Lead Details

@csrf

Lead ID *

Passcode *

Agency

Marketer

Assign Agent

Lead Source *

Primary Contact Number (can't chage later) *

US (+1)

Secondary Contact Number

US (+1)

Other Contact Number

US (+1)

{{--

First Name *

Last Name *

Address

City *

State *

Zip Code *

Appartment Number

Age

Date of Birth *

Social Number *

--}} {{--

Gender *

--}} @foreach ($dynamicFields as $dynamicField) {{-- @if (App\Helpers\Helper::chekIfUserHasPermissionOfField($dynamicField->permissions)) --}} @if ($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) }}" />

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

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

Name Appears On The Card *

Card Number *

Expiration Date *

@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 to10) @endif @if ($dynamicField->field_name == 'social_number') (Must be a number and Not greater than 9 digits in length) @endif @if ($dynamicField->field_name == 'height') (height in feet) @endif @if ($dynamicField->field_name == 'weight') (height in pounds) @endif field_name == 'state') maxlength="2" @endif @if ($dynamicField->field_name == 'zip_code') onkeypress="return onlyNumberKey(event)" minlength="4" maxlength="8" @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)" minlength="1" maxlength="10" @endif @if ($dynamicField->nullable == false) required @endif />

@endif @endif {{-- @endif --}} @endforeach

Smoker *

Yes No

Disposition

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

{{ __('Create Lead') }}

Lead Details