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Server: Microsoft-IIS/8.5
System: Windows NT YDAWBH120 6.3 build 9600 (Windows Server 2012 R2 Standard Edition) AMD64
User: tentjecom_web (0)
PHP: 7.4.14
Disabled: NONE
Upload Files
File: D:/HostingSpaces/SBogers60/agrimac.nl/app/storage/views/54390f73853745171448d2870184c7fc
<div class="small-offer-form">

    <?php if(!$page->send): ?>

        <h3><?php echo KommaLang::get('smallOfferForm.title'); ?></h3>
        <p><?php echo KommaLang::get('smallOfferForm.text'); ?></p>

        <?php echo Form::open(['url' => URL::to(route('smallOffer.process'), [], true), 'id' => 'smallOfferForm', 'class' => 'form']); ?>


    <input name="truckType" type="hidden" value="<?php echo $page->project->translation->name_short; ?>">

        <div class="name form-element ">
            <?php echo Form::label('name',trans('translations.name')); ?>

            <span class="error-message <?php echo ($errors->has('name')? 'active' :''); ?>"><?php echo $errors->first('name'); ?></span>
            <?php echo Form::text('name', Input::old('name'), ['id' => 'name']); ?>

        </div>

        <div class="company form-element">
            <?php echo Form::label('company',trans('translations.company')); ?>

            <span class="error-message <?php echo ($errors->has('company')? 'active' :''); ?>"><?php echo $errors->first('company'); ?></span>
            <?php echo Form::text('company', Input::old('company'), ['id' => 'company']); ?>

        </div>

        <div class="city form-element">
            <?php echo Form::label('city',trans('translations.city')); ?>

            <span class="error-message <?php echo ($errors->has('city')? 'active' :''); ?>"><?php echo $errors->first('city'); ?></span>
            <?php echo Form::text('city', Input::old('city'), ['id' => 'city']); ?>

        </div>

        <div class="phone form-element">
            <?php echo Form::label('phone',trans('translations.phone')); ?>

            <span class="error-message <?php echo ($errors->has('phone')? 'active' :''); ?>"><?php echo $errors->first('phone'); ?></span>
            <?php echo Form::text('phone', Input::old('phone'), ['id' => 'phone']); ?>

        </div>
        <div class="time-slot form-element select">
            <p class="label"><?php echo \Illuminate\Support\Facades\Lang::get('translations.bestContactMoment'); ?></p>
            <div class="select-wrapper">
                <span class="icon"></span>
                <select name="timeSlot" id="timeSlot">


                    <?php foreach(trans('translations.timeSlots') as $key => $value): ?>
                        <option <?php if(Input::old('timeSlot', null) == $value): ?> selected="selected"
                                <?php endif; ?> value="<?php echo $value; ?>"><?php echo $value; ?></option>
                    <?php endforeach; ?>

                </select>
            </div>
        </div>


        <div class="submit">
            <p class="button">
                <?php echo \Illuminate\Support\Facades\Lang::get('translations.send2'); ?>
            </p>
            <?php echo Form::submit(trans('translations.send2')); ?>

        </div>

        <?php echo Form::close(); ?>


    <?php endif; ?>

</div>