24 lines
1.5 KiB
PHP
24 lines
1.5 KiB
PHP
<div class="mb-3">
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<label class="form-label" for="nomor_pelanggan">Nomor Pelanggan</label>
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<input type="text" id="nomor_pelanggan" name="nomor_pelanggan" class="form-control" placeholder="Enter nomor_pelanggan" value="{{ old('nomor_pelanggan', $data->nomor_pelanggan ?? '') }}" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="kota_pelayanan">Kota Pelayanan</label>
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<input type="text" id="kota_pelayanan" name="kota_pelayanan" class="form-control" placeholder="Enter kota_pelayanan" value="{{ old('kota_pelayanan', $data->kota_pelayanan ?? '') }}" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="nama">Nama</label>
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<input type="text" id="nama" name="nama" class="form-control" placeholder="Enter nama" value="{{ old('nama', $data->nama ?? '') }}" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="alamat">Alamat</label>
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<textarea class="form-control" id="alamat" name="alamat" rows="5" required>{{ old('alamat', $data->alamat ?? '') }}</textarea>
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</div>
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<div class="mb-3">
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<label class="form-label" for="latitude">Latitude</label>
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<input type="text" id="latitude" name="latitude" class="form-control" placeholder="Enter latitude" value="{{ old('latitude', $data->latitude ?? '') }}" required>
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</div>
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<div class="mb-3">
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<label class="form-label" for="longitude">Longitude</label>
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<input type="text" id="longitude" name="longitude" class="form-control" placeholder="Enter longitude" value="{{ old('longitude', $data->longitude ?? '') }}" required>
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</div> |