@extends('layouts.master')

@section('content')
    <div class="content d-flex flex-column flex-column-fluid" id="kt_content">
        <div id="kt_content_container" class="container-xxl">
            <div class="flex-lg-row-fluid">
                <div class="d-flex flex-wrap flex-stack pb-7">
                    <div class="d-flex flex-wrap align-items-center my-1">
                        <h3 class="fw-bold me-5 my-1">Carrier add
                        </h3>
                    </div>
                </div>
            
                <div class="tab-content">
                    <div id="kt_project_users_table_pane" class="tab-pane fade show active">
                        <div class="card card-flush">
                            <div class="card-body pt-0">
                                <div class="table-responsive p-5">
                                    <form action="{{route('carrierProfile.store')}}" method="post" enctype="multipart/form-data">
                                        @csrf
                                        
                                        <div class="row">
                                        <h3>Carrier Info</h3>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="NAME">Name</label> <span style="color:red">*</span>
                                                    <input type="text" name="NAME" id="NAME" class="form-control" value="" required> 
                                                    <input type="hidden" name="POLICY_NUM" id="POLICY_NUM" class="form-control" value="0">
                                                    <input type="hidden" name="CREATED_DATE" id="CREATED_DATE" class="form-control" value="2025-12-09">
                                                    <input type="hidden" name="MODIFIED_DATE" id="MODIFIED_DATE" class="form-control" value="2025-12-09">
                                                    <input type="hidden" name="MODIFIED_BY" id="MODIFIED_BY" class="form-control" value="1">
                                                    

                                                    
                                                </div>
                                            </div>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="CONTACT_NAME">CONTACT</label> <span style="color:red">*</span>
                                                    <input type="text" name="CONTACT_NAME" id="CONTACT_NAME" class="form-control" value="" required>
                                                </div>
                                            </div>
                                            
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="CONTRACT_ID">EFS Contract Id</label>
                                                    <input type="number" name="CONTRACT_ID" id="CONTRACT_ID" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>

                                        <!-- second row  -->
                                          <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="DOT">DOT #</label>
                                                    <input type="text" name="DOT" id="DOT" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="x_NAME">MC #</label>
                                                    <input type="text" name="MC" id="MC" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="CONTACT_TITLE">Contact Title</label>
                                                    <input type="text" name="CONTACT_TITLE" id="CONTACT_TITLE" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                        <!-- third row  -->
                                            <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="PHONE">PHONE</label><span style="color:red">*</span>
                                                    <input type="text" name="PHONE" id="PHONE" class="form-control" value="" required>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="EMAIL">Email</label><span style="color:red">*</span>
                                                    <input type="email" name="EMAIL" id="EMAIL" class="form-control" value="" required>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="ALT_EMAIL">ALT Email</label>
                                                    <input type="text" name="ALT_EMAIL" id="ALT_EMAIL" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                         <!-- forth row  -->
                                         <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="NUM_TRUCKS"># TRUCKS</label>
                                                    <input type="number" name="NUM_TRUCKS" id="NUM_TRUCKS" class="form-control" value="">
                                                </div>
                                            </div>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="PHONE">ADDRESS</label>
                                                    <textarea name="BILL_TO" id="BILL_TO" cols="15" rows="3"  class="form-control"></textarea>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="EMAIL">NOTES</label>
                                                    <textarea  name="SETUP_NOTES" id="SETUP_NOTES" cols="35" rows="4"  class="form-control"></textarea>
                                                </div>
                                            </div>
                                        </div>

                                     


                                          <!-- forth row  -->
                                          <div class="row">
                                          <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="SUBFLEET">Policy #</label>
                                                    <input type="number" name="SUBFLEET" id="NAME" class="form-control" value="">
                                                </div>
                                            </div>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="SALES_AGENT">Sales Agent</label><span style="color:red">*</span>
                                                    <select class="custom-select form-control" id="SALES_AGENT" name="SALES_AGENT" style="cursor: auto;" required>
		                                                <option value="">Please select</option>
                                                        <option value="1">test</option>		
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="col-md-4">
                                                 <div class="form-group">
                                                    <label for="PHONE">ACTIVE</label><span style="color:red">*</span><br>
                                                    <input type="radio"   name="ACTIVE" id="" value="1" required> <label for="ACTIVE">ACTIVE</label>
                                                    <input type="radio"  name="ACTIVE" id="" value="0" required>  <label for="INACTIVE">INACTIVE</label>
                                                </div>
                                            </div>
                                             
                                        </div>



                                       

