<div class="pop-up-background"> <div class="background"></div> <div class="pop-up"> <header> <div class="logo"></div> </header> <div class="thanks"> <h4><?php echo \Illuminate\Support\Facades\Lang::get('translations.thanksTitle'); ?></h4> <p><?php echo \Illuminate\Support\Facades\Lang::get('translations.thanksText'); ?></p> <div class="close"><p><?php echo \Illuminate\Support\Facades\Lang::get('translations.close'); ?></p></div> </div> <?php echo Form::open(['method' => 'post', 'url' => '/mailInformation', 'id'=>'popUpMail']); ?> <section class="input"> <?php /* <h5><?php echo \Illuminate\Support\Facades\Lang::get('translations.howCanWeHelp'); ?></h5>*/ ?> <h2 class="in-touch"><?php echo \Illuminate\Support\Facades\Lang::get('translations.keepUptodateLocation'); ?></h2> <div class="checkBox hide"> <?php if((isset($data->city) && $data->city != null )): ?> <?php echo Form::checkbox($data->city, $data->city, 1,['id'=>'city_name']); ?> <?php elseif(\Input::has('city') && (\Input::get('city') != '')): ?> ) <?php echo Form::checkbox(\Input::get('city'), \Input::get('city'), 1,['id'=>'city_name']); ?> <?php endif; ?> <?php echo Form::checkbox(\Input::get('city'), \Input::get('city'), 1,['id'=>'city_name']); ?> <?php echo Form::label('city_name', trans('translations.keepUptodateLocation')); ?> </div> </section> <hr> <section class="form"> <h5><?php echo \Illuminate\Support\Facades\Lang::get('translations.yourInfo'); ?></h5> <div class="contact-info"> <div class="input-rows"> <?php echo Form::label('name', trans('translations.name')); ?> <?php echo Form::text('name', null ,['id'=>'name', 'placeholder' => trans('translations.name')]); ?> </div> <div class="input-rows"> <?php echo Form::label('sur_name', trans('translations.surName')); ?> <?php echo Form::text('sur_name', null ,['id'=>'sur_name', 'placeholder' => trans('translations.surName')]); ?> </div> <div class="input-rows"> <?php echo Form::label('email', trans('translations.email')); ?> <?php echo Form::email('email', null ,['id'=>'email', 'placeholder' => trans('translations.email')]); ?> </div> <div class="input-rows"> <?php echo Form::label('phone', trans('translations.phone')); ?> <?php echo Form::text('phone', null ,['id'=>'phone', 'placeholder' => trans('translations.phone')]); ?> </div> <div class="input-rows text-area-row"> <?php echo Form::label('extra_message', trans('translations.extraMessage')); ?> <?php echo Form::textarea('extra_message', null ,['id'=>'extra_message', 'rows'=>'6', 'data-autoresize'=>'', 'placeholder' => trans('translations.extraMessage')]); ?> </div> <div class="hide"> <?php echo Form::submit('Zoeken'); ?> </div> </div> </section> <?php echo Form::close(); ?> <div id="sendButton"> <p><?php echo \Illuminate\Support\Facades\Lang::get('translations.sendButton'); ?></p> </div> </div> </div>