{!! Form::open([
'url' => 'api/lead',
'id' => 'lead',
'class' => 'ajaxform',
'data-endpoint' => 'lead']) !!}
{!! Form::hidden('referrer', $referrer) !!}
{!! Form::hidden('id', null, ['id' => 'lead_id']) !!}
{!! Form::hidden('isVoucherClaim', true) !!}
{!! Form::text('fullname', null, [
'placeholder' => 'Full name',
'class' => 'form-control',
'maxlength' => 240]) !!}
{!! Form::text('adr[address_line_1]',
$address->address_line_1 ?? '', [
'placeholder' => '1st line of address',
'class' => 'form-control',
'maxlength' => 240]) !!}
{!! Form::text('adr[address_line_2]',
$address->address_line_2 ?? '', [
'placeholder' => '2nd line of address',
'class' => 'form-control',
'maxlength' => 240]) !!}
{!! Form::text('adr[address_line_3]',
$address->address_line_3 ?? '', [
'placeholder' => '3rd line of address',
'class' => 'form-control',
'maxlength' => 240]) !!}
{!! Form::text('adr[city]',
$address->city ?? '', [
'placeholder' => 'City / Town',
'class' => 'form-control',
'id' => 'adr_city',
'maxlength' => 120]) !!}
{!! Form::text('adr[county]',
$address->county ?? '', [
'placeholder' => 'County / Region',
'class' => 'form-control',
'id' => 'adr_county',
'maxlength' => 120]) !!}
{!! Form::text('adr[postcode]',
$address->postcode ?? '', [
'placeholder' => 'Postcode',
'class' => 'form-control',
'id' => 'adr_postcode',
'maxlength' => 12]) !!}
{!! Form::email('adr[email]', null, [
'placeholder' => 'Email',
'class' => 'form-control',
'autocomplete' => 'email',
'maxlength' => 120]) !!}
{!! Form::email('cemail', null, [
'placeholder' => 'Confirm email',
'class' => 'form-control',
'autocomplete' => 'email',
'maxlength' => 120]) !!}
{!! Form::text('adr[telephone]', null, [
'placeholder' => '*Contact phone number',
'class' => 'form-control',
'maxlength' => 22]) !!}
Address type:
{!! Form::select('adr[type]',
array_slice(config('enum.address_types'), 0, 3),
$address->type ?? 1, ['id' => 'type-select']) !!}
{!! Form::checkbox('contact_consent', 1, false,
['id' => 'contact_consent', 'class' => 'p-0']) !!}
{!! Form::label('contact_consent', '
Confirm you give consent for us to contact you with updates about our internet service in your area.') !!}
{!! Form::close() !!}