@extends('frontend.layouts.app')

@section('content')
<style type="text/css">
   .page-header  {position: relative; display: flex;  align-items: center; background: url("{{ asset('frontend/images/enquiry.jpg') }}") 0 0 no-repeat; background-position: 0 0; background-size: 100%; min-height: 160px; padding: 0}
    .head-text { margin:0; font-size: 30px }
    .head-text  {}
    .card {
    box-shadow: 0px 1px 5px 1px rgb(0 0 0 / 10%);
    border-radius: 5px;
    margin: 20px 0 10px;
    padding: 25px;
    background: #fff;
    }
    .page-title {font-size: 20px}
    .form-control {border-color: #ccc}
    .enq_form .form-group label {font-weight: 600}
</style>
     <div class="page-header">
        <div class="container pl-2 pl-md-5">
            <h1 class="head-text">Online Store/Partner Enquiry Form</h1>
        </div>
    </div>
    <div  >
       <div class="section-block enq_form pt-4 bg-light">
        <div class="container">
             <div class="row">
                 <div class="col-md-11 mx-auto">
                     <h4 class="page-title">Personal Details</h4>
                     <div class="card">
                         <div class="row">
                                <div class="col-md-4">
                                    <div class="form-group">
                                        <label>Full Name <span>*</span></label>
                                        <input type="text" placeholder="What should we call you?" class="form-control" name="name" required="" id="name" />
                                    </div>
                                </div>
                                <div class="col-md-4">
                                    <div class="form-group">
                                        <label>DOB (mm/dd/yyyy) <span>*</span></label>
                                        <input type="text"  placeholder="01/01/1970" class="form-control" name="mobile" required="" id="mobile" />
                                    </div>
                                </div>
                                 <div class="col-md-4">
                                    <div class="form-group">
                                        <label>Email <span>*</span></label>
                                        <input type="email" placeholder="Where should we email you back?" class="form-control" name="email" required="" id="email" />
                                    </div>
                                </div>
                                <div class="col-md-12">
                                    <div class="form-group">
                                        <label>Address <span>*</span></label>
                                        <textarea placeholder="Enter your address" class="form-control" name="address"></textarea>

                                    </div>
                                </div>

                                <div class="col-md-4">
                                    <div class="form-group">
                                        <label>Mobile No. <span>*</span></label>
                                        <input type="text"   placeholder="Where should we call you?" class="form-control" name="mobile" required="" id="mobile" />
                                    </div>
                                </div>
                                 <div class="col-md-4">
                                    <div class="form-group">
                                        <label>Highest Educational Qualification  <span>*</span></label>
                                        <input type="text"   placeholder="Enter here" class="form-control" name="education" required=""   />
                                    </div>
                                </div>

                                <div class="col-md-4">
                                    <div class="form-group">
                                        <label>Profession  <span>*</span></label>

                                        <select class="form-control" name="experience" id="experience">
                                            <option value="1">Service</option>
                                            <option value="2">Self Employed</option>

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


                            </div>

                     </div>
                       <h4 class="page-title mt-4">Business/ Service Profile</h4>
                         <div class="card">
                             <div class="row">
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Firm/Employer Name<span>*</span></label>
                                            <input type="text" placeholder="Enter here" class="form-control" name="emp_name" required=""   />
                                        </div>
                                    </div>
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Nature of Business of Firm/ Employer <span>*</span></label>
                                            <input type="text"  placeholder="Enter here" class="form-control" name="nature" required=""   />
                                        </div>
                                    </div>
                                     <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Years of Experience (Service/ Business) <span>*</span></label>
                                            <input type="text" placeholder="Enter here" class="form-control" name="exp" required=""  />
                                        </div>
                                    </div>
                                     <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Current Annual Turnover (Rs Lacs/annum) <span>*</span></label>
                                            <input type="text" placeholder="Enter here" class="form-control" name="trunover" required=""  />
                                        </div>
                                    </div>

