@include('dashboard.layouts.header')

<!-- Content Wrapper. Contains page content -->
<div class="content-wrapper">
  <!-- Content Header (Page header) -->
  <section class="content-header">
    <div class="container-fluid">
      <div class="row mb-2">
        <div class="col-sm-6">
          <h1>Authorization to Process Tax Liabilities</h1>
        </div>
        <div class="col-sm-6">
          <ol class="breadcrumb float-sm-right">
            <li class="breadcrumb-item"><a href="/dashboard">Home</a></li>
            <li class="breadcrumb-item active">Authorization to Process Tax Liabilities</li>
          </ol>
        </div>
      </div>
    </div><!-- /.container-fluid -->
  </section>

  <!-- Main content -->
  <section class="content">
    <div class="container-fluid">
      <div class="row">
        <!-- left column -->
        <div class="col-md-12">
          <!-- general form elements -->
          <div class="card card-primary">
            <div class="card-header">
              <h3 class="card-title">Authorization to Process Tax Liabilities</h3>
            </div>
            </br>
            @if (session('success'))
            <div class="alert alert-success">
              {{ session('success') }}
            </div>
            @endif
            @if(isset($report))
            <form action="{{ route('authorizatio-tax-liabilities-submit-form.update', $report->id) }}" method="POST" onsubmit="disableButton()">
              @csrf
              @method('PUT')
              @else
              <form action="{{ route('authorizatio-tax-liabilities-submit-form') }}" method="POST" onsubmit="disableButton()">
                @csrf
                @endif
                <div class="card-body">
                  <!-- Authorization Information -->
                  <h4>Authorization Information</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="officerName">Authorized Officer Name</label>
                        <input type="text" value="{{ old('officer_name', $report->officer_name ?? '') }}" class="form-control" name="officer_name" id="officerName" placeholder="Enter officer name">
                        @error('officer_name')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>

                      <div class="form-group">
                        <label for="taxLiabilities">Authorization to Process the Following Tax Liabilities</label><br>
                        <input type="checkbox" id="salesTax" name="sales_tax" value="yes" {{ old('sales_tax', $report->sales_tax ?? '') == 'yes' ? 'checked' : '' }}>
                        <label for="salesTax" style="font-weight: 100;">All quarterly sales tax or any outstanding liabilities related to sales tax</label><br>
                        <input type="checkbox" id="payrollTax" name="payroll_tax" value="yes" {{ old('payroll_tax', $report->payroll_tax ?? '') == 'yes' ? 'checked' : '' }}>
                        <label for="payrollTax" style="font-weight: 100;">All payroll related liabilities</label>

                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="businessName">Business Name</label>
                        <input type="text" value="{{ old('business_name', $report->business_name ?? '') }}" class="form-control" name="business_name" id="businessName" placeholder="Enter business name">
                        @error('business_name')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>

                      <div class="form-group">
                        <label for="taxLiabilities">-</label><br>
                        <input type="checkbox" id="corporationTax" name="corporation_tax" value="yes" {{ old('corporation_tax', $report->corporation_tax ?? '') == 'yes' ? 'checked' : '' }}>
                        <label for="corporationTax" style="font-weight: 100;">All corporation tax related liabilities</label><br>
                        <input type="checkbox" id="individualTax" name="individual_tax" value="yes" {{ old('individual_tax', $report->individual_tax ?? '') == 'yes' ? 'checked' : '' }}>
                        <label for="individualTax" style="font-weight: 100;">Individual tax liabilities</label>
                      </div>
                    </div>
                  </div>





                  <!-- Contact Information -->
                  <h4>Contact Information</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="firstName">First Name</label>
                        <input type="text" value="{{ old('first_name', $report->first_name ?? '') }}" class="form-control" name="first_name" id="firstName" placeholder="Enter first name">
                        @error('first_name')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>

