@include('dashboard.layouts.header')

<!-- Content Wrapper. Contains page content -->
<div class="content-wrapper">
  <!-- Content Header (Page header) -->
  <section class="content-header">
    <div class="container-fluid">
      <div class="row mb-2">
        <div class="col-sm-6">
          <h1>Corporation Registration Form</h1>
        </div>
        <div class="col-sm-6">
          <ol class="breadcrumb float-sm-right">
            <li class="breadcrumb-item"><a href="/dashboard">Home</a></li>
            <li class="breadcrumb-item active">Corporation Registration Form</li>
          </ol>
        </div>
      </div>
    </div><!-- /.container-fluid -->
  </section>

  <!-- Main content -->
  <section class="content">
    <div class="container-fluid">
      <div class="row">
        <!-- left column -->
        <div class="col-md-12">
          <!-- general form elements -->
          <div class="card card-primary">
            <div class="card-header">
              <h3 class="card-title">Corporation Registration Form</h3>
            </div>
            </br>
            @if (session('success'))
            <div class="alert alert-success">
              {{ session('success') }}
            </div>
            @endif
            @if(isset($report))
            <form action="{{ route('corporation-registration-form-submit-form.update', $report->id) }}" method="POST" onsubmit="disableButton()">
              @csrf
              @method('PUT')
              @else
              <form action="{{ route('corporation-registration-form-submit-form') }}" method="POST" onsubmit="disableButton()">
                @csrf
                @endif
                <div class="card-body">
                  <!-- Contact Information -->
                  <h4>Incorporation Authorization</h4>
                  <div class="form-group">
                    <p>
                      I, <input type="text" value="{{ old('authorizer_name', $report->authorizer_name ?? '') }}" class="form-control d-inline-block w-auto" name="authorizer_name" placeholder="Your Name">,
                      authorize ITAXEXPERTS.COM to file incorporation papers with the
                      <input type="text" value="{{ old('state', $report->state ?? '') }}" class="form-control d-inline-block w-auto" name="state" placeholder="State">
                      (State) for one of the following corporations, depending on availability of name:
                    </p>
                    @error('authorizer_name')
                    <span class="text-danger">{{ $message }}</span>
                    @enderror
                    </br>
                    @error('state')
                    <span class="text-danger">{{ $message }}</span>
                    @enderror
                  </div>

                  <div class="row">
                    <div class="col-md-6 col-print-6">

                      <div class="form-group">
                        <label for="entityType">Type of Entity</label>
                        <select class="form-control" name="entity_type" id="entityType">
                          <option value="Corporation" {{ old('entity_type', $report->entity_type ?? '') == 'Corporation' ? 'selected' : '' }}>Corporation</option>
                          <option value="LLC" {{ old('entity_type', $report->entity_type ?? '') == 'LLC' ? 'selected' : '' }}>LLC</option>
                          <option value="LLP" {{ old('entity_type', $report->entity_type ?? '') == 'LLP' ? 'selected' : '' }}>LLP</option>
                        </select>
                      </div>

                      <div class="form-group">
                        <label for="corporationName2">Preferred Corporation Name 2</label>
                        <input type="text" value="{{ old('corporation_name_2', $report->corporation_name_2 ?? '') }}" class="form-control" name="corporation_name_2" id="corporationName2" placeholder="Enter second choice">
                      </div>

                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="corporationName1">Preferred Corporation Name 1</label>
                        <input type="text" value="{{ old('corporation_name_1', $report->corporation_name_1 ?? '') }}" class="form-control" name="corporation_name_1" id="corporationName1" placeholder="Enter first choice">
                      </div>

                      <div class="form-group">
                        <label for="corporationName3">Preferred Corporation Name 3</label>
                        <input type="text" value="{{ old('corporation_name_3', $report->corporation_name_3 ?? '') }}" class="form-control" name="corporation_name_3" id="corporationName3" placeholder="Enter third choice">
                      </div>

