@extends('layout.AtoZPortal.login')

@section('content')
<style>
	.portalcountry{
		background-color: #1f1f1f !important;
	}
</style>
   <div class="login-container">

   	<div class="login-header login-caret">

   		<div class="login-content">

			@if(Session::get('user_site_configrations.Logo')!='')
				<a href="" class="logo">
					<img src="{{Session::get('user_site_configrations.Logo')}}" width="120" alt="" />
				</a>
			@endif

   			<p class="description" style="color: #fff">Create an account, it's free and takes few moments only!</p>

   			<!-- progress bar indicator -->
   			<div class="login-progressbar-indicator">
   				<h3>43%</h3>
   				<span>logging in...</span>
   			</div>
   		</div>

   	</div>

   	<div class="login-progressbar">
   		<div></div>
   	</div>

   	<div class="login-form">

   		<div class="login-content">

            <div class="form-login-error">
                <h3>Problem Registering</h3>
                <p></p>
            </div>
            <div class="form-register-success">
                <i class="entypo-check"></i>
                <h3>You have been successfully registered.</h3>
                <p>We have emailed you the login details for your account.</p>
            </div>
   			<form method="post" role="form" id="form_portal_register">




   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-user"></i>
   								</div>
   								<input type="text" class="form-control" name="AccountName" id="AccountName" placeholder="Account Name" autocomplete="off" />
   							</div>
   						</div>
   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-user"></i>
   								</div>

   								<input type="text" class="form-control" name="FirstName" id="FirstName" placeholder="First Name" autocomplete="off" />
   							</div>
   						</div>
   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-user"></i>
   								</div>

   								<input type="text" class="form-control" name="LastName" id="LastName" placeholder="Last Name" autocomplete="off" />
   							</div>
   						</div>
						<div class="form-group">
							<div class="input-group">
								<div class="input-group-addon">
									<i class="entypo-user"></i>
								</div>

								<input type="text" class="form-control" name="Address1" id="Address1" placeholder="Address Line 1" autocomplete="off" />
							</div>
						</div>
						<div class="form-group">
							<div class="input-group">
								<div class="input-group-addon">
									<i class="entypo-user"></i>
								</div>

								<input type="text" class="form-control" name="Address2" id="Address2" placeholder="Address Line 2" autocomplete="off" />
							</div>
						</div>
						<div class="form-group">
							<div class="input-group">
								<div class="input-group-addon">
									<i class="entypo-user"></i>
								</div>

								<input type="text" class="form-control" name="City" id="City" placeholder="City" autocomplete="off" />
							</div>
						</div>
						<div class="form-group">
							<div class="input-group">
								<div class="input-group-addon">
									<i class="entypo-user"></i>
								</div>

								<input type="text" class="form-control" name="PostCode" id="PostCode" placeholder="PostCode" autocomplete="off" />
							</div>
						</div>
						<div class="form-group">
							<div class="input-group">
								<div class="input-group-addon">
									<i class="entypo-user"></i>
								</div>
								{{Form::select('Country', Country::getCountryDropdownList(),'',array("class"=>"form-control portalcountry"))}}
							</div>
						</div>

   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-phone"></i>
   								</div>

   								<input type="text" class="form-control" name="Phone" id="Phone" placeholder="Phone Number" data-mask="phone" autocomplete="off" />
   							</div>
   						</div>

   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-mail"></i>
   								</div>

   								<input type="text" class="form-control" name="Email" id="Email" data-mask="email" placeholder="E-mail" autocomplete="off" />
   							</div>
   						</div>

   						<div class="form-group">
   							<div class="input-group">
   								<div class="input-group-addon">
   									<i class="entypo-lock"></i>
   								</div>

   								<input type="password" class="form-control" name="Password" id="Password" placeholder="Choose Password" autocomplete="off" />
   							</div>
   						</div>



   						<div class="form-group">
                            <button type="submit" class="btn btn-primary btn-block btn-login">
                                <i class="entypo-right-open-mini"></i>
                                Register
                            </button>
                        </div>



   			</form>


   			<div class="login-bottom-links">

   				<a href="{{URL::to('/portal/login')}}" class="link">
   					<i class="entypo-lock"></i>
   					Return to Login Page
   				</a>

   				<br />



   			</div>

   		</div>

   	</div>

   </div>


@stop