                      <div class="form-group">
                        <label for="contactPhone">Phone</label>
                        <input type="tel" value="{{ old('contact_phone', $report->contact_phone ?? '') }}" class="form-control" name="contact_phone" id="contactPhone" placeholder="(123) 456-7890">
                        @error('contact_phone')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>
                      <div class="form-group">
                        <label for="contactCityStateZip">City, State, Zip</label>
                        <input type="text" value="{{ old('contact_city_state_zip', $report->contact_city_state_zip ?? '') }}" class="form-control" name="contact_city_state_zip" id="contactCityStateZip" placeholder="Enter city, state, zip">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="lastName">Last Name</label>
                        <input type="text" value="{{ old('last_name', $report->last_name ?? '') }}" class="form-control" name="last_name" id="lastName" placeholder="Enter last name">
                        @error('last_name')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>
                      <div class="form-group">
                        <label for="contactEmail">Email</label>
                        <input type="email" value="{{ old('contact_email', $report->contact_email ?? '') }}" class="form-control" name="contact_email" id="contactEmail" placeholder="Enter email">
                        @error('contact_email')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>
                      <div class="form-group">
                        <label for="contactFax">Fax</label>
                        <input type="tel" value="{{ old('contact_fax', $report->contact_fax ?? '') }}" class="form-control" name="contact_fax" id="contactFax" placeholder="(123) 456-7890">
                      </div>
                    </div>

                    <div class="col-md-12">

                      <div class="form-group">
                        <label for="contactAddress">Address</label>
                        <input type="text" value="{{ old('contact_address', $report->contact_address ?? '') }}" class="form-control" name="contact_address" id="contactAddress" placeholder="Enter address">
                      </div>
                    </div>


                  </div>


                  <!-- Company Information -->
                  <h4>Company Information</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="entityName">Name of Entity</label>
                        <input type="text" value="{{ old('entity_name', $report->entity_name ?? '') }}" class="form-control" name="entity_name" id="entityName" placeholder="Enter entity name">
                      </div>

                      <div class="form-group">
                        <label for="dateFormation">Date of Formation (mm/dd/yyyy)</label>
                        <input type="date" value="{{ old('date_formation', $report->date_formation ?? '') }}" class="form-control" name="date_formation" id="dateFormation">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="entityType">Type of Entity</label>
                        <select class="form-control" name="entity_type" id="entityType">
                          <option value="Corporation" {{ old('entity_type', $report->entity_type ?? '') == 'Corporation' ? 'selected' : '' }}>Corporation</option>
                          <option value="S Corporation" {{ old('entity_type', $report->entity_type ?? '') == 'S Corporation' ? 'selected' : '' }}>S Corporation</option>
                          <option value="Partnership" {{ old('entity_type', $report->entity_type ?? '') == 'Partnership' ? 'selected' : '' }}>Partnership</option>
                          <option value="Single Member LLC" {{ old('entity_type', $report->entity_type ?? '') == 'Single Member LLC' ? 'selected' : '' }}>Single Member LLC</option>
                          <option value="Multi Member LLC" {{ old('entity_type', $report->entity_type ?? '') == 'Multi Member LLC' ? 'selected' : '' }}>Multi Member LLC</option>
                          <option value="Sole Proprietor" {{ old('entity_type', $report->entity_type ?? '') == 'Sole Proprietor' ? 'selected' : '' }}>Sole Proprietor</option>
                        </select>
                      </div>
                      <div class="form-group">
                        <label for="companyCityStateZip">City, State, Zip</label>
                        <input type="text" value="{{ old('company_city_state_zip', $report->company_city_state_zip ?? '') }}" class="form-control" name="company_city_state_zip" id="companyCityStateZip" placeholder="Enter city, state, zip">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="stateFormation">State of Formation</label>
                        <input type="text" value="{{ old('state_formation', $report->state_formation ?? '') }}" class="form-control" name="state_formation" id="stateFormation" placeholder="Enter state">
                      </div>
                      <div class="form-group">
                        <label for="companySuite">Suite/Apt</label>
                        <input type="text" value="{{ old('company_suite', $report->company_suite ?? '') }}" class="form-control" name="company_suite" id="companySuite" placeholder="Enter suite/apt">
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="einNumber">EIN Number</label>
                        <input type="text" value="{{ old('ein_number', $report->ein_number ?? '') }}" class="form-control" name="ein_number" id="einNumber" placeholder="Enter EIN">
                      </div>


