@section('page-title', 'Create Lead') @push('vendor-css') @endpush

@if (count($errors) > 0)

Error! @foreach ($errors->all() as $error) {{ $error }}
@endforeach

@endif

Lead Details

@can('create-follow-ups') @endcan @can('update-follow-ups') @endcan

Primary Contact Number

Dialer Lead Id

@csrf

Lead ID *

Passcode *

@if(!auth()->user()->hasRole('Agent')) @if ( (auth()->user()->hasRole('Marketer') && auth()->user()->userDetails->can_assign == 1) || !auth()->user()->hasRole('Marketer'))

Assign Agent

@endif @endif @if (in_array('lead_source', $defaultFields))

Lead Source *

@endif @if (in_array('primary_contact', $defaultFields))

Primary Contact Number (can't change later) *

US (+1)

@endif @if (in_array('secondary_contact', $defaultFields))

Secondary Contact Number

US (+1)

@endif @if (in_array('other_contact', $defaultFields))

Other Contact Number

US (+1)

@endif @foreach ($dynamicFields as $dynamicField) @if (App\Helpers\Helper::chekIfUserHasPermissionOfField($dynamicField->permissions)) @if ($dynamicField->field_type == 'select')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif

@elseif ($dynamicField->field_type == 'textarea')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif

@elseif ($dynamicField->field_type == 'checkbox')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif nullable == false) required @endif />

@elseif($dynamicField->field_type == 'phone')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif

US (+1) nullable == false) required @endif autocomplete="{{ $dynamicField->field_name }}" class="form-control contact-number" minlength="10" maxlength="10" name="{{ $dynamicField->field_name }}" value="{{ old($dynamicField->field_name) }}" />

@elseif($dynamicField->field_type == 'time')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif nullable == false) required @endif />

@else @if ($dynamicField->field_name == 'payment_type')

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif Card Account

@if (in_array('name_appears_on_the_card', $defaultFields))

Name Appears On The Card @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('card_number', $defaultFields))

Card Number @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('expiration_date', $defaultFields))

Expiration Date @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('cvv', $defaultFields))

CVV @if ($leadType !== 'ACA') * @endif

@endif

@if (in_array('account_title', $defaultFields))

Account Title @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('bank_name', $defaultFields))

Bank Name @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('routing_number', $defaultFields))

Routing Number @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('account_number', $defaultFields))

Account Number @if ($leadType !== 'ACA') * @endif

@endif @if (in_array('account_ownership', $defaultFields))

Account Ownership Joint Single

@endif @if (in_array('account_type', $defaultFields))

Savings Check-Ins

@endif @if (in_array('account_opening_state', $defaultFields))

Account Opening State @if ($leadType !== 'ACA') * @endif {{--

--}}

@endif

@else

{{ ucwords(str_replace('_', ' ', $dynamicField->field_name)) }} @if ($dynamicField->nullable == false) * @endif @if ($dynamicField->field_name == 'state') (Must be fewer than 2 characters) @endif @if ($dynamicField->field_name == 'zip_code') (Must be a number) @endif @if ($dynamicField->field_name == 'age') (Must be a number) @endif @if ($dynamicField->field_name == 'number_of_beneficiaries') (Must be number between 1 to 10) @endif @if ($dynamicField->field_name == 'height') (height in feet) @endif @if ($dynamicField->field_name == 'weight') (weight in pounds) @endif @if ($dynamicField->field_name == 'coverage_type') @endif @if ($dynamicField->field_name == 'source_of_income') @endif

