{{ $pages->fldPagesName }}
{!! $pages->fldPagesDescription !!} @if(Session::has('error')){{ Session::get('error') }}
@endif
{!! Form::open(array('url' => '/registration', 'method' => 'post', 'class' => 'row-fluid input-100 bill-info','id'=>'registration_form', 'onSubmit'=>'return validateMeForm()')); !!}
{!! Form::label('firstname', 'First Name *'); !!}
{!! Form::text('firstname',"",array('id'=>'firstname','required','class'=>'form-control char-only')) !!}
@if($errors->registration->first('firstname'))
{!!$errors->registration->first('firstname')!!}
@endif
{!! Form::label('lastname', 'Last Name *'); !!}
{!! Form::text('lastname', "",array('id'=>'lastname','required','class'=>'form-control')) !!}
@if($errors->registration->first('lastname'))
{!!$errors->registration->first('lastname')!!}
@endif
{!! Form::label('email', 'Email Address *'); !!}
{!! Form::email('email',"",array('id'=>'email','required','class'=>'form-control')) !!}
@if($errors->registration->first('email'))
{!!$errors->registration->first('email')!!}
@endif
{!! Form::label('phone', 'Phone Number *'); !!}
{!! Form::text('phone',"",array('id'=>'phone','required','class'=>'form-control phone_us')) !!}
@if($errors->registration->first('phone'))
{!!$errors->registration->first('phone')!!}
@endif
{!! Form::label('password', 'Password *',array( )); !!}
{!! Form::password('password','',array('id'=>'password','required'=>'required','class'=>'form-control password-fld')) !!}
@if($errors->registration->first('password'))
at least 8 char | an uppercase | a number | special char |
{!!$errors->registration->first('password')!!}
@endif
{!! Form::label('password_confirmation', 'Retype Password *'); !!}
{!! Form::password('password_confirmation','',array('id'=>'password_confirmation','required','class'=>'form-control password-confirm-fld')) !!}
@if($errors->registration->first('password_confirmation'))
{!!$errors->registration->first('password_confirmation')!!}
@endif
Please Wait...
{!! Form::submit('Register',array('name'=>'register','class'=>'uk-button uk-button-primary uk-display-inline-block widauto'))!!}
Registered Customers
If you already have an account with us, please log in.
{!! Html::link('login', "Login",array('class'=>'uk-button float-none uk-button-primary')) !!}