@extends('layout')
@section('content')
<div class="account">
    <div class="account-bg">
       <div class="container account-content">
          <div class="account-container col-md-6 col-md-offset-3">
            <div class="register-header"><img src="/resources/assets/rutsen/img/register-header.png"></div>
            <div class="register-sub"><i class = "fa fa-user"></i> Personal Information</div>
            <div class="register-holder">
                <form id="add-customer-form" method="post" action="account">
                   <input type="hidden" name="_token" value="{{{ csrf_token() }}}" />
                   <input type="submit" class="hide">
                   <div class = "form">
                    <form method="POST">
                        <div class="form-group col-md-12">
                            <label for="name">Full Name</label>  
                            <input id="name" type="text" class="form-control" name = "rname" value = "{{ Request::input('rname') }}">
                        </div>
                        <div class="form-group col-md-6 bday">
                            <label style="display:block;" for="bday">Birthday</label>
                            <input class="form-control" type="text" id="datepicker" name="customer_birthday" style="width: 100px;" value="{{Request::input('customer_birthday')}}">
                        </div>
                        <div class="col-md-12 nopadding">
                           <select name="rmonth" id="mbirthday">
                               <option value="1">January</option>
                               <option value="2">February</option>
                               <option value="3">March</option>
                               <option value="4">April</option>
                               <option value="5">May</option>
                               <option value="6">June</option>
                               <option value="7">July</option>
                               <option value="8">August</option>
                               <option value="9">September</option>
                               <option value="10">October</option>
                               <option value="11">November</option>
                               <option value="12">December</option>
                           </select>
                           <select id = "dbirthday" name = "rday" required = "required">    
                                @for($birthday = 1; $birthday <= 31; $birthday++)
                                <option> 
                                    {{ $birthday }}
                                </option>
                            @endfor             
                           </select>
                           <select id="ybirthday" name="ryear">
                                <option value='' disabled selected style='display: none;'>Year</option>     
                                @for($birthday = (date("Y") - 120); $birthday <= date("Y"); $birthday++)
                                    <option {{ (date("Y")-18) == $birthday ? 'selected' : '' }}>
                                        {{ $birthday }}
                                    </option>
                                @endfor
                           </select>
                        </div>
                        <div class="form-group col-md-6">
                            <div>
                                <label for="gender">Gender</label>
                                @if($error_message['gender'])
                                    <div class = "alert alert-danger">
                                        <ul>
                                            @foreach ($error_message['gender'] as $element)
                                                <li>{{$element}}</li>
                                            @endforeach
                                        </ul>
                                    </div>
                                @endif
                            </div>
                        </div>
                        <div role="form">                           
                            <label class="radio-inline">
                                <input id = "gender1" type = "radio" name = "gender" value = "Male" {{ Request::input('gender') == 'Male' ? 'checked="checked' : '' }}> Male
                            </label>
                            <label class = "radio-inline">
                                <input id = "gender2" type = "radio" name = "gender" value = "Female" {{ Request::input('gender') == 'Female' ? 'checked="checked' : '' }}> Female
                            </label>                                
                        </div>
                        <div class="form-group col-md-12">
                            <div>
                                <label for="address">Address</label>                            
                                @if($error_message['address'])
                                    <div class = "alert alert-danger">
                                        <ul>
                                            @foreach ($error_message['address'] as $element)
                                            <li>{{$element}}</li>
                                            @endforeach
                                        </ul>
                                    </div>
                                @endif
