@extends('portal.layout.main')

@section('main-container')
    <section class="content blog-page">
        <div class="body_scroll">
            <div class="block-header">
                <div class="row">
                    <div class="col-lg-7 col-md-6 col-sm-12">

                        <ul class="breadcrumb mt-3">
                            <li class="breadcrumb-item"><a href="#"><i class="zmdi zmdi-home"></i>Home</a></li>
                            <li class="breadcrumb-item"><a href="#">Bill</a></li>

                        </ul>
                        <button class="btn btn-primary btn-icon mobile_menu" type="button"><i
                                class="zmdi zmdi-sort-amount-desc"></i></button>
                    </div>
                    <div class="col-lg-5 col-md-6 col-sm-12">
                        <div class="d-flex justify-content-end flex-wrap gap-2">
                            <button class="btn btn-primary btn-icon right_icon_toggle_btn" type="button">
                                <i class="zmdi zmdi-arrow-right"></i>
                            </button>

                        </div>
                    </div>


                </div>
            </div>
            <div class="container-fluid">
                <div class="row">
                    <div class="col-lg-12">
                        <div class="card">
                            <div class="body">
                                <div class="position-relative mb-3">
                                    <h4 class="m-0 responsive-title">Broadband Bill</h4>
                                    <a href="#" class="position-absolute"
                                        style="right: 0; top: 50%; transform: translateY(-50%);">
                                        <button class="btn btn-secondary btn-icon" type="button">
                                            <i class="zmdi zmdi-time-restore"></i> History
                                        </button>
                                    </a>
                                </div>

                                <form action="#" method="POST">
                                    <div class="form-group">
                                        <label for="account_number">Account/Subscriber Number</label>
                                        <input type="text" id="account_number" name="account_number" class="form-control"
                                            placeholder="Enter Account or Subscriber Number" required>
                                    </div>

                                    <div class="form-group">
                                        <label for="broadband_provider">Broadband Provider</label>
                                        <select name="broadband_provider" id="broadband_provider" class="form-control ms"
                                            required>
                                            <option value="">Select Broadband Provider*</option>
                                            <option value="Airtel Broadband">Airtel Broadband</option>
                                            <option value="Jio Fiber">Jio Fiber</option>
                                            <option value="BSNL Broadband">BSNL Broadband</option>
                                            <option value="ACT Fibernet">ACT Fibernet</option>
                                            <option value="Hathway">Hathway</option>
                                            <option value="You Broadband">You Broadband</option>
                                            <!-- Add more broadband providers as needed -->
                                        </select>
                                    </div>


                                    <div class="form-group">
                                        <label for="amount">Bill Amount (INR)</label>
                                        <input type="number" id="amount" name="amount" class="form-control"
                                            placeholder="Enter Bill Amount" required min="1" step="0.01">
                                    </div>

                                    <div class="form-group">
                                        <label for="bill_month">Bill Month</label>
                                        <input type="month" id="bill_month" name="bill_month" class="form-control"
                                            required>
                                    </div>

                                    <div class="form-group">
                                        <label for="mobile">Registered Mobile Number</label>
                                        <input type="text" minlength="10" maxlength="10" name="mobile"
                                            class="form-control"
                                            oninput="this.value = this.value.replace(/[^0-9.+]/g, '').replace(/(\..*?)\..*/g, '$1')"
                                            placeholder="Enter Mobile Number" required pattern="[0-9]{10}">
                                    </div>

                                    <button type="submit" class="btn btn-primary waves-effect">Pay Broadband Bill</button>
                                </form>




                            </div>
                        </div>


                    </div>
                </div>
            </div>
        </div>
    </section>
@endsection