<section>
    <h2 class="mt-0 text-center">OH Nein ... alle Tester sind bereits vergriffen!</h2>
    <p class="text-center mb-4">ERINNERUNGS-SERVICE:<br>
        Lass Deine Kontaktdaten da, damit wir Dich informieren können, wenn es Nachschub gibt ...</p>
        <div class="row justify-content-md-center">
            <div class="col-lg-8">
                <div class="row">
                    <div class="col-12">
                        <div class="form-group {{ $errors->has('salutation') ? 'error' : '' }}">
                            <label for="salutation">Anrede <span class="required">*</span></label>
                            <select id="salutation" name="salutation" class="form-control selectpicker revalidat"
                                data-style="btn-default" data-error="#error-salutation" required>
                                {!! HTMLHelper::getSalutation(old('salutation')) !!}
                            </select>
                            <div id="error-salutation" class="text-left"></div>
                            @if ($errors->has('billing_salutation'))
                                <label for="billing_salutation" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('billing_salutation') }}</label>
                            @endif
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="firstname">Vorname <span class="required">*</span></label>
                            {!! Form::text('firstname', '', ['class' => 'form-control ' . ($errors->has('firstname') ? 'error' : ''), 'id' => 'firstname', 'required' => true]) !!}
                            @if ($errors->has('firstname'))
                                <label for="firstname" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('firstname') }}</label>
                            @endif
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="lastname">Nachname <span class="required">*</span></label>
                            {!! Form::text('lastname', '', ['class' => 'form-control ' . ($errors->has('lastname') ? 'error' : ''), 'id' => 'lastname', 'required' => true]) !!}
                            @if ($errors->has('lastname'))
                                <label for="lastname" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('lastname') }}</label>
                            @endif
                        </div>
                    </div>

                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="zipcode">PLZ <span class="required">*</span></label>
                            {!! Form::text('zipcode', '', ['class' => 'form-control ' . ($errors->has('zipcode') ? 'error' : ''), 'id' => 'zipcode', 'required' => true]) !!}
                            @if ($errors->has('zipcode'))
                                <label for="zipcode" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('zipcode') }}</label>
                            @endif
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label for="city">Stadt <span class="required">*</span></label>
                            {!! Form::text('city', '', ['class' => 'form-control ' . ($errors->has('city') ? 'error' : ''), 'id' => 'city', 'required' => true]) !!}
                            @if ($errors->has('city'))
                                <label for="city" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('city') }}</label>
                            @endif
                        </div>
                    </div>
                    <div class="col-12">
                        <div class="form-group">
                            <label for="email">E-Mail <span class="required">*</span></label>
                            {!! Form::email('email', '', ['class' => 'form-control ' . ($errors->has('email') ? 'error' : ''), 'id' => 'email', 'required' => true]) !!}
                            @if ($errors->has('email'))
                                <label for="email" class="error text-danger small"
                                    style="display: block;">{{ $errors->first('email') }}</label>
                            @endif
                            <i>Aus Sicherheitsgründen erhälst du eine E-Mail als Bestätigung, die Du über einen Link bestätigen musst.</i>

                        </div>
                    </div>
                    <div class="col-12">
                        <div class="form-group">
                            <label class="switcher switcher-success">
                                {!! Form::checkbox('accepted_data', 1, '', ['id' => 'accepted_data', 'class' => 'switcher-input', 'data-error' => '#error-accepted_data', 'required' => true]) !!}
                                <span class="switcher-indicator">
                                    <span class="switcher-yes">
                                        <span class="ion ion-md-checkmark"></span>
                                    </span>
                                    <span class="switcher-no">
                                    </span>
                                </span>
                                <span class="switcher-label">Mit Klick auf "Absenden" akzeptiere ich die
                                    <a href="https://www.gruene-seele.bio/agb/" target="_blank"
                                        class="text-secondary">Allgemeinen
                                        Geschäftsbedingungen</a> und die
                                    <a href="https://www.gruene-seele.bio/datenschutzerklaerung/" target="_bank"
                                        class="text-secondary">Datenschutzbelehrung</a>, damit für den Reminder
                                    meine Daten verarbeitet werden können. <span class="required">*</span>
                            </label>
                            <div id="error-accepted_data"></div>
                        </div>
                        <div class="text-center">
                            {!! Form::hidden("action", "submit-reminder-service") !!}
                            <button type="submit" class="btn btn-primary btn-lg mt-4 mb-4 button-prevent-multiple-submits">
                                <i class="ion ion-ios-paper-plane"></i> Absenden <i class="spinner fa fa-spinner fa-spin"></i>
                            </button>
                        </div>
                    </div>
                  
                </div>
            </div>
        </div>
        <div class="row">
            <div class="col-12">
                <hr class="">
            </div>
        </div>
</section>