                            </div>
                            <textarea id="address" class="form-control" name = "raddress">{{ Request::input('raddress') }}</textarea>
                        </div>
                        <div class="form-group col-md-6">
                            <div>
                                <label for="ea">Email Address</label>
                                @if($error_message['email'])
                                    <div class = "alert alert-danger">
                                        <ul>
                                            @foreach ($error_message['email'] as $element)
                                            <li>{{$element}}</li>
                                            @endforeach
                                        </ul>
                                    </div>
                                @endif
                            </div>
                            <input id="ea" type="text" class="form-control" name = "remail" value = "{{ Request::input('remail') }}">
                            <div>
                                <input type="checkbox" name="subscribe" value="Yes" /> Subscribe to newsletter<div>(Subscribing needs email confirmation).</div>
                            </div>
                            <div class="message-ea">We will send messages to the above email address. Please ensure the email address is accessible and up-to-date</div>
                        </div>
                        <div class="form-group col-md-6">
                            <div>
                                <label for="cn">Contact Number</label>
                                @if($error_message['contact'])
                                    <div class = "alert alert-danger">
                                        <ul>
                                            @foreach ($error_message['contact'] as $element)
                                            <li>{{$element}}</li>
                                            @endforeach
                                        </ul>
                                    </div>
                                @endif
                            </div>
                            <input id="cn contact-number" type="text" class="form-control" name = "rcontact" value = "{{ Request::input('rcontact') }}">
                        </div>
                        <div class = "form-group col-md-12">                    
                            <label>Province</label>
                            @if($error_message['province'])
                                <div class = "alert alert-danger">
                                    <ul>
                                        @foreach ($error_message['province'] as $element)
                                        <li>{{$element}}</li>
                                        @endforeach
                                    </ul>
                                </div>
                            @endif  
                            <select id = "province" name = "p" class = "form-control load-child-location province " target = ".municipality">
                                @foreach($province as $location)
                                    <option {{ $location->location_id == $_province ? 'selected="selected"' : '' }}
                                    value = "{{ $location->location_id }}">{{ $location->location_name }}
                                    </option>
                                @endforeach
                            </select>
                        </div>
                        <div class = "form-group col-md-12">
                            <label>City / Municipality</label>
                            @if($error_message['municipality'])
                                <div class = "alert alert-danger">
                                    <ul>
                                        @foreach ($error_message['municipality'] as $element)
                                            <li>{{$element}}</li>
                                        @endforeach
                                    </ul>
                                </div>
                            @endif      
                            <select id = "province" name = "cm" class = "form-control load-child-location municipality " target = ".barangay">
                                @foreach($municipality as $location)
                                    <option {{ $location->location_id == $_municipality ? 'selected="selected"' : '' }}
                                    value = "{{ $location->location_id }}">{{ $location->location_name }}
                                    </option>
                                @endforeach
                            </select>
                        </div>
                        <div class = "form-group col-md-12">
                            <label >Barangay</label>    
                            @if($error_message['barangay'])
                                <div class = "alert alert-danger">
                                    <ul>
                                        @foreach ($error_message['barangay'] as $element)
                                            <li>{{$element}}</li>
                                        @endforeach
                                    </ul>
                                </div>
                            @endif  
