@include('admin.includes.head')
@include('admin.includes.sidebar')
@include('admin.includes.topbar')
<!-- Main content-->
<!-- Main content-->

<div class="container">
    <div class="row p-4 ">
        <div class="col-md-12 mx-auto d-block card shadow-lg p-5 my-2">
            <form
                action="{{ route('admin.request-refund-payment', [base64_encode($payment_data[0]['insertedId']), base64_encode($payment_data[0]['memberId'])]) }}"
                method="post">
                @csrf
                <fieldset class="border-2">
                    <legend class="legend-outer  float-none w-auto"> Payment Refund Form ( Order No#:
                        {{ $payment_data[0]['batchNo'] }})</legend>

                    <div class="row">
                        <div class="col-md-12">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Service Name</legend>
                                <div class="input-group">
                                    <i class="fa fa-place-of-worship fa2"></i>
                                    <input type="text" class="form-control border-dark mb-1 " name="serviceName"
                                        id="serviceName" placeholder="Service Date"
                                        value="{{ old('serviceName', isset($payment_data[0]['paymentsData'][0]['ServiceSetup']) ? $payment_data[0]['paymentsData'][0]['ServiceSetup'] : '') }}
"
                                        required readonly>
                                    <input type="text" name="orderno" value="{{ $payment_data[0]['batchNo'] }}"
                                        hidden>
                                </div>
                            </fieldset>
                        </div>
                        <div class="col-md-4">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Service Date</legend>
                                <div class="input-group">
                                    <i class="fa fa-calendar fa2"></i>
                                    <input type="text" class="form-control border-dark mb-1 " name="serviceDate"
                                        id="serviceDate" placeholder="Service Date"
                                        value="{{ old('serviceDate', isset($payment_data[0]['paymentsData'][0]['serviceDate']) ? $payment_data[0]['paymentsData'][0]['serviceDate'] : '') }}
"
                                        required readonly>
                                </div>
                            </fieldset>
                        </div>
                        <div class="col-md-2">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Quantity</legend>
                                <div class="input-group">
                                    <input type="text" class="form-control border-dark mb-1 " name="serviceQty"
                                        id="serviceQty" placeholder="Service Quantity"
                                        value="{{ old('serviceQty', isset($payment_data[0]['paymentsData'][0]['qty']) ? $payment_data[0]['paymentsData'][0]['qty'] : '') }}
"
                                        required readonly>
                                </div>
                            </fieldset>
                        </div>


                        <div class="col-md-3">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Service Amount</legend>
                                <div class="input-group">
                                    <i class="fa fa-dollar fa2"></i>
                                    <input type="text" class="form-control border-dark mb-1 " name="serviceAmount"
                                        id="serviceAmount" placeholder="Service Amount"
                                        value=" {{ price_format($payment_data[0]['paymentsData'][0]['serviceAmount'], 2) }}
"
                                        required readonly>
                                </div>
                            </fieldset>
                        </div>
                        <div class="col-md-3">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Refundable Amount</legend>
                                <div class="input-group">
                                    <i class="fa fa-dollar fa2"></i>
                                    <input type="text" class="form-control border-dark mb-1 " name="RefundableAmount"
                                        id="RefundableAmount" placeholder="Refundable Amount" value="" required
                                        readonly>
                                </div>
                            </fieldset>
                        </div>


                        <div class="col-md-12">
                            <fieldset class="border">
                                <legend class="legend-inner float-none w-auto required">Reason Of Refund</legend>
                                <div class="input-group">
                                    <textarea class="form-control border-dark mb-1 " name="reason" id="reason"
                                        placeholder="Describe Your Reason of Refund" required></textarea>
                                </div>
                            </fieldset>
                        </div>
                        <center><button type="submit" class="btn btn-success mb-3">Request Refund</button></center>
                    </div>
                </fieldset>
            </form>
        </div>

    </div>
</div>
</div>
<!-- End Main content-->
@include('admin.includes.footer')
<script>
    $(document).ready(function() {
        $("#heading").text('Payment Refund Form');
    });
</script>
</body>

</html>
