
<?php $__env->startSection('content'); ?>
<div class="cmn-section">
    <div class="container">
        <div class="row justify-content-center">
            <div class="col-md-8">
                <div class="card custom--card">
                    <div class="card-body">
                        <form method="POST" action="<?php echo e(route('user.data.submit')); ?>">
                            <?php echo csrf_field(); ?>
                            <div class="row">
                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('First Name'); ?></label>
                                    <input type="text" class="form-control form--control" name="firstname" value="<?php echo e(old('firstname')); ?>" required>
                                </div>

                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('Last Name'); ?></label>
                                    <input type="text" class="form-control form--control" name="lastname" value="<?php echo e(old('lastname')); ?>" required>
                                </div>
                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('Address'); ?></label>
                                    <input type="text" class="form-control form--control" name="address" value="<?php echo e(old('address')); ?>">
                                </div>
                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('State'); ?></label>
                                    <input type="text" class="form-control form--control" name="state" value="<?php echo e(old('state')); ?>">
                                </div>
                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('Zip Code'); ?></label>
                                    <input type="text" class="form-control form--control" name="zip" value="<?php echo e(old('zip')); ?>">
                                </div>

                                <div class="form-group col-sm-6">
                                    <label class="form-label"><?php echo app('translator')->get('City'); ?></label>
                                    <input type="text" class="form-control form--control" name="city" value="<?php echo e(old('city')); ?>">
                                </div>
                            </div>
                            <div class="form-group">
                                <button type="submit" class="btn btn--base btn--lg w-100">
                                    <?php echo app('translator')->get('Submit'); ?>
                                </button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<?php $__env->stopSection(); ?>

<?php echo $__env->make($activeTemplate.'layouts.frontend', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/kutwos5/public_html/core/resources/views/templates/ptc_diamond/user/user_data.blade.php ENDPATH**/ ?>