
<html>
    <head>

    <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap@4.3.1/dist/css/bootstrap.min.css" integrity="sha384-ggOyR0iXCbMQv3Xipma34MD+dH/1fQ784/j6cY/iJTQUOhcWr7x9JvoRxT2MZw1T" crossorigin="anonymous">
    </head>
    <style>
      input{
        text-align: right;
      }
    </style>
    <body>

    <nav class="navbar navbar-expand-lg navbar-light bg-dark py-4">
  <a class="navbar-brand" href="#">Navbar</a>
  <button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarSupportedContent" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation">
    <span class="navbar-toggler-icon"></span>
  </button>

  <div class="collapse navbar-collapse" id="navbarSupportedContent">
    <ul class="navbar-nav mr-auto">
      <li class="nav-item active">
        <a class="nav-link" href="#">Home <span class="sr-only">(current)</span></a>
      </li>
      <li class="nav-item">
        <a class="nav-link" href="#">Link</a>
      </li>
      <li class="nav-item dropdown">
        <a class="nav-link dropdown-toggle" href="#" id="navbarDropdown" role="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
          Dropdown
        </a>
        <div class="dropdown-menu" aria-labelledby="navbarDropdown">
        
          <div class="dropdown-divider"></div>
          
        </div>
      </li>
     
    </ul>
    
  </div>
</nav>

    <div class="container py-5" style="text-align: right;">
    <div class="card py-3">
    <div class=" col-12">
 <form action="<?php echo e(url('/email')); ?>" method="post">
    <?php echo csrf_field(); ?>
  <div class="form-group">
    
    <label >رقم العضوية</label>
    <input style="text-align: right;" type="text" class="form-control"  name="member_id" placeholder="ادخل رقم العضوية" required>
    
  </div>

  <div class="form-group">
    
    <label >رقم الفاتورة</label>
    <input type="number" class="form-control"  name="bill" placeholder="ادخل رقم الفانورة" required>
    
  </div>

  <div class="form-group">
    
    <label > اسم العميل الثلاثي</label>
    <input type="text" class="form-control" name="name"  placeholder="ادخل الاسم " required>
    
  </div>

  <div class="form-group">
    
    <label > رقم الجوال  </label>
    <input type="number" class="form-control" name="phone"  placeholder="ادخل الرقم " required>
    
  </div>

  <div class="form-group">
    
    <label >نوع السيارة </label>
    <input type="text" class="form-control" name="car_type"  placeholder="ادخل النوع " required>
    
  </div>

  <div class="form-group">
    
    <label > (رقم الشاسي (الهيكل </label>
    <input type="number" class="form-control"  name="chassie" placeholder="ادخل الرقم " required>
    
  </div>

  <div class="form-group">
    
    <label > رقم اللوحة </label>
    <input type="text" class="form-control"  name="bord_number" placeholder="ادخل الرقم " required>
    
  </div>

  <div class="form-group">
    
    <label > *موديل السيارة</label>
    <input type="text" class="form-control" name="model"  placeholder="ادخل الرقم " required>
    
  </div>
  
  <div class="form-group">
    
    <label > تاريخ تغيير الكفرات</label>
    <input type="date" class="form-control" name="date"  placeholder="ادخل التاريخ " required>
    
  </div>
  
  <button type="submit" class="btn btn-primary">ارسل</button>
</form> 
</div>
 </div>
 
    </div>

    <!-- Footer -->
<footer class="text-center text-lg-start bg-light text-muted">
  <!-- Section: Social media -->
  <section class="d-flex justify-content-center justify-content-lg-between p-4 border-bottom">
    <!-- Left -->
    <div class="me-5 d-none d-lg-block">

    </div>
    <!-- Left -->

    <!-- Right -->
    <div>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-facebook-f"></i>
      </a>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-twitter"></i>
      </a>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-google"></i>
      </a>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-instagram"></i>
      </a>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-linkedin"></i>
      </a>
      <a href="" class="me-4 text-reset">
        <i class="fab fa-github"></i>
      </a>
    </div>
    <!-- Right -->
  </section>
  <!-- Section: Social media -->

  <!-- Section: Links  -->
  <section class="">
    <div class="container text-center text-md-start mt-5">
      <!-- Grid row -->
      <div class="row mt-3">
        <!-- Grid column -->
        <div class="col-md-3 col-lg-4 col-xl-3 mx-auto mb-4">
          <!-- Content -->
          <h6 class="text-uppercase fw-bold mb-4">
            <i class="fas fa-gem me-3"></i>Company name
          </h6>
          <p>
            Here you can use rows and columns to organize your footer content. Lorem ipsum
            dolor sit amet, consectetur adipisicing elit.
          </p>
        </div>
        <!-- Grid column -->

        <!-- Grid column -->
        <div class="col-md-2 col-lg-2 col-xl-2 mx-auto mb-4">
          <!-- Links -->
          <h6 class="text-uppercase fw-bold mb-4">
            Products
          </h6>
          <p>
            <a href="#!" class="text-reset">Angular</a>
          </p>
          <p>
            <a href="#!" class="text-reset">React</a>
          </p>
          <p>
            <a href="#!" class="text-reset">Vue</a>
          </p>
          <p>
            <a href="#!" class="text-reset">Laravel</a>
          </p>
        </div>
        <!-- Grid column -->

        <!-- Grid column -->
        <div class="col-md-3 col-lg-2 col-xl-2 mx-auto mb-4">
          <!-- Links -->
          <h6 class="text-uppercase fw-bold mb-4">
            Useful links
          </h6>
          <p>
            <a href="#!" class="text-reset">Pricing</a>
          </p>
          <p>
            <a href="#!" class="text-reset">Settings</a>
          </p>
          <p>
            <a href="#!" class="text-reset">Orders</a>
          </p>
          <p>
            <a href="#!" class="text-reset">Help</a>
          </p>
        </div>
        <!-- Grid column -->

        <!-- Grid column -->
        <div class="col-md-4 col-lg-3 col-xl-3 mx-auto mb-md-0 mb-4">
          <!-- Links -->
          <h6 class="text-uppercase fw-bold mb-4">Contact</h6>
          <p><i class="fas fa-home me-3"></i> New York, NY 10012, US</p>
          <p>
            <i class="fas fa-envelope me-3"></i>
            info@example.com
          </p>
          <p><i class="fas fa-phone me-3"></i> + 01 234 567 88</p>
          <p><i class="fas fa-print me-3"></i> + 01 234 567 89</p>
        </div>
        <!-- Grid column -->
      </div>
      <!-- Grid row -->
    </div>
  </section>
  <!-- Section: Links  -->

  <!-- Copyright -->
  <div class="text-center p-4" style="background-color: rgba(0, 0, 0, 0.05);">
    © 2021 Copyright:
    <a class="text-reset fw-bold" href="https://mdbootstrap.com/">MDBootstrap.com</a>
  </div>
  <!-- Copyright -->
</footer>
<!-- Footer -->
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    </body>
</html>

 
<?php /**PATH E:\laravel\contactus_form\contactus_form2\resources\views/contactus.blade.php ENDPATH**/ ?>