suwako / LittleBeast

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LittleBeast / view / openprovider / createcustomer.maron
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1{@ include(common/header) @}
2 <h2>新規顧客様作成</h2>
3{@ if (!empty($err)) @}
4 <p class="errormes">
5{@ foreach ($err as $e) @}
6 {{ $e }}<br />
7{@ endforeach @}
8 </p>
9{@ endif @}
10 <p>
11 <form method="POST" action="/openprovider/createcustomer">
12 <h3>会社情報</h3>
13 <p>個人の場合、入力が不要です。</p>
14 <table>
15 <tbody>
16 <tr>
17 <td><label for="company_name">会社名</label></td>
18 <td><input type="text" name="company_name" value="{{ $data['company_name'] ?? '' }}" /></td>
19 </tr>
20 <tr>
21 <td><label for="company_registration_number">法人番号</label></td>
22 <td><input type="text" name="company_registration_number" value="{{ $data['additional_data']['company_registration_number'] ?? '' }}" /></td>
23 </tr>
24 <tr>
25 <td><label for="company_url">ウェブサイト</label></td>
26 <td><input type="text" name="company_url" value="{{ $data['additional_data']['company_url'] ?? '' }}" /></td>
27 </tr>
28 </tbody>
29 </table>
30 <h3>個人情報</h3>
31 <table>
32 <tbody>
33 <tr>
34 <td><label for="last_name">姓名（ローマ字）*</label></td>
35 <td>
36 <input type="text" name="last_name" placeholder="Taro" value="{{ $data['name']['last_name'] ?? '' }}" />
37 <input type="text" name="first_name" placeholder="Yamada" value="{{ $data['name']['first_name'] ?? '' }}" />
38 </td>
39 </tr>
40 <tr>
41 <td><label for="phone.country_code">電話番号*</label></td>
42 <td>
43 <input type="text" name="phone.country_code" placeholder="+81" value="{{ $data['phone']['country_code'] ?? '' }}" />
44 <input type="number" name="phone.area_code" placeholder="43" value="{{ $data['phone']['area_code'] ?? '' }}" />
45 <input type="number" name="phone.subscriber_number" placeholder="0000000" value="{{ $data['phone']['subscriber_number'] ?? '' }}" />
46 </td>
47 </tr>
48 <tr>
49 <td><label for="fax.country_code">FAX</label></td>
50 <td>
51 <input type="text" name="fax.country_code" placeholder="+81" value="{{ $data['fax']['country_code'] ?? '' }}" />
52 <input type="number" name="fax.area_code" placeholder="43" value="{{ $data['fax']['area_code'] ?? '' }}" />
53 <input type="number" name="fax.subscriber_number" placeholder="0000000" value="{{ $data['fax']['subscriber_number'] ?? '' }}" />
54 </td>
55 </tr>
56 <tr>
57 <td><label for="email">メールアドレス*</label></td>
58 <td><input type="text" name="email" placeholder="taro@076.co.jp" value="{{ $data['email'] ?? '' }}" /></td>
59 </tr>
60 <tr>
61 <td><label for="birth_year">生年月日</label></td>
62 <td>
63 <input type="number" name="birth_year" placeholder="1970" value="{{ $data['birth']['year'] ?? '' }}" />年
64 <input type="number" name="birth_month" placeholder="12" value="{{ $data['birth']['month'] ?? '' }}" />月
65 <input type="number" name="birth_day" placeholder="31" value="{{ $data['birth']['day'] ?? '' }}" />日
66 </td>
67 </tr>
68 </tbody>
69 </table>
70 <h3>住所情報</h3>
71 <table>
72 <tbody>
73 <tr>
74 <td><label for="address_zipcode">郵便番号*（ハイフン付き）</label></td>
75 <td>〒<input type="number" name="address_zipcode" value="{{ $data['address']['zipcode'] ?? '' }}" /></td>
76 </tr>
77 <tr>
78 <td><label for="address_state">都道府県*</label></td>
79 <td><input type="text" name="address_state" value="{{ $data['address']['state'] ?? '' }}" /></td>
80 </tr>
81 <tr>
82 <td><label for="address_city">市区町村*</label></td>
83 <td><input type="text" name="address_city" value="{{ $data['address']['city'] ?? '' }}" /></td>
84 </tr>
85 <tr>
86 <td><label for="address_street">町名*</label></td>
87 <td><input type="text" name="address_street" value="{{ $data['address']['street'] ?? '' }}" /></td>
88 </tr>
89 <tr>
90 <td><label for="address_number">番地*</label></td>
91 <td><input type="text" name="address_number" value="{{ $data['address']['number'] ?? '' }}" /></td>
92 </tr>
93 <tr>
94 <td><label for="address_country">国</label></td>
95 <td>
96 <select name="address_country">
97 <option value="JP" selected="selected">日本</option>
98 <option value="NL">オランダ</option>
99 </select>
100 </td>
101 </tr>
102 <tr>
103 <td><label for="comments">メモ</label></td>
104 <td><input type="text" name="comments" value="{{ $data['comments'] ?? '' }}" /></td>
105 </tr>
106 </tbody>
107 </table>
108 <button>送信</button>
109 </form>
110 </p>
111{@ include(common/footer) @}