@extends('layout')
@section('metatitle', $metatitle )
@section('metadescription', $metatitle )
@section('metakeywords', $metatitle )


@section('content')
@include('layouts._slider',array('slug' => 'Stadiu cerere de racordare', 'title' => $metatitle))
    <div class="container">
        @include('layouts._flash')
    </div>


    <div class="spacer">
    </div>


    <!-- My profile start -->
    <div class="content-area my-profile">
        <div class="container">
            <div class="row">
                <div class="col-lg-3 col-md-3 col-sm-12">
                    @include('auth._menu')

                </div>
                <div class="col-lg-9 col-md-9 col-sm-12">
                    <!-- My address start-->
                    <div class="my-address status_crm">
                        <div class="main-title-2">
                            <h1>{{ $metatitle }}</h1>
                        </div>


												<div class="panel panel-info">
							<div class="panel-heading">
								<h3 class="panel-title">Va rugam sa introduceti numarul si data cererii de racordare</h3>
							</div>
								<div class="panel-body row"><h3 class="panel-title"></h3>
								<div class="col-sm-3"></div>
								<div class="col-sm-6">
									<form action="" method="POST">
										{{ csrf_field()  }}
									  <div class="form-group row">
										<div class="col-sm-6 text-center">
											<label for="numarCerere">Numarul cererii</label>
										</div>
										<div class="col-sm-6">
											<input  type="number" min="1" max="99999" class="form-control" id="numarCerere" name="numarCerere" placeholder="Introduceti numarul" required>
										</div>
									  </div>
									  <div class="form-group row">
										<div class="col-sm-6 text-center">
											<label for="dataCererii">Data cererii:</label>
										</div>
										<div class="col-sm-6">
											<input type="date" class="form-control" id="dataCererii" name="dataCerere" aria-describedby="dataHelp" placeholder="Introduceti data" required>
										</div>
											<input type="hidden" name="nrIncercari" value="{{$incercari}}">
									  </div>
										<div class="text-center">
											<button type="submit" class="btn btn-primary">Trimite</button>
										</div>
									</form>
								</div>
								<div class="col-sm-3"></div>
							</div>
						</div>
	                    </div>
                    <!-- My address end -->
                </div>
            </div>
        </div>
    </div>

    <!-- My profile end -->

@endsection