{{-- resources/views/resiliation/verify.blade.php --}}
@extends('layouts.app')
@section('title','Confirmer ma résiliation')
@section('content')

    <div class="page-header parallaxie">
        <div class="container">
            <div class="row">
                <div class="col-lg-12">
                    <div class="page-header-box">
                        <h1>Résilier mon contrat</h1>
                        <nav class="wow fadeInUp">
                            <ol class="breadcrumb">
                                <li class="breadcrumb-item"><a href="{{ url('/') }}">Accueil</a></li>
                                <li class="breadcrumb-item active" aria-current="page">Résilier mon contrat</li>
                            </ol>
                        </nav>
                    </div>
                </div>
            </div>
        </div>
    </div>

    <div class="page-contact-us">

        <div class="container">
            <div class="row align-items-center">
                <div class="col-12">
                    <div class="contact-information">
                        <div class="section-title">
                            <p class="wow fadeInUp">Résilier mon contrat</p>
                            <h2>Résilier mon contrat EquitAssistance</h2>
                        </div>
                    </div>
                </div>

                <div class="col-12">
                    <div class="contact-us-form">
                        <div class="contact-form">
                            <form action="{{ route('resiliation.store') }}" method="POST" enctype="multipart/form-data" class="contact-us-form wow fadeInUp">
                                @csrf

                                <div class="row g-3">
                                    @php
                                        $labels = [
                                          'personne'=>'Type de personne',
                                          'nom'=>'Nom',
                                          'prenom'=>'Prénom',
                                          'raison_sociale'=>'Raison sociale',
                                          'telephone'=>'Téléphone',
                                          'email'=>'Email',
                                          'reference'=>'Référence du contrat',
                                          'motif'=>'Motif',
                                          'date_evenement'=>"Date de l'événement",
                                        ];
                                    @endphp

                                    @foreach($labels as $k=>$label)
                                        @if(!empty($data[$k]))
                                            <div class="col-md-6">
                                                <label class="form-label">{{ $label }}</label>
                                                <input type="text" class="form-control" value="{{ $data[$k] }}" readonly>
                                            </div>
                                        @endif
                                    @endforeach

                                    <div class="col-md-12 mt-3">
                                        <label class="form-label">Ajouter un justificatif (optionnel)</label>
                                        <input type="file" name="justificatif" class="form-control" accept=".pdf,.jpg,.jpeg,.png,.doc,.docx">
                                        <small class="text-muted">Max 10 Mo.</small>
                                    </div>

                                    <div class="col-12">
                                        <button class="btn-default mt-3" type="submit">Confirmer ma demande de résiliation</button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>

                <div class="col-12 mt-5">
                    @include('partials.coordonnees')
                </div>

            </div>
        </div>
    </div>
@endsection