<?php $__env->startSection('content'); ?>
	<div class="row">
    	<div class="col-lg-12">
    		<h1 class="page-header">Notifications</h1>
    	</div>
    </div>
            <div class="row">
                <div class="col-lg-12">
                    <div class="panel panel-default">
                    
                    	<?php if(session('status')): ?>
						<div class="alert alert-success">
							<?php echo e(session('status')); ?>

						</div>
						<?php endif; ?>
						<?php if(count($errors) > 0): ?>
							<div class="alert alert-danger">
								<strong>Whoops!</strong> There were some problems with your input.<br><br>
								<ul>
									<?php foreach($errors->all() as $error): ?>
										<li><?php echo e($error); ?></li>
									<?php endforeach; ?>
								</ul>
							</div>
						<?php endif; ?>

						<div class="panel-heading">
							Add Record
                        </div>
                        <div class="panel-body">
                            <div class="row">
                                <div class="col-lg-12">
				                    <form class="form-horizontal" role="form" method="POST" action="<?php echo e(url('admin/emma/add')); ?>">
										<input type="hidden" name="_token" value="<?php echo e(csrf_token()); ?>">
										<div class="form-group">
											<label class="col-md-2 control-label">Email</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="email" value="<?php echo e(old('email')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">First Name</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="first_name" value="<?php echo e(old('first_name')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Last Name</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="last_name" value="<?php echo e(old('last_name')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Company Name</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="company_name" value="<?php echo e(old('company_name')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Address</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="address" value="<?php echo e(old('address')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">City</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="city" value="<?php echo e(old('city')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">State</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="state" value="<?php echo e(old('state')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Zip Code</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="postal_code" value="<?php echo e(old('postal_code')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Phone</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="phone" value="<?php echo e(old('phone')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Account #</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="account" value="<?php echo e(old('account')); ?>">	
											</div>
										</div>

										<input type="hidden" class="form-control" name="connection_type" value="Business">	

										<div class="form-group">
											<label class="col-md-2 control-label">Account Exec</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="account_exec" value="<?php echo e(old('account_exec')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Region</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="region" value="<?php echo e(old('region')); ?>">	
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Start Date</label>
											<div class="col-md-8">
												<input type="text" class="form-control" name="start_date" value="<?php echo e(old('start_date')); ?>" placeholder="Example: @D:2015-12-27">	
											</div>
										</div>
										<!-- 
										<div class="form-group">
											<label class="col-md-2 control-label">Business</label>
											<div class="col-md-1">
												<input type="checkbox" class="form-control" name="business_group" value="1" <?php echo e(old('business_group') ? 'checked': ''); ?>>
											</div>
										</div>
										<div class="form-group">
											<label class="col-md-2 control-label">Technical</label>
											<div class="col-md-1">
												<input type="checkbox" class="form-control" name="technical_group" value="1" <?php echo e(old('technical_group') ? 'checked': ''); ?>>
											</div>
										</div>
										-->
										
										<div class="form-group">
											<div class="col-md-6 col-md-offset-0">
												<button type="submit" class="btn btn-primary">
													<i class="fa fa-cloud-upload fa-fw"></i> Add
												</button>
											</div>
										</div>
										
									</form>
								</div>
							</div>
						</div>
					</div>
				</div>
			</div>


<?php $__env->stopSection(); ?>

<?php $__env->startSection('extras'); ?>

<?php $__env->stopSection(); ?>
<?php echo $__env->make('residential.templates.uadmin', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>