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

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


                        <div class="card">
                                    <div class="card-header">
                                        <h5>Désinscription client </h5>
                                    </div>
                                    <div class="card-body">
                                <div class="col-md-12">
                                    <form action="<?php echo e(asset('close_account')); ?>" method="POST">
                                        <?php echo csrf_field(); ?>
                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Alias</label>
                                            <input type="text" class="form-control" name="alias" placeholder="Alias client" required>
                                        </div>
                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Date fermeture</label>
                                            <input type="text" class="form-control" readonly name="close_date" value="<?php echo e($formattedDate); ?>" required>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Origine</label>
                                            <select name="orig" class="form-control" id="">
                                                <option value="Bank">Bank</option>
                                                <option value="Client">Client</option>
                                                <option value="Orange" disabled>Orange</option>
                                            </select>
                                        </div>

                                        <div class="form-group">
                                            <label for="exampleInputEmail1">Motif</label>
                                            <textarea name="motif" id="" cols="30" class="form-control" rows="10">

                                            </textarea>
                                        </div>

                                        <button type="submit" class="btn btn-primary">Désinscrire</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\api_web_orange_caece\resources\views/registration_module/disable_client_form.blade.php ENDPATH**/ ?>