                                </div>

                          </div>

                         <h4 class="page-title mt-4">Proposal Details</h4>
                         <div class="card">
                             <div class="row">
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>City for Khadi India online store<span>*</span></label>
                                            <select class="form-control">
                                                <option>Lucknow</option>
                                                <option>Delhi</option>
                                                <option>Mumbai</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Proposed Location/ Market<span>*</span></label>
                                            <input type="text"   placeholder="Enter here" class="form-control" name="location" required=""   />
                                        </div>
                                    </div>
                                     <div class="col-md-4">
                                        <div class="form-group">
                                            <label>State <span>*</span></label>
                                            <select class="form-control">
                                                <option>Uttar Pradesh</option>
                                                <option>Delhi</option>
                                                <option>Maharashtra</option>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Type of products you are interested with <span>*</span></label>
                                            <select class="form-control">
                                                <option>Select</option>
                                                <option>Apparel / Fabrics / Clothing / Sarees</option>
                                                <option>Beauty Care (Shampoo, Hair oil, Face cream etc.) </option>
                                               <option> Essential items (Masks, Sanitizers etc.) </option>
                                                <option>Pooja items (Dhoop/ Agarbatti etc.) </option>
                                                <option>Furniture's</option>
                                                <option>Gift Items</option>
                                                <option>Grocery (Spices, Papad, Honey, Cereals, Consumables etc.)</option>
                                                <option>Health & Wellness Products (Herbal, diet products etc.)</option>
                                                <option>Home Furnishing (Bedsheets, Towels, Kitchen Linens etc.)</option>
                                                <option>Home Décor</option>
                                                <option>Leather Products (Leather bags, Belts, Shoes etc.)</option>
                                                <option>Personal care (Soaps, toothpaste etc.)</option>
                                                <option>Stationary</option>
                                                <option>All  of the above</option>

                                            </select>
                                        </div>
                                    </div>
                                     <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Your Investment Budget (Rs Lacs) <span>*</span></label>
                                            <input type="text" placeholder="Enter here" class="form-control" name="budget" required=""  />
                                        </div>
                                    </div>
                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label>Other Major Brands Present in the Vicinity <span>*</span></label>
                                            <input type="text" placeholder="Enter here" class="form-control" name="brands" required=""  />
                                        </div>
                                    </div>

                                </div>

                          </div>

                            <h4 class="page-title mt-4">Property Details</h4>
                             <div class="card mb-5">
                                 <div class="row">
                                        <div class="col-md-4">
                                            <div class="form-group">
                                                <label>Property<span>*</span></label>
                                                <select class="form-control">
                                                   <option>Rented</option>
                                                   <option>Owned</option>

                                                </select>
                                            </div>
                                        </div>
                                        <div class="col-md-4">
                                            <div class="form-group">
                                                <label>Area in sq. ft (Carpet)<span>*</span></label>
                                                <input type="text"   placeholder="Enter here" class="form-control" name="area" required=""   />
                                            </div>
                                        </div>
                                         <div class="col-md-4">
                                            <div class="form-group">
                                                <label>No. of floors <span>*</span></label>
                                                <input type="text"   placeholder="Enter here" class="form-control" name="floors" required=""   />
                                            </div>
                                        </div>
                                        <div class="col-md-4">
                                            <div class="form-group">
                                                <label>Proposed Floor <span>*</span></label>
                                                <input type="text"   placeholder="Enter here" class="form-control" name="p-floor" required=""   />
                                            </div>
                                        </div>
                                         <div class="col-md-4">
                                            <div class="form-group">
                                                <label>Frontage (in feet) <span>*</span></label>
                                                <input type="text"   placeholder="Enter here" class="form-control" name="frontage" required=""   />
                                            </div>
                                        </div>


                                    </div>

                                </div>
                                <div class="col-md-12 text-right mt-2 pr-0">
                                    <div class="form-group mb-5">
                                        <input type="hidden" value="Yes" class="btn" name="action" />
                                        <input type="button"   class="btn btn-secondary btn-lg" value="Submit" />
                                    </div>
                                </div>
                     </div>
             </div>
        </div>
    </div>

@endsection