                    </div>
                  </div>

                  <div class="form-group">
                    <label for="address">The address of the corporation will be:</label>
                    <textarea class="form-control" name="corporation_address" id="address" rows="3" placeholder="Enter corporation address">{{ old('corporation_address', $report->corporation_address ?? '') }}</textarea>
                  </div>

                  <div class="form-group">
                    <label for="businessPurpose">Business Purpose:</label>
                    <textarea class="form-control" name="business_purpose" id="businessPurpose" rows="3" placeholder="Describe business purpose">{{ old('business_purpose', $report->business_purpose ?? '') }}</textarea>
                  </div>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="processing_time">Processing Time (select one)</label>
                        <select class="form-control" name="processing_time" id="processing_time">
                          <option value="Regular Processing Time" {{ old('processing_time', $report->processing_time ?? '') == 'Regular Processing Time' ? 'selected' : '' }}>Regular Processing Time</option>
                          <option value="Expedited Processing Time" {{ old('processing_time', $report->processing_time ?? '') == 'Expedited Processing Time' ? 'selected' : '' }}>Expedited Processing Time</option>
                          <option value="24 Hours Processing Time" {{ old('processing_time', $report->processing_time ?? '') == '24 Hours Processing Time' ? 'selected' : '' }}>24 Hours Processing Time</option>
                        </select>
                      </div>
                    </div>
                  </div>
                  <div class="form-group">
                    <p>
                      I also agree to pay a professional fee of US $
                      <input type="number" value="{{ old('professional_fee', $report->professional_fee ?? '') }}" class="form-control d-inline-block w-auto" name="professional_fee" placeholder="Enter amount">
                      to ITAXEXPERTS.COM to register my corporation and apply for a Corporate Tax ID number (FEIN #).
                      All other services such as state registration fees, certified copies, and corporation kits, etc., will be paid separately.
                    </p>
                  </div>

                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="shareholderName">Shareholder Name</label>
                        <input type="text" value="{{ old('shareholder_name', $report->shareholder_name ?? '') }}" class="form-control" name="shareholder_name" id="shareholderName" placeholder="Enter shareholder name">
                      </div>
                      <div class="form-group">
                        <label for="shareholderSignature">Shareholder Signature</label>
                        <input type="text" value="{{ old('shareholder_signature', $report->shareholder_signature ?? '') }}" class="form-control" name="shareholder_signature" id="shareholderSignature" placeholder="Enter your signature">
                      </div>

                    </div>

                    <div class="col-md-6 col-print-6">

                      <div class="form-group">
                        <label for="signatureDate">Date</label>
                        <input type="date" value="{{ old('signature_date', $report->signature_date ?? '') }}" class="form-control" name="signature_date" id="signatureDate">
                      </div>

                    </div>

                  </div>

                  <!-- Shareholder/Officer Information -->
                  <h4>Shareholder Information</h4>

                  <!-- Shareholder 1 -->
                  <h4>Shareholder 1</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="shareholder1Name">Full Name</label>
                        <input type="text" value="{{ old('shareholder1_name', $report->shareholder1_name ?? '') }}" class="form-control" name="shareholder1_name" id="shareholder1Name" placeholder="Enter Full Name">
                      </div>

                      <div class="form-group">
                        <label for="shareholder1Ownership">Percentage of Ownership</label>
                        <input type="text" value="{{ old('shareholder1_ownership', $report->shareholder1_ownership ?? '') }}" class="form-control" name="shareholder1_ownership" id="shareholder1Ownership" placeholder="Enter Ownership Percentage">
                      </div>

                      <div class="form-group">
                        <label for="shareholder1CityStateZip">City, State, Zip</label>
                        <input type="text" value="{{ old('shareholder1_city_state_zip', $report->shareholder1_city_state_zip ?? '') }}" class="form-control" name="shareholder1_city_state_zip" id="shareholder1CityStateZip" placeholder="Enter City, State, Zip">
                      </div>



                    </div>

                    <div class="col-md-6 col-print-6">

                      <div class="form-group">
                        <label for="shareholder1SSN">Social Security Number</label>
                        <input type="text" value="{{ old('shareholder1_ssn', $report->shareholder1_ssn ?? '') }}" class="form-control" name="shareholder1_ssn" id="shareholder1SSN" placeholder="999-99-9999">
                      </div>

