Agent Details
{!! html()->form('POST', route('merchant.application.submit'))->attributes(['id' => 'merchant_application_form', 'data-parsley-validate' => true])->open() !!}
@csrf
Name *
{!! html()->text(
'agent_full_name',
old('agent_full_name')
? old('agent_full_name')
: (isset($data->agent->full_name)
? $data->agent->full_name
: $auth_data->full_name),
)->class('form-control')->placeholder('Enter your name')->attribute('autocomplete', 'off')->attribute('readonly', !$is_auth_user ? true : (!$is_admin ? true : true)) !!}
@if ($errors->has('agent_full_name'))
{{ $errors->first('agent_full_name') }}
@endif
Email *
{!! html()->email(
'agent_email',
old('agent_email')
? old('agent_email')
: (isset($data->agent->email)
? $data->agent->email
: $auth_data->email),
)->class('form-control')->placeholder('Enter your email')->attribute('autocomplete', 'off')->attribute('readonly', !$is_auth_user ? true : (!$is_admin ? true : true)) !!}
@if ($errors->has('agent_email'))
{{ $errors->first('agent_email') }}
@endif
Sales ID
{!! html()->text(
'sales_id',
old('sales_id')
? old('sales_id')
: (isset($data->sales_id)
? $data->sales_id
: (isset($auth_data->sales_id)
? $auth_data->sales_id
: '')),
)->class('form-control')->attribute('readonly', true)->placeholder('*Auto-generated after creation') !!}
@php
$tooltips = [
1 => 'Complete and submit the full application together with the merchant.',
2 => 'Finalize pricing, product selection, and merchant details before sending the application for the merchant to complete and submit.',
];
@endphp
Business Details
{!! html()->label('Legal Name', 'business_name') !!}*
{!! html()->text('business_name', $business->business_name ?? '')->class('form-control')->required() !!}
{!! html()->label('DBA Name', 'dba_statement_descriptor') !!}*
{!! html()->text('dba_name', $business->dba_statement_descriptor ?? '')->class('form-control')->required() !!}
{!! html()->label('Address', 'business_addressline_one') !!}*
{!! html()->text('business_addressline_one', $business->business_addressline_one ?? '')->class('form-control location-address')->id('business_address_line_one')->required() !!}
{!! \App\Helpers\Helper::addressNote() !!}
{!! html()->label('Address 2 (Optional)', 'business_addressline_two') !!}
{!! html()->text('business_addressline_two', $business->business_addressline_two ?? '')->class('form-control') !!}
{{-- {!! html()->label('City', 'business_city_id') !!}*
{!! html()->select('business_city_id', ['' => 'Select'] + $cities, $business->business_city_id ?? '')->class('form-control select2') !!} --}}
{!! html()->label('City', 'city_name') !!}*
{!! html()->text('city_name', $business->city_name ?? '')->class('form-control')->required() !!}
{!! html()->label('State', 'business_state_id') !!}*
{!! html()->select('business_state_id', ['' => 'Select'] + $states, $business->business_state_id ?? '')->class('form-control select2')->required() !!}
{!! html()->label('Zip', 'zip') !!}*
{!! html()->text('zip', $business->zip ?? '')->class('form-control numeric')->attribute('minlength', 5)->attribute('maxlength', 5)->required() !!}
{!! html()->label('Email Address', 'business_email') !!}
{!! html()->email('business_email', $business->business_email ?? '')->class('form-control disable-autocomplete')->attribute('autocomplete', 'off') !!}
{!! html()->label('Start Date', 'business_established_date') !!}
{!! html()->text('business_established_date', $business->business_established_date ?? '')->class('form-control datepicker') !!}
{{--
{!! html()->label('EIN (Federal Tax ID #)', 'business_ein') !!}
{!! html()->text('business_ein', $business->business_ein ?? '')->class('form-control') !!}
->required()
--}}
{!! html()->label('TIN Type', 'tin_type_id') !!}
{!! html()->select('tin_type_id', ['' => 'Select'] + $tin_types, $business->tin_type_id ?? '')->class('form-control select2')->id('tin_type_id') !!}
This field is
required.