                    </div>
                    <div class="col-md-12">
                      <div class="form-group">
                        <label for="companyAddress">Address</label>
                        <input type="text" value="{{ old('company_address', $report->company_address ?? '') }}" class="form-control" name="company_address" id="companyAddress" placeholder="Enter company address">
                      </div>
                    </div>
                  </div>


                  <!-- Bank Information -->
                  <h4>Bank Information</h4>
                  <div class="row">
                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="accountTitle">Account Title</label>
                        <input type="text" value="{{ old('account_title', $report->account_title ?? '') }}" class="form-control" name="account_title" id="accountTitle" placeholder="Enter account title">
                        @error('account_title')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>
                      <!-- Agreement -->
                      <div class="form-group">
                        <label for="feeAmount">Fee Amount</label>
                        <input type="text" value="{{ old('fee_amount', $report->fee_amount ?? '') }}" class="form-control" name="fee_amount" id="feeAmount" placeholder="Enter fee amount">
                      </div>
                      <div class="form-group">
                        <label for="accountNumber">Bank Account Number</label>
                        <input type="text" value="{{ old('account_number', $report->account_number ?? '') }}" class="form-control" name="account_number" id="accountNumber" placeholder="Enter bank account number">
                        @error('account_number')
                        <span class="text-danger">{{ $message }}</span>
                        @enderror
                      </div>
                    </div>

                    <div class="col-md-6 col-print-6">
                      <div class="form-group">
                        <label for="routingNumber">Routing Number</label>
                        <input type="text" value="{{ old('routing_number', $report->routing_number ?? '') }}" class="form-control" name="routing_number" id="routingNumber" placeholder="Enter routing number">
                      </div>
                      <div class="form-group">
                        <label for="officerSignature">Corporate Officer Name</label>
                        <input type="text" value="{{ old('officer_signature', $report->officer_signature ?? '') }}" class="form-control" name="officer_signature" id="officerSignature" placeholder="Enter officer name">
                      </div>
                      <div class="form-group">
                        <label for="signatureDate">Signature Date</label>
                        <input type="date" value="{{ old('signature_date', $report->signature_date ?? '') }}" class="form-control" name="signature_date" id="signatureDate">
                      </div>
                    </div>

                  </div>

                </div>

                <div class="card-footer">
                  <button type="submit" class="btn btn-primary" id="submitButton">Submit</button>
                </div>
              </form>


          </div>
        </div>
      </div>
    </div>
  </section>
</div>
@include('dashboard.layouts.footer')

<script>
  function formatUSPhone(input) {

    let value = input.value.replace(/\D/g, ''); // remove non-digits
    if (value.length > 3 && value.length <= 6) {
      input.value = `(${value.slice(0, 3)}) ${value.slice(3)}`;
    } else if (value.length > 6) {
      input.value = `(${value.slice(0, 3)}) ${value.slice(3, 6)}-${value.slice(6, 10)}`;
    } else {
      input.value = value;
    }
  }
  document.addEventListener("DOMContentLoaded", function() {
    document.getElementById('contactFax').addEventListener('input', function() {
      formatUSPhone(this);
    });
    document.getElementById('contactPhone').addEventListener('input', function() {
      formatUSPhone(this);
    });
  });
</script>

<script>
  $(function() {
    bsCustomFileInput.init();
  });
</script>
<script>
  function disableButton() {
    let btn = document.getElementById('submitButton');
    btn.disabled = true;
    btn.innerText = 'Submitting...'; // Change button text

    // Allow form submission
    return true;
  }
</script>
</body>

</html>