                      <div class="form-group">
                        <label for="shareholder1Phone">Phone</label>
                        <input type="tel" value="{{ old('shareholder1_phone', $report->shareholder1_phone ?? '') }}" class="form-control" name="shareholder1_phone" id="shareholder1Phone" placeholder="(123) 456-7890">
                      </div>

                      <div class="form-group">
                        <label for="shareholder1Fax">Fax</label>
                        <input type="tel" value="{{ old('shareholder1_fax', $report->shareholder1_fax ?? '') }}" class="form-control" name="shareholder1_fax" id="shareholder1Fax" placeholder="(123) 456-7890">
                      </div>
                    </div>

                  </div>
                  <div class="row">
                    <div class="col-md-12">
                      <div class="form-group">
                        <label for="shareholder1Address">Residence Address</label>
                        <input type="text" value="{{ old('shareholder1_address', $report->shareholder1_address ?? '') }}" class="form-control" name="shareholder1_address" id="shareholder1Address" placeholder="Enter Address">
                      </div>
                    </div>
                  </div>
                  <!-- Shareholder 2 -->
                  </br>
                  <h4>Shareholder 2</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="shareholder2Name">Full Name</label>
                        <input type="text" value="{{ old('shareholder2_name', $report->shareholder2_name ?? '') }}" class="form-control" name="shareholder2_name" id="shareholder2Name" placeholder="Enter Full Name">
                      </div>
                      <div class="form-group">
                        <label for="shareholder2Ownership">Percentage of Ownership</label>
                        <input type="text" value="{{ old('shareholder2_ownership', $report->shareholder2_ownership ?? '') }}" class="form-control" name="shareholder2_ownership" id="shareholder2Ownership" placeholder="Enter Ownership Percentage">
                      </div>
                      <div class="form-group">
                        <label for="shareholder2CityStateZip">City, State, Zip</label>
                        <input type="text" value="{{ old('shareholder2_city_state_zip', $report->shareholder2_city_state_zip ?? '') }}" class="form-control" name="shareholder2_city_state_zip" id="shareholder2CityStateZip" placeholder="Enter City, State, Zip">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="shareholder2SSN">Social Security Number</label>
                        <input type="text" value="{{ old('shareholder2_ssn', $report->shareholder2_ssn ?? '') }}" class="form-control" name="shareholder2_ssn" id="shareholder2SSN" placeholder="999-99-9999">
                      </div>

                      <div class="form-group">
                        <label for="shareholder2Phone">Phone</label>
                        <input type="tel" value="{{ old('shareholder2_phone', $report->shareholder2_phone ?? '') }}" class="form-control" name="shareholder2_phone" id="shareholder2Phone" placeholder="(123) 456-7890">
                      </div>

                      <div class="form-group">
                        <label for="shareholder2Fax">Fax</label>
                        <input type="tel" value="{{ old('shareholder2_fax', $report->shareholder2_fax ?? '') }}" class="form-control" name="shareholder2_fax" id="shareholder2Fax" placeholder="(123) 456-7890">
                      </div>
                    </div>
                  </div>

                  <div class="row">
                    <div class="col-md-12">

                      <div class="form-group">
                        <label for="shareholder2Address">Residence Address</label>
                        <input type="text" value="{{ old('shareholder2_address', $report->shareholder2_address ?? '') }}" class="form-control" name="shareholder2_address" id="shareholder2Address" placeholder="Enter Address">
                      </div>
                    </div>
                  </div>


                  <!-- Credit Card Authorization -->
                  <hr>
                  <h4>Credit Card Authorization</h4>
                  </br>
                  <div class="row">
                    <div class="col-md-6 col-print-6">

                      <div class="form-group">
                        <label for="cardholderName">Name on the Credit Card</label>
                        <input type="text" value="{{ old('cardholder_name', $report->cardholder_name ?? '') }}" class="form-control" name="cardholder_name" id="cardholderName" placeholder="Enter name">
                      </div>