                                      
                                         <!-- fifth row  -->
                                         <div class="row">
                                            <h3>Rate Info</h3>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="PHONE">CREDIT OR CARD LIMITS</label><br>
                                                    <input type="radio"   name="SUB_STATUS" id="" value="CREDIT"> <label for="SUB_STATUS_0_118295">CREDIT</label>
                                                    <input type="radio"  name="SUB_STATUS" id="" value="LIMIT">  <label for="SUB_STATUS_0_118295">LIMIT</label>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                 <div class="form-group">
                                                    <label for="PHONE">CREDIT OR CARD LIMITS</label><span style="color:red">*</span><br>
                                                    <input type="radio"   name="EMAIL_REPORTS" id="" value="YES" required> <label for="EMAIL_REPORTS">YES</label>
                                                    <input type="radio"  name="EMAIL_REPORTS" id="" value="NO" required>  <label for="EMAIL_REPORTS">NO</label>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="ALT_EMAIL">AUTOMATED WEEKLY EMAILS</label>
                                                    <input type="text" name="ALT_EMAIL" id="ALT_EMAIL" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                         <!-- sixth row  -->
                                         <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="MARGIN_RATE">MIN RATE (TMS KEEPS)</label>
                                                    <input type="number" name="MARGIN_RATE" id="MARGIN_RATE" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="AMB_RATE">AMBEST RATE</label>
                                                    <input type="number" name="AMB_RATE" id="AMB_RATE" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="SAPP_RATE">SAPP BROS RATE</label>
                                                    <input type="number" name="SAPP_RATE" id="SAPP_RATE" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                         <!-- seven row  -->
                                         <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="TA_RATE">TA RATE</label><span style="color:red">*</span>
                                                    <input type="number" name="TA_RATE" id="TA_RATE" class="form-control" value="" required>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="PILOT_RATE">Pilot/Flying J RATE</label><span style="color:red">*</span>
                                                    <input type="number" name="PILOT_RATE" id="PILOT_RATE" class="form-control" value="" required>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="SAPP_RATE">SAPP BROS RATE</label>
                                                    <input type="number" name="SAPP_RATE" id="SAPP_RATE" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>

                                             <!-- eighth row  -->
                                             <div class="row">
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="RR_RATE">ROAD RANGER RATE</label></label><span style="color:red">*</span>
                                                    <input type="number" name="RR_RATE" id="RR_RATE" class="form-control" value="" required>
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="AMB_RATE">Charge Swipe Fee</label>
                                                    <input type="radio"   name="BANK_REJECTS" id="" value="1"> <label for="BANK_REJECTS">YES</label>
                                                    <input type="radio"  name="BANK_REJECTS" id="" value="0">  <label for="BANK_REJECTS">NO</label>
                                                </div>
                                            </div>
                                          
                                        </div>


                                             <!-- nine row  -->
                                             <div class="row">
                                                <h3>Payment Details</h3>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="MARGIN_RATE">Pay Days</label><br>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="MON"> <label  for="x_PAYMENT_TERMS[]">MON</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="TUE"> <label  for="x_PAYMENT_TERMS[]">TUE</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="WED"> <label  for="x_PAYMENT_TERMS[]">WED</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="THU"> <label  for="x_PAYMENT_TERMS[]">THU</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="FRI"> <label  for="x_PAYMENT_TERMS[]">FRI</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="SUN"> <label  for="x_PAYMENT_TERMS[]">SUN</label>
                                                    <input type="checkbox" name="PAYMENT_TERMS[]"   value="PRE"> <label  for="x_PAYMENT_TERMS[]">PRE PAID</label>                                                   
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="AMB_RATE">Bank Account #</label>
                                                    <input type="text" name="ACH_ACC" id="ACH_ACC" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="ACH_ROUTE">Bank Routing #</label>
                                                    <input type="text" name="ACH_ROUTE" id="ACH_ROUTE" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                          <!-- ten row  -->
                                          <div class="row">
                                                <h3>Money Codes</h3>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="MC_LIMIT">Max Amount Per Transaction</label>
                                                    <input type="number" name="MC_LIMIT" id="MC_LIMIT" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="MC_DAYS">Max Transactions per Day</label>
                                                    <input type="number" name="MC_DAYS" id="MC_DAYS" class="form-control" value="">
                                                </div>
                                            </div>
                                             <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="MC_WEEK">Max Transaction per Week</label>
                                                    <input type="number" name="MC_WEEK" id="MC_WEEK" class="form-control" value="">
                                                </div>
                                            </div>
                                        </div>
                                           <!-- ten row  -->
                                           <div class="row">
                                                <h3>Carrier Documents</h3>
                                            <div class="col-md-4">
                                                <div class="form-group">
                                                    <label for="DOCUMENTS">Documents</label>
                                                    <input type="file" name="DOCUMENTS" id="DOCUMENTS" class="form-control" value="">
                                                </div>
                                            </div>
                                            
                                        </div>
                                         <!-- ten row  -->
                                         <div class="row mt-3">
                                            
                                            <div class="col-md-4">
                                                <div class="form-group">

                                                    <button type="submit" class="btn btn-primary">Save </button>
                                                </div>
                                            </div>
                                            
                                        </div>


                                    </form>
                                 
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
@endsection()
@section('script')
 
    <script>
       
    </script>
@endsection()