@extends('layouts.main') @section('content')
{{ Form::label("code","作業連番",["class"=>"control-label btn"]) }} | {{ Form::text("code", "", ["class"=>"form-control", "id"=>"code", "style"=>"width:120px", "readonly"]) }} | {{ Form::label("accept_ymd","受付日",["class"=>"control-label btn"]) }} | {{ Form::text("accept_ymd", date("Y/m/d"), ["class"=>"form-control", "id"=>"accept_ymd", "style"=>"width:120px"]) }} | {{ Form::label("accrual_ymd","発生日",["class"=>"control-label btn"]) }} | {{ Form::text("accrual_ymd", date("Y/m/d"), ["class"=>"form-control", "id"=>"accrual_ymd", "style"=>"width:120px"]) }} |
{{ Form::label("company_tel","電話元TEL",["class"=>"control-label btn"]) }} | {{ Form::text("company_tel", "", ["class"=>"form-control", "id"=>"company_tel", "maxlength"=>"14", 'onChange' => 'getCompany()', 'list'=>'company_tel_list']) }} | {{ Form::label("company_username","電話元担当者",["class"=>"control-label btn"]) }} | {{ Form::text("company_username", "", ["class"=>"form-control", "id"=>"company_username", 'list'=>'company_username_list']) }} | {{ Form::label("company_name","電話元名称",["class"=>"control-label btn"]) }} | {{ Form::text("company_name", "", ["class"=>"form-control", "id"=>"company_name", 'list'=>'company_name_list']) }} |
{{ Form::label("agency_name", "販売店名", ["class"=>"control-label btn"]) }} | {{ Form::text("agency_name", "", ["class"=>"form-control", "id"=>"agency_name", "list"=>"agency_name_list"]) }} | ||||
{{ Form::label("customer_tel","ユーザーTEL",["class"=>"control-label btn"]) }} | {{ Form::tel("customer_tel", "", ["class"=>"form-control", "id"=>"customer_tel", "maxlength"=>"12", "pattern"=>"\d{1,5}-\d{1,4}-\d{3,4}", 'onChange' => 'getCustomer()']) }} | {{ Form::label("customer_username","ユーザー担当者",["class"=>"control-label btn"]) }} | {{ Form::text("customer_username", "", ["class"=>"form-control", "id"=>"customer_username"]) }} | {{ Form::label("customer_name","ユーザー名称",["class"=>"control-label btn"]) }} | {{ Form::text("customer_name", "", ["class"=>"form-control", "id"=>"customer_name"]) }} |
{{ Form::label("customer_address", "ユーザー住所", ["class"=>"control-label btn"]) }} | {{ Form::tel("customer_zipcode", "", ["class"=>"form-control", "id"=>"customer_zipcode", "style"=>"width:7%", "maxlength" => "8", "pattern"=>"\d{3}-\d{4}", "onKeyUp"=>"AjaxZip3.zip2addr(this,'','customer_pref','customer_address1');"]) }} {{ Form::select('customer_pref', $pref_datas, "", ['class' => 'form-control', 'id' => 'customer_pref', "style"=>"width:10%"]) }} {{ Form::text("customer_address1", "", ["class"=>"form-control", "id"=>"customer_address1", "style"=>"width:40%"]) }} {{ Form::text("customer_address2", "", ["class"=>"form-control", "id"=>"customer_address2", "style"=>"width:40%"]) }} | ||||
{{ Form::label("item_name","機種",["class"=>"control-label btn"]) }} | {{ Form::select('item_name', $item_datas, "", ['class' => 'form-control validate[required]', 'id' => 'item_name', 'onChange' => 'makeList_Errorcode()']) }} | {{ Form::label("machine_no","機番",["class"=>"control-label btn"]) }} | {{ Form::text("machine_no", "", ["class"=>"form-control validate[required]", "id"=>"machine_no", "style"=>"width:120px"]) }} | {{ Form::label("deliver_ymd","納入日",["class"=>"control-label btn"]) }} | {{ Form::text("deliver_ymd", "", ["class"=>"form-control", "id"=>"deliver_ymd", "style"=>"width:120px"]) }} |
{{ Form::label("request_info", "依頼内容", ["class"=>"control-label btn"]) }} | {{ Form::textarea("request_info", "", ["class"=>"form-control", "id"=>"request_info", 'rows' => '4']) }} | ||||
{{ Form::label("error_code","エラーコード",["class"=>"control-label btn"]) }} | {{ Form::select('error_code', $error_codes, "", ['class' => 'form-control', 'id' => 'error_code']) }} | {{ Form::label("visit_date","訪問希望日",["class"=>"control-label btn"]) }} | {{ Form::text("visit_date", "", ["class"=>"form-control", "id"=>"visit_date", "style"=>"width:120px"]) }} | ||
{{ Form::label("memo", "特記事項", ["class"=>"control-label btn"]) }} | {{ Form::textarea("memo", "", ["class"=>"form-control", "id"=>"memo", 'rows' => '4']) }} | ||||
{{ Form::label("service_name","依頼先名称",["class"=>"control-label btn"]) }} | {{ Form::text('service_name', "", ['class' => 'form-control', 'id' => 'service_name', 'list'=>'service_name_list']) }} | ||||
{{ Form::label("reception_name", "電話受付者", ["class"=>"control-label btn"]) }} | {{ Form::text("reception_name", $request->reception_name, ["class"=>"form-control", "id"=>"reception_name"]) }} |