Information du Client

{{ Form::open(array('url' => 'register/step5', 'enctype'=>'multipart/form-data')) }}

E-mail Agence {{ Form::text('email', Input::get('email-step2'), array('class' => 'form-control', 'placeholder' => 'agent@agence.voyage', 'readonly' => 'readonly')) }}

Nom de l'Agence * {{ Form::text('agencyname','', array('class' => 'form-control', 'placeholder' => 'Nom de l\'Agence')) }}

Prenom * {{ Form::text('firstname','', array('class' => 'form-control', 'placeholder' => 'Prénom')) }}

Nom * {{ Form::text('lastname','', array('class' => 'form-control', 'placeholder' => 'Nom de Famille')) }}

Titre {{ Form::text('agenttitle','', array('class' => 'form-control', 'placeholder' => 'Conseiller en voyage')) }}

No. Telephone * {{ Form::text('phone','', array('class' => 'form-control', 'placeholder' => 'eg: 555-555-1212')) }}

Extension {{ Form::text('agentphonepost','', array('class' => 'form-control', 'placeholder' => '123')) }}

Numero IATA {{ Form::text('IATA','', array('class' => 'form-control', 'placeholder' => '45125 12451 12451 12451 ')) }}

Numero CLIA {{ Form::text('CLIA','', array('class' => 'form-control', 'placeholder' => '1234567890 ')) }}

GDS {{ Form::select('gds', array('', 'Sabre', 'Amadeus', 'Travelport'), '', array('class' => 'form-control')) }}

Localisation de l'Agence

Adresse Civique

Ville

Etat/Province/Region

Code Postale / ZIP Code

Pays

Téléphone

Courriel

Site Web

Photo de Profil

{{-- Form::hidden('sendpromos', 0) --}} {{-- Form::checkbox('sendpromos', 1, 1, ['class' => 'i-check', 'style' => 'position: absolute; opacity: 0;']) --}} {{ Lang::get('Acceptez-vous de recevoir des promotions ?') }}

{{ Form::label('wherex', 'Où avez-vous entendu parlé de nous ?'); }} {{ Form::textarea('wherex', '', ['rows' => '5']) }}