@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>Credit Card Authorization</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">Credit Card Authorization</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">Credit Card Authorization</h3>
            </div>
            </br>
            @if (session('success'))
            <div class="alert alert-success">
              {{ session('success') }}
            </div>
            @endif
            @if(isset($report))
            <form action="{{ route('credit-card-authorization-submit-form.update', $report->id) }}" method="POST" onsubmit="disableButton()">
              @csrf
              @method('PUT')
              @else
              <form action="{{ route('credit-card-authorization-submit-form') }}" method="POST" onsubmit="disableButton()">
                @csrf
                @endif
                <div class="card-body">
                  <!-- Authorization Information -->
                  <h4>Authorization Information</h4>

                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="clientName">Name</label>
                        <input type="text" value="{{ old('client_name', $report->client_name ?? '') }}" class="form-control" name="client_name" id="clientName" placeholder="Enter Your Name">
                        @error('client_name')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>

                      <div class="form-group">
                        <label for="companyName">Company Name</label>
                        <input type="text" value="{{ old('company_name', $report->company_name ?? '') }}" class="form-control" name="company_name" id="companyName" placeholder="Enter Company Name">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="service">Service</label>
                        <input type="text" value="{{ old('service', $report->service ?? '') }}" class="form-control" name="service" id="service" placeholder="Enter Service">
                      </div>

                      <div class="form-group">
                        <label for="feeAmount">Fee Amount (USD)</label>
                        <input type="text" value="{{ old('fee_amount', $report->fee_amount ?? '') }}" class="form-control" name="fee_amount" id="feeAmount" placeholder="Enter Fee Amount">
                      </div>
                    </div>

                  </div>


                  <!-- Credit Card Authorization -->
                  <h4>Credit Card Authorization</h4>

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

                      <div class="form-group">
                        <label for="cardType">Card Type</label>
                        <select class="form-control" id="cardType" name="card_type">
                          <option value="Visa" {{ old('card_type', $report->card_type ?? '') == 'Visa' ? 'selected' : '' }}>Visa</option>
                          <option value="MasterCard" {{ old('card_type', $report->card_type ?? '') == 'MasterCard' ? 'selected' : '' }}>MasterCard</option>
                          <option value="American Express" {{ old('card_type', $report->card_type ?? '') == 'American Express' ? 'selected' : '' }}>American Express</option>
                          <option value="Discover" {{ old('card_type', $report->card_type ?? '') == 'Discover' ? 'selected' : '' }}>Discover</option>
                        </select>
                      </div>

                      <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 Credit Card Number">
                      </div>


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

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

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



                    </div>


                    <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('card_holder_name', $report->card_holder_name ?? '') }}" class="form-control" name="card_holder_name" id="cardHolderName" placeholder="Enter Name on the Credit Card">
                      </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 class="form-group">
                        <label for="billingState">State</label>
                        <input type="text" value="{{ old('billing_state', $report->billing_state ?? '') }}" class="form-control" name="billing_state" id="billingState" placeholder="Enter State">
                      </div>
                      <!-- Signature -->
                      <div class="form-group">
                        <label for="signature">Signature of Card Holder</label>
                        <input type="text" value="{{ old('signature', $report->signature ?? '') }}" class="form-control" name="signature" id="signature" placeholder="Enter Signature">
                      </div>

                    </div>
                  </div>

                  <div class="form-group">
                    <label for="billingAddress">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>
                  <!-- Notes Section -->
                  <div class="form-group">
                    <label for="notes">Notes</label>
                    <textarea class="form-control" name="notes" id="notes" rows="3" placeholder="Enter any notes">{{ old('notes', $report->notes ?? '') }}</textarea>
                  </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() {
    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>