{{ HTML::style('css/travel/new_address.css') }}

{{ Form::hidden('new-address-url', action('NewAddressController@postNewAddress', array()), array('id'=>'new-address-url')) }}
{{ Form::hidden('load-counties', action('NewAddressController@getCounties', array()), array('id'=>'load-counties')) }}
{{ Form::hidden('load-parishes', action('NewAddressController@getParishes', array()), array('id'=>'load-parishes')) }}

{{ Form::open(array('url' => '', 'class' => 'form-create', 'method' => 'POST', 'id' => 'newAddressForm')) }}

{{ Form::hidden('serial_fml', $param, array('id'=>'serial_fml')) }}
{{ Form::hidden('travel_address', 'YES', array('id'=>'travel_address_fma')) }}
{{ Form::hidden('serial_std', $serial_std, array('id'=>'serial_std')) }}
<div class="form-group hide">
    <div class="input-group" >
        <span class="input-group-addon addon-lg" id="basic-addon6">Tipo</span>
        {{ Form::select('address_type',$types,'OTHER', array('class'=>'form-control', 'id'=>'address_type')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Calle Principal</span>
        {{ Form::text('main_street', null, array('class'=>'form-control', 'id'=>'main_street')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Número</span>
        {{ Form::text('number', null, array('class'=>'form-control', 'id'=>'number')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Calle Secundaria</span>
        {{ Form::text('secondary_street', null, array('class'=>'form-control', 'id'=>'secondary_street')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Provincia</span>
        {{ Form::select('state',array(''=>'- Seleccione -') + $states,null, array('class'=>'form-control', 'id'=>'state')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Cantón</span>
        {{ Form::select('county',array(''=>'- Seleccione -'),null, array('class'=>'form-control', 'id'=>'county')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg" id="basic-addon6">Parroquia</span>
        {{ Form::select('parish',array(''=>'- Seleccione -'),null, array('class'=>'form-control', 'id'=>'parish')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Teléfono </span>
        {{ Form::text('phone1', null, array('class'=>'form-control', 'id'=>'phone1')) }}
    </div>
</div>
<div class="form-group toHide">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Extensión</span>
        {{ Form::text('ext_phone1', null, array('class'=>'form-control', 'id'=>'ext_phone1')) }}
    </div>
</div>

<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Sector</span>
        {{ Form::text('sector', null, array('class'=>'form-control', 'id'=>'sector')) }}
    </div>
</div>
<div class="form-group">
    <div class="input-group">
        <span class="input-group-addon addon-lg">Referencia</span>
        {{ Form::text('refenece', null, array('class'=>'form-control', 'id'=>'refenece')) }}
    </div>
</div>
<div class="form-group">
    {{ Form::submit('Guardar', array('class'=>'btn btn-success form-control'))}}
</div>

{{ Form::close() }}
{{ HTML::script('js/newAddress/new_address.js') }}