                            <select id = "province" name = "b" class = "form-control barangay">
                                @foreach($barangay as $location)
                                    <option {{ $location->location_id == $_barangay ? 'selected="selected"' : '' }}
                                    value = "{{ $location->location_id }}">{{ $location->location_name }}
                                    </option>
                                @endforeach
                            </select>
                        </div>
                        <div class="col-md-12 nopadding">
                            <div class="form-group col-md-6">
                                <div>
                                    <label for="pw">Password</label>
                                    @if($error_message['password'])
                                        <div class = "alert alert-danger">
                                            <ul>
                                                @foreach ($error_message['password'] as $element)
                                                    <li>{{$element}}</li>
                                                @endforeach
                                            </ul>
                                        </div>
                                    @endif  
                                </div>
                                <input id="pw" type="password" class="form-control" name = "rpassword" value = "{{ Request::input('rpassword') }}">
                            </div>
                        </div>
                        <div class="col-md-12 nopadding">
                            <div class="form-group col-md-6">
                                <div>
                                    <label for="rpw">Retype Password</label>
                                    @if($error_message['confirm_password'])
                                        <div class = "alert alert-danger">
                                            <ul>
                                                @foreach ($error_message['confirm_password'] as $element)
                                                    <li>{{$element}}</li>
                                                @endforeach
                                            </ul>
                                        </div>
                                    @endif  
                                </div>
                                <input id="rpw" type="password" class="form-control" name = "rrepeat" value = "{{ Request::input('rrepeat') }}">
                            </div>
                        </div>
                        <div class="col-md-12 nopadding">
                            <div class="form-group col-md-6">
                                <button class = "btn btn-primary" type = "button" onclick = "$('#add-customer-form').submit();"><i onclick = "location.href = ''"></i>SUBMIT</button>
                            </div>
                        </div>
                    </form>
                </form>
            </div>
       </div>
   </div>
</div>
@endsection

@section('css')
<link rel="stylesheet" type="text/css" href="resources/assets/jquery-ui/jquery-ui.css">
<link rel="stylesheet" href="resources/assets/frontend/css/registration.css">
@endsection

@section('script')
<script type = "text/javascript" src = "resources/assets/rutsen/js/checkout.js"></script>
<script type="text/javascript" src="resources/assets/jquery-ui/jquery-ui.js"></script>
<script type="text/javascript">
$(document).ready(function()
{   
    $( "#datepicker" ).datepicker({
        changeMonth: true,
        changeYear: true,
        yearRange:'-90:+0'
    });

    var $test = {"children":[{"id":36140,"name":"Alicia"},{"id":36141,"name":"Amihan"},{"id":36142,"name":"Apolonio Samson"},{"id":36143,"name":"Aurora"},{"id":36144,"name":"Baesa"},{"id":36145,"name":"Bagbag"},{"id":36147,"name":"Bagong Lipunan Ng Crame"},{"id":36148,"name":"Bagong Pag~Asa"},{"id":36149,"name":"Bagong Silangan"},{"id":36150,"name":"Bagumbayan"},{"id":36146,"name":"Bagumbuhay"},{"id":36151,"name":"Bahay Toro"},{"id":36152,"name":"Balingasa"},{"id":36274,"name":"Balong Bato"},{"id":36278,"name":"Batasan Hills"},{"id":36153,"name":"Bayanihan"},{"id":36154,"name":"Blue Ridge A"},{"id":36155,"name":"Blue Ridge B"},{"id":36156,"name":"Botocan"},{"id":36157,"name":"Bungad"},{"id":36158,"name":"Camp Aguinaldo"},{"id":36275,"name":"Capri"},{"id":36159,"name":"Central"},{"id":36160,"name":"Claro"},{"id":36161,"name":"Commonwealth"},{"id":36164,"name":"Culiat"},{"id":36165,"name":"Damar"},{"id":36166,"name":"Damayan"},{"id":36167,"name":"Damayang Lagi"},{"id":36168,"name":"Del Monte"},{"id":36169,"name":"Dioquino Zobel"},{"id":36172,"name":"Don Manuel"},{"id":36170,"name":"Dona Imelda"},{"id":36171,"name":"Dona Josefa"},{"id":36173,"name":"Duyan~Duyan"},{"id":36174,"name":"E. Rodriguez"},{"id":36175,"name":"East Kamias"},{"id":36176,"name":"Escopa I"},{"id":36177,"name":"Escopa Ii"},{"id":36178,"name":"Escopa Iii"},{"id":36179,"name":"Escopa Iv"},{"id":36180,"name":"Fairview"},{"id":36280,"name":"Greater Lagro"},{"id":36182,"name":"Gulod"},{"id":36279,"name":"Holy Spirit"},{"id":36183,"name":"Horseshoe"},{"id":36184,"name":"Immaculate Concepcion"},{"id":36185,"name":"Kaligayahan"},{"id":36186,"name":"Kalusugan"},{"id":36187,"name":"Kamuning"},{"id":36188,"name":"Katipunan"},{"id":36189,"name":"Kaunlaran"},{"id":36163,"name":"Kristong