn btn-primary btn-block">
                            Register
                        </button>
                    </div>
                </div>
            </form>
        </div>

    </div>

    </div>
    </section><!-- End Contact Section -->
@endsection