{!! html()->label('TIN', 'tin') !!}
{!! html()->text('tin', $business->tin ?? '')->class('form-control input-mask')->id('tin')->attribute('data-inputmask', "'mask': '99-9999999'")->attribute('autocomplete', 'off') !!}
This field is
required.
@php
$selectedKey = array_search('Salon & Spa', $business_types); // Find key for "Salon & Spa"
@endphp
{{-- {!! html()->label('Type of Business', 'master_business_type_id') !!} *
{!! html()->select(
'master_business_type_id',
['' => 'Select'] + $business_types,
old('master_business_type_id', $business->master_business_type_id ?? ''),
)->class('form-control') !!} --}}
{!! html()->label('Type of Business', 'master_business_type_id') !!}
@foreach ($business_types as $key => $type)
{{ $type }}
@endforeach
Owners Info
{!! html()->hidden('owner_id', $primary_owner->id ?? 0) !!}
{!! html()->label('First Name', 'owner_first_name') !!}*
{!! html()->text('owner_first_name', $primary_owner->first_name ?? '')->class('form-control')->required() !!}
{!! html()->label('Last Name', 'owner_last_name') !!}*
{!! html()->text('owner_last_name', $primary_owner->last_name ?? '')->class('form-control')->required() !!}
{!! html()->label('Date Of Birth', 'dob') !!}
{!! html()->text('dob', $primary_owner->dob ?? '')->class('form-control datepicker') !!}
{!! html()->label('Email', 'owner_email') !!}*
{!! html()->text('owner_email', $primary_owner->email ?? '')->class('form-control')->required() !!}
{!! html()->label('Address', 'addressline_one') !!}
{!! html()->text('addressline_one', $primary_owner->addressline_one ?? '')->class('form-control location-address')->id('address_line_one') !!}
{!! \App\Helpers\Helper::addressNote() !!}
{!! html()->label('Address 2 (Optional)', 'addressline_two') !!}
{!! html()->text('addressline_two', $primary_owner->addressline_two ?? '')->class('form-control') !!}
{{-- {!! html()->label('City', 'city_id') !!}*
{!! html()->select('city_id', ['' => 'Select'] + $cities, $primary_owner->location_city_id ?? '')->class('form-control select2') !!} --}}
{!! html()->label('City', 'owner_city_name') !!}
{!! html()->text('owner_city_name', $primary_owner->city_name ?? '')->class('form-control') !!}
{!! html()->label('State', 'state_id') !!}
{!! html()->select('state_id', ['' => 'Select'] + $states, $primary_owner->location_state_id ?? '')->class('form-control select2') !!}
{!! html()->label('Zip', 'owners_zip') !!}
{!! html()->text('owners_zip', $primary_owner->zip ?? '')->class('form-control numeric') !!}
Processing Fees
{!! html()->label('Pricing Plan')->for('pricing_plan_type') !!}
@foreach ($plans as $value => $label)
pricing_plan_type ?? '') === (string) $value ? 'selected' : '' }}>
{{ $label }}
@endforeach
{!! html()->label('Daily Discount')->for('daily_discount_type') !!}
Select
@foreach ($options as $value => $tooltip)
daily_discount_type ?? '') === (string) $value ? 'selected' : '' }}>
{{ $value }}
@endforeach
Note: Applies equally to Visa,
MasterCard,
Amex, Discover, and PIN Debit.
{{-- Note section for funding type visibility control --}}
Note: Next business day funding
available for qualified merchants.
Software
@if (
!isset($data) ||
(isset($data) && $data->application_method_type_id == 1) ||
(isset($data) && $data->application_method_type_id == 2 && isset($location) && $location->status < 4))
{!! html()->button()->type('submit')->class('btn btn-primary btn-lg w-md')->id('submit-btn')->html('
Next ') !!}
@else
View Application
{{--
Previous
--}}
@endif
{!! html()->form()->close() !!}