@if ( $dynamicField->field_name == 'monthly_premium' || $dynamicField->field_name == 'annual_premium' || $dynamicField->field_name == 'face_amount') $ @endif @if ( $dynamicField->field_name !== 'coverage_type' && $dynamicField->field_name !== 'insurance_product' && $dynamicField->field_name !== 'insurance_carrier' && $dynamicField->field_name !== 'insurance_plan' && $dynamicField->field_name !== 'source_of_income') field_type == 'file') accept=".csv,.txt,.xlx,.xls,.xlsx,.pdf,.doc,.docx" @endif @if ($dynamicField->field_type == 'image') accept=".gpg,.png,.jpeg,.jpg,image/gif" @endif name="{{ $dynamicField->field_name }}" @if ($dynamicField->field_name == 'address') id="address" value="{{ old($dynamicField->field_name) }}" @endif @if ($dynamicField->field_name == 'application_date') value="{{ now()->format('Y-m-d') }}" @else value="{{ old($dynamicField->field_name) }}" @endif @if ($dynamicField->field_name == 'dialer_lead_id') id="dialer_lead_id" @endif @if ($dynamicField->field_name == 'first_name') id="first_name" @endif @if ($dynamicField->field_name == 'last_name') id="last_name" @endif @if ($dynamicField->field_name == 'middle_name') id="middle_name" @endif @if ($dynamicField->field_name == 'tcpa_name_status') id="tcpa_name_status" @endif @if ($dynamicField->field_name == 'bla_status') id="bla_status" @endif @if ($dynamicField->field_name == 'age') id="age" @endif @if ($dynamicField->field_name == 'dob') id="dob" @endif @if ($dynamicField->field_name == 'dialer_lead_id') id="dialer_lead_id" @endif @if ($dynamicField->field_name == 'state') maxlength="2" @endif @if ($dynamicField->field_name == 'face_amount') step="any" min="{{ $face_amount_limits['settings']['min'] }}" max="{{ $face_amount_limits['settings']['max'] }}" @endif @if ($dynamicField->field_name == 'zip_code') onkeypress="return onlyNumberKey(event)" minlength="5" maxlength="5" @endif @if ($dynamicField->field_name == 'monthly_premium') id="monthly_premium" step="any" @endif @if ($dynamicField->field_name == 'annual_premium') id="annual_premium" step="any" @endif @if ($dynamicField->field_name == 'initial_draft_date') id="initial_draft_date" autocomplete="off" @endif @if ($dynamicField->field_name == 'future_draft_date') id="future_draft_date" readonly autocomplete="off" @endif @if ($dynamicField->field_name == 'number_of_beneficiaries') onkeypress="return onlyNumberKey(event)" min="0" max="10" @endif {{-- @if ($dynamicField->field_name == 'social_number') onkeypress="return onlyNumberKey(event)" oninput="formatSocialNumber(event)" minlength="9" maxlength="9" @endif --}} @if ($dynamicField->nullable == false) required @endif /> @endif

@if ($dynamicField->field_name == 'face_amount')

@endif @if ($dynamicField->field_name == 'monthly_premium')

@endif @if ($dynamicField->field_name == 'dob')

@endif

@if ($dynamicField->field_name == 'address')

@endif @if ($dynamicField->field_name == 'last_name')

@endif @if ($dynamicField->field_name == 'coverage_type') @if (in_array('carrier_id', $defaultFields))

Insurance Carrier

@endif @if (in_array('plan_id', $defaultFields))

Insurance Plan

@endif @if (in_array('product_id', $defaultFields))

Insurance Product @if (auth()->user()->hasRole('Marketer'))

@else

@endif

@endif @endif @endif @endif @endif @endforeach @if (in_array('ssn', $defaultFields))

Social Security Number (Must be a number and Not greater than 9 digits in length) @if($leadType !== 'Medicare' && $leadType !== 'ACA') * @endif

@endif @if (auth()->user()->hasRole('Marketer'))

Account Status

@endif @if (in_array('smoker', $defaultFields))

Smoker *

Yes No

@endif

Disposition

@foreach ($dispositions as $disposition) @if (App\Helpers\Helper::permisstionToDisposition(auth()->user()->roles[0]->id, $disposition->id)) {{--

{{ __('Create Lead') }}

Lead Details