Hari"},{"id":36190,"name":"Krus Na Ligas"},{"id":36191,"name":"Laging Handa"},{"id":36192,"name":"Libis"},{"id":36193,"name":"Lourdes"},{"id":36194,"name":"Loyola Heights"},{"id":36195,"name":"Maharlika"},{"id":36196,"name":"Malaya"},{"id":36198,"name":"Mangga"},{"id":36197,"name":"Manresa"},{"id":36199,"name":"Mariana"},{"id":36200,"name":"Mariblo"},{"id":36201,"name":"Marilag"},{"id":36202,"name":"Masagana"},{"id":36203,"name":"Masambong"},{"id":36205,"name":"Matandang Balara"},{"id":36206,"name":"Milagrosa"},{"id":36181,"name":"N.s. Amoranto (Gintong Silahis)"},{"id":36207,"name":"Nagkaisang Nayon"},{"id":36208,"name":"Nayong Kanluran"},{"id":36162,"name":"New Era (Constitution Hills)"},{"id":36281,"name":"North Fairview"},{"id":36209,"name":"Novaliches Proper"},{"id":36210,"name":"Obrero"},{"id":36211,"name":"Old Capitol Site"},{"id":36212,"name":"Paang Bundok"},{"id":36213,"name":"Pag~ibig Sa Nayon"},{"id":36214,"name":"Paligsahan"},{"id":36215,"name":"Paltok"},{"id":36216,"name":"Pansol"},{"id":36217,"name":"Paraiso"},{"id":36218,"name":"Pasong Putik Proper"},{"id":36219,"name":"Pasong Tamo"},{"id":36277,"name":"Payatas"},{"id":36220,"name":"Phil~Am"},{"id":36222,"name":"Pinagkaisahan"},{"id":36221,"name":"Pinyahan"},{"id":36223,"name":"Project 6"},{"id":36224,"name":"Quirino 2A"},{"id":36225,"name":"Quirino 2B"},{"id":36226,"name":"Quirino 2C"},{"id":36227,"name":"Quirino 3A"},{"id":36228,"name":"Ramon Magsaysay"},{"id":36229,"name":"Roxas"},{"id":36230,"name":"Sacred Heart"},{"id":36231,"name":"Saint Ignatius"},{"id":36232,"name":"Saint Peter"},{"id":36233,"name":"Salvacion"},{"id":36234,"name":"San Agustin"},{"id":36235,"name":"San Antonio"},{"id":36236,"name":"San Bartolome"},{"id":36237,"name":"San Isidro"},{"id":36238,"name":"San Isidro Labrador"},{"id":36239,"name":"San Jose"},{"id":36240,"name":"San Martin De Porres"},{"id":36241,"name":"San Roque"},{"id":36242,"name":"San Vicente"},{"id":36276,"name":"Sangandaan"},{"id":36243,"name":"Santa Cruz"},{"id":36244,"name":"Santa Lucia"},{"id":36245,"name":"Santa Monica"},{"id":36246,"name":"Santa Teresita"},{"id":36247,"name":"Santo Cristo"},{"id":36204,"name":"Santo Domingo (Matalahib)"},{"id":36248,"name":"Santo Nino"},{"id":36249,"name":"Santol"},{"id":36250,"name":"Sauyo"},{"id":36251,"name":"Sienna"},{"id":36252,"name":"Sikatuna Village"},{"id":36253,"name":"Silangan"},{"id":36254,"name":"Socorro"},{"id":36255,"name":"South Triangle"},{"id":36256,"name":"Tagumpay"},{"id":36257,"name":"Talayan"},{"id":36258,"name":"Talipapa"},{"id":36259,"name":"Tandang Sora"},{"id":36260,"name":"Tatalon"},{"id":36261,"name":"Teachers Village East"},{"id":36262,"name":"Teachers Village West"},{"id":36263,"name":"U.p. Campus"},{"id":36264,"name":"U.p. Village"},{"id":36265,"name":"Ugong Norte"},{"id":36266,"name":"Unang Sigaw"},{"id":36267,"name":"Valencia"},{"id":36268,"name":"Vasra"},{"id":36269,"name":"Veterans Village"},{"id":36270,"name":"Villa Maria Clara"},{"id":36271,"name":"West Kamias"},{"id":36272,"name":"West Triangle"},{"id":36273,"name":"White Plains"}]};
    var regions = {"42":["Abra",[{"id":"246","name":"Bangued","address":"","is_gst_free":""},{"id":"278","name":"Boliney","address":"","is_gst_free":""},{"id":"287","name":"Bucay","address":"","is_gst_free":""},{"id":"309","name":"Bucloc","address":"","is_gst_free":""},{"id":"314","name":"Daguioman","address":"","is_gst_free":""},{"id":"319","name":"Danglas","address":"","is_gst_free":""},{"id":"327","name":"Dolores","address":"","is_gst_free":""},{"id":"343","name":"La Paz","address":"","is_gst_free":""},{"id":"356","name":"Lacub","address":"","is_gst_free":""},{"id":"363","name":"Lagangilang","address":"","is_gst_free":""},{"id":"381","name":"Lagayan","address":"","is_gst_free":""},{"id":"387","name":"Langiden","address":"","is_gst_free":""},{"id":"394","name":"Licuan~Baay","address":"","is_gst_free":""},{"id":"406","name":"Luba","address":"","is_gst_free":""},{"id":"415","name":"Malibcong","address":"","is_gst_free":""},{"id":"428","name":"Manabo","address":"","is_gst_free":""},{"id":"440","name":"Penarrubia","address":"","is_gst_free":""},{"id":"450","name":"Pidigan","address":"","is_gst_free":""},{"id":"466","name":"Pilar","address":"","is_gst_free":""},{"id":"486","name":"Sallapadan","address":"","is_gst_free":""},{"id":"496","name":"San Isidro","address":"","is_gst_free":""},{"id":"506","name":"San Juan","address":"","is_gst_free":""},{"id":"526","name":"San Quintin","address":"","is_gst_free":""},{"id":"533","name":"Tayum","address":"","is_gst_free":""},{"id":"545","name":"Tineg","address":"","is_gst_free":""},{"id":"556","name":"Tubo","address":"","is_gst_free":""},{"id":"567","name":"Villaviciosa","address":"","is_gst_free":""}]],"43":["Agusan Del Norte",[{"id":"576","name":"Buenavista","address":"","is_gst_free":""},{"id":"601","name":"Butuan City","address":"","is_gst_free":""},{"id":"688","name":"Cabadbaran City","address":"","is_gst_free":""},{"id":"719","name":"Carmen","address":"","is_gst_free":""},{"id":"728","name":"Jabonga","address":"","is_gst_free":""},{"id":"744","name":"Kitcharao","address":"","is_gst_free":""},{"id":"756","name":"Las Nieves","address":"","is_gst_free":""},{"id":"777","name":"Magallanes","address":"","is_gst_free":""},{"id":"786","name":"Nasipit","address":"","is_gst_free":""},{"id":"806","name":"Remedios T. 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