                      <div class="form-group">
                        <label for="cardExpiration">CC Expiration Date</label>
                        <input type="month" value="{{ old('card_expiration', $report->card_expiration ?? '') }}" class="form-control" name="card_expiration" id="cardExpiration">
                      </div>


                      <div class="form-group">
                        <label for="billingCityStateZip">City, State, Zip</label>
                        <input type="text" value="{{ old('billing_city_state_zip', $report->billing_city_state_zip ?? '') }}" class="form-control" name="billing_city_state_zip" id="billingCityStateZip" placeholder="Enter city, state, zip">
                      </div>

                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="cardNumber">Credit Card Number</label>
                        <input type="text" value="{{ old('card_number', $report->card_number ?? '') }}" class="form-control" name="card_number" id="cardNumber" placeholder="Enter card number">
                      </div>

                      <div class="form-group">
                        <label for="csvCode">Security (CSV) Code</label>
                        <input type="text" value="{{ old('csv_code', $report->csv_code ?? '') }}" class="form-control" name="csv_code" id="csvCode" placeholder="Enter CSV code">
                      </div>


                    </div>
                  </div>

                  <div class="row">
                    <div class="col-md-12">
                      <div class="form-group">
                        <label for="billingAddress">CC Billing Address</label>
                        <input type="text" value="{{ old('billing_address', $report->billing_address ?? '') }}" class="form-control" name="billing_address" id="billingAddress" placeholder="Enter billing address">
                      </div>
                    </div>
                    <div class="col-md-12">
                      <div class="form-group">
                        <label for="billingCityStateZip">Note</label>
                        <input type="text" value="{{ old('notes', $report->notes ?? '') }}" class="form-control" name="notes" id="note" placeholder="Enter Note">
                      </div>
                    </div>
                  </div>
                  <div class="card-footer">
                    <button type="submit" class="btn btn-primary" id="submitButton">Submit</button>
                  </div>
              </form>

          </div>
        </div>
      </div>
    </div>
  </section>
</div>
@include('dashboard.layouts.footer')

<script>
  function formatUSPhone(input) {

    let value = input.value.replace(/\D/g, ''); // remove non-digits
    if (value.length > 3 && value.length <= 6) {
      input.value = `(${value.slice(0, 3)}) ${value.slice(3)}`;
    } else if (value.length > 6) {
      input.value = `(${value.slice(0, 3)}) ${value.slice(3, 6)}-${value.slice(6, 10)}`;
    } else {
      input.value = value;
    }
  }
  document.addEventListener("DOMContentLoaded", function() {
    document.getElementById('shareholder1Phone').addEventListener('input', function() {
      formatUSPhone(this);
    });
    document.getElementById('shareholder1Fax').addEventListener('input', function() {
      formatUSPhone(this);
    });
    document.getElementById('shareholder2Phone').addEventListener('input', function() {
      formatUSPhone(this);
    });
    document.getElementById('shareholder2Fax').addEventListener('input', function() {
      formatUSPhone(this);
    });
  });

  function formatUSSSN(input) {
    let value = input.value.replace(/\D/g, ''); // remove all non-digits

    if (value.length > 5) {
      // 123-45-6789
      input.value = `${value.slice(0, 3)}-${value.slice(3, 5)}-${value.slice(5, 9)}`;
    } else if (value.length > 3) {
      // 123-45
      input.value = `${value.slice(0, 3)}-${value.slice(3, 5)}`;
    } else {
      // 123
      input.value = value;
    }
  }
  document.addEventListener("DOMContentLoaded", function() {
    document.getElementById('shareholder1SSN').addEventListener('input', function() {
      formatUSSSN(this);
    });
    document.getElementById('shareholder2SSN').addEventListener('input', function() {
      formatUSSSN(this);
    });

  });
</script>

<script>
  $(function() {
    bsCustomFileInput.init();
  });
</script>
<script>
  function disableButton() {
    let btn = document.getElementById('submitButton');
    btn.disabled = true;
    btn.innerText = 'Submitting...'; // Change button text

    // Allow form submission
    return true;
  }
</script>
</body>

</html>