@extends('layouts.app')

@section('content')

<div id="contact" class="container-fluid">
    <div class="pageTopTitle">
        <h1>Contact</h1>
        <span>お問い合わせ</span>
    </div>
    <div class="container">
        <div class="contentArea">
        <form action="contact/confirm" method="post">
            {{ csrf_field() }}
            <table id="contactTable">
                <tbody>
                    <tr>
                        <th>お名前<span class="required">※</span></th>
                        <td>
                            <input type="text" name="last_name" class="form-control input-box" id="InputLastName" value="{{ old('last_name') }}" placeholder="姓">
                            <input type="text" name="first_name" class="form-control input-box" id="InputFirstName" value="{{ old('first_name') }}" placeholder="名">
                            <span class="validation">{{ $errors->first('last_name') }}</span>
                            <span class="validation">{{ $errors->first('first_name') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>お名前(フリガナ)<span class="required">※</span></th>
                        <td>
                            <input type="text" name="last_name_kana" class="form-control input-box" id="InputLastNameKana" value="{{ old('last_name_kana') }}" placeholder="セイ">
                            <input type="text" name="first_name_kana" class="form-control input-box" id="InputFirstNameKana" value="{{ old('last_name_kana') }}" placeholder="メイ">
                            <span class="validation">{{ $errors->first('last_name_kana') }}</span>
                            <span class="validation">{{ $errors->first('first_name_kana') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>会社名</th>
                        <td>
                            <input type="text" name="company" class="form-control" id="InputCompany" value="{{ old('company') }}" placeholder="例:株式会社田中箸店">
                        </td>
                    </tr>
                    <tr>
                        <th>郵便番号<span class="required">※</span></th>
                        <td>
                            <input type="text" name="post" class="form-control" id="InputPost" value="{{ old('post') }}" placeholder="例:917-0027">
                            <span class="validation">{{ $errors->first('post') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>ご住所1<span class="required">※</span><br/>(都道府県 市区町村名)</th>
                        <td>
                            <select name="pref" class="select-box" id="SelectPref" value="{{ old('pref') }}">
                                <option value>都道府県を選択</option>
                                @foreach($prefectures as $prefecture)
                                <option value="{{ $prefecture->name }}"@if(old('pref') == $prefecture->name) selected @endif>{{ $prefecture->name }}</option>
                                @endforeach
                            </select>
                            <span class="validation">{{ $errors->first('pref') }}</span>
                            <input type="text" name="address01" class="form-control m-t-16" id="InputAddress01" value="{{ old('address01') }}" placeholder="例:小浜市生守">
                            <span class="validation">{{ $errors->first('address01') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>ご住所2<span class="required">※</span><br/>(番地・マンション名)</th>
                        <td>
                            <input type="text" name="address02" class="form-control" id="InputAddress02" value="{{ old('address02') }}" placeholder="例:23-4">
                            <span class="validation">{{ $errors->first('address02') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>電話番号<span class="required">※</span></th>
                        <td>
                            <input type="text" name="tel" class="form-control" id="InputTel" value="{{ old('tel') }}" placeholder="例:0770-56-3355">
                            <span class="validation">{{ $errors->first('tel') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>FAX番号</th>
                        <td>
                            <input type="text" name="fax" class="form-control" id="InputFax" value="{{ old('fax') }}" placeholder="例:0770-56-5530">
                        </td>
                    </tr>
                    <tr>
                        <th>Emailアドレス<span class="required">※</span></th>
                        <td>
                            <input type="text" name="email" class="form-control" id="InputEmail" value="{{ old('email') }}" placeholder="例:メールアドレス">
                            <span class="validation">{{ $errors->first('email') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>Emailアドレス(確認用)<span class="required">※</span></th>
                        <td>
                            <input type="text" name="email_confirmation" class="form-control" id="InputEmail" value="{{ old('email_confirmation') }}" placeholder="例:メールアドレス(確認用)">
                            <span class="validation">{{ $errors->first('email_confirmation') }}</span>
                        </td>
                    </tr>
                    <tr>
                        <th>お問い合わせ内容<span class="required">※</span><br/>(1,000文字まで)</th>
                        <td>
                            <textarea name="message" class="text-box" id="InputMessage" value="{{ old('message') }}" cols="10" rows="8">{{ old('message') }}</textarea>
                            <span class="validation">{{ $errors->first('message') }}</span>
                        </td>
                    </tr>
                </tbody>
            </table>
            <div class="contentBtn">
                <input type="submit" name="action" class="btn btnPrimary" value="確認画面へ">
            </div>
        </form>
        </div>
    </div>

</div>

@endsection