<!DOCTYPE html>
<html lang="en">
    <head>
        <meta charset="utf-8">
        <meta http-equiv="X-UA-Compatible" content="IE=edge">
        <meta name="viewport" content="width=device-width, initial-scale=1">
        <title><?php echo SITE_NAME; ?> Agent</title>

        <!-- Global stylesheets -->
        <link href="https://fonts.googleapis.com/css?family=Roboto:400,300,100,500,700,900" rel="stylesheet" type="text/css">
        <link href="/assets/css/icons/icomoon/styles.css" rel="stylesheet" type="text/css">
        <link href="/assets/css/bootstrap.css" rel="stylesheet" type="text/css">
        <link href="/assets/css/core.css" rel="stylesheet" type="text/css">
        <link href="/assets/css/components.css" rel="stylesheet" type="text/css">
        <link href="/assets/css/colors.css" rel="stylesheet" type="text/css">
        <!-- /global stylesheets -->

        <!-- Core JS files -->
        <script type="text/javascript" src="/assets/js/plugins/loaders/pace.min.js"></script>
        <script type="text/javascript" src="/assets/js/core/libraries/jquery.min.js"></script>
        <script type="text/javascript" src="/assets/js/core/libraries/bootstrap.min.js"></script>
        <script type="text/javascript" src="/assets/js/plugins/loaders/blockui.min.js"></script>
        <!-- /core JS files -->


        <!-- Theme JS files -->
        <script type="text/javascript" src="/assets/js/core/app.js"></script>
        <!-- /theme JS files -->

    </head>

    <body class="login-container" style="background-color: #ffffff;">



        <!-- Page container -->
        <div class="page-container">

            <!-- Page content -->
            <div class="page-content">

                <!-- Main content -->
                <div class="content-wrapper">

                    <div class="panel panel-body login-form" >
                        <div class="thumb">                                    
                            <a href="/"><img src="/assets/images/logo.png" alt="<?php echo SITE_NAME; ?>"></a>
                        </div> 
                    </div>

                    <!-- Registration form -->
                    <?php echo form_open('signup'); ?>
                        <div class="row">
                            <div class="col-lg-6 col-lg-offset-3">
                                <div class="panel registration-form">
                                    <div class="panel-body">
                                        <div class="text-center">                                                                            
                                            <h5 class="content-group-lg">Create account <small class="display-block">All fields are required</small></h5>
                                        </div>
 <?php echo $action_message; ?>
                                        <div class="form-group has-feedback">
                                            <?= form_error('agent_name') ?>
                                            <input type="text" class="form-control" placeholder="Location or business name" name="agent_name" value="<?=set_value('agent_name')?>">
                                            <div class="form-control-feedback">
                                                <i class="icon-user-plus text-muted"></i>
                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('firstname') ?>
                                                    <input type="text" class="form-control" placeholder="Contact firstname" name="firstname" value="<?=set_value('firstname')?>">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-user-check text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>

                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('lastname') ?>
                                                    <input type="text" class="form-control" placeholder="Contact lastname" name="lastname" value="<?=set_value('lastname')?>">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-user-check text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('username') ?>
                                                    <input type="email" class="form-control" placeholder="Your Username - Email" name="username" value="<?=set_value('username')?>">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-user-lock text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>

                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('password') ?>
                                                    <input type="password" class="form-control" placeholder="Create password" name="password">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-user-lock text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>

                                        
                                         <div class="row">
                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('street') ?>
                                            <input type="text" class="form-control" placeholder="Business Address" name="street" value="<?=set_value('street')?>">
                                            <div class="form-control-feedback">
                                                <i class="icon-user-plus text-muted"></i>
                                            </div>
                                                </div>
                                            </div>

                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
<?= form_error('zipcode') ?>
                                            <input type="text" class="form-control" placeholder="Zip Code" name="zipcode" value="<?=set_value('zipcode')?>">
                                            <div class="form-control-feedback">
                                                <i class="icon-user-plus text-muted"></i>
                                            </div>
                                                </div>
                                            </div>
                                        </div>
                                       
                                        
               
                                        
                                        <div class="row">
                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('city') ?>
                                                    <input type="text" class="form-control" placeholder="City"  value="<?= set_value('city') ?>" name="city">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-mention text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>

                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('state') ?>
                                                    <select name="state" class="form-control" >
                                                        <option value="">Select State</option>
                                                        <option value="GA"<?=$state=='GA'?' selected':''?>>Georgia</option> 
                                                    </select>
                                                    <div class="form-control-feedback">
                                                        <i class="icon-mention text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                                    <?= form_error('phone') ?>
                                                    <input type="text" class="form-control" placeholder="Phone"  value="<?= set_value('phone') ?>" name="phone">
                                                    <div class="form-control-feedback">
                                                        <i class="icon-mention text-muted"></i>
                                                    </div>
                                                </div>
                                            </div>

                                            <div class="col-md-6">
                                                <div class="form-group has-feedback">
                                      
                                                </div>
                                            </div>
                                        </div>
                                        
                                        <div class="form-group">                                                               

                                            <div class="checkbox">
                                                <label>
                                                    <?= form_error('tos') ?>
                                                    <input type="checkbox" name="tos" value="1" class="styled"<?=(isset($tos) && $tos==1)?' checked':''?>>
                                                    Accept <a href="#">terms of service</a>
                                                </label>
                                            </div>
                                        </div>

                                        <div class="text-right">
                                            <button type="submit" class="btn btn-link"><i class="icon-arrow-left13 position-left"></i> Back to login form</button>
                                            <button type="submit" class="btn bg-teal-400 btn-labeled btn-labeled-right ml-10"><b><i class="icon-plus3"></i></b> Create account</button>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </form>
                    <!-- /registration form -->

                </div>
                <!-- /main content -->

            </div>
            <!-- /page content -->

        </div>
        <!-- /page container -->





	<!-- Footer -->
	<div class="navbar navbar-default navbar-fixed-bottom footer">
		<ul class="nav navbar-nav visible-xs-block">
			<li><a class="text-center collapsed" data-toggle="collapse" data-target="#footer"><i class="icon-circle-up2"></i></a></li>
		</ul>

		<div class="navbar-collapse collapse" id="footer">
                    <div class="navbar-text just-white" >
				&copy; 2018. <a href="#"><?php echo SITE_NAME; ?></a>
			</div>

			<div class="navbar-right">
				<ul class="nav navbar-nav just-white">
					<li><a href="/">Home</a></li>
					<li><a href="#">Terms</a></li>
					<li><a href="#">Contact</a></li>
				</ul>
			</div>
		</div>
	</div>
	<!-- /footer -->

</body>
</html>

