<?php $__env->startSection('title','INSCRIPTION'); ?>
<?php $__env->startSection('content'); ?>

                        <!-- [ Main Content ] start -->
                        <div class="col-6">


                        <div class="card">
                                    <div class="card-header">
                                        <h5>INSCRIPTION CLIENT</h5>
                                    </div>
                                    <div class="card-body">
                                <div class="col-md-12">
                                    <form action="<?php echo e(asset('confirm_registration')); ?>" method="POST">
                                        <?php echo csrf_field(); ?>
                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Numéro de téléphone (MSISDN)</label>
                                            <input type="number" class="form-control" name="msisdn" value="<?php echo e($msisdn ?? ""); ?>" placeholder="Contact client" required>
                                        </div>
                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Alias(CODE MEMBRE)</label>
                                            <input type="text" class="form-control" name="alias" maxlength="22" placeholder="ID CLIENT" required>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Code service</label>
                                            <select name="code_service" class="form-control" id="">
                                                <option value="1">Charge</option>
                                                <option value="2">Discharge</option>
                                                <option value="3">Charge & Discharge</option>
                                            </select>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Libelle(Information client)</label>
                                            <input type="text" class="form-control" name="libelle" placeholder="Libelle" required>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Devise</label>
                                            <select name="devise" class="form-control" id="">
                                                <option value="952">FCFA</option>
                                            </select>
                                        </div>


                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Clé d'activation</label>
                                            <input type="text" class="form-control" name="key" value="<?php echo e($key ?? ""); ?>" placeholder="Clé" required>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Date activation</label>
                                            <input type="text" class="form-control" readonly name="active_date" value="<?php echo e($formattedDate); ?>" required>
                                        </div>
                                        <button type="submit" class="btn btn-primary">Valider l'inscription</button>
                                    </form>
                                </div>
                                <!-- [ Main Content ] end -->
                            </div>
                        </div>
                    </div>

<?php $__env->stopSection(); ?>

<?php echo $__env->make('admin.layout', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH C:\laragon\www\b2w_caece\b2w_caece\resources\views/registration_module/confirm_registration_form.blade.php ENDPATH**/ ?>