{!! Form::hidden('id', null, ['id' => 'id']) !!}

{!! Form::hidden('provider_id', null, ['id' => 'provider_id']) !!}

<div class = "form-group">
    {!! Form::label('bank_id', 'Bank:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
    {!! Form::select('bank_id', $bank_list, null, ['class' => 'form-control', 'required']) !!}
    </div>   
</div>
    
<div class = "form-group">
    {!! Form::label('branch_code', 'Branch Code:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
     {!! Form::text('branch_code', null, ['class' => 'form-control', 'maxlength' => 20]) !!}
    </div>   
</div>
   
<div class = "form-group">
    {!! Form::label('account_no', 'Account No:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
        {!! Form::text('account_no', null, ['class' => 'form-control margin-bottom', 'maxlength' => 20, 'required']) !!}
    </div>    
</div>
    
 <div class = "form-group">
    {!! Form::label('branch_name', 'Branch Name:', ['class' => 'control-label col-sm-2']) !!}
     <div class="col-sm-10">
    {!! Form::text('branch_name', null, ['class' => 'form-control', 'maxlength' => 30]) !!}
    </div>    
 </div>
      
<div class = "form-group">   
    {!! Form::label('bank_code', 'Bank Code:', ['class' => 'control-label col-sm-2']) !!}
     <div class="col-sm-10">
    {!! Form::text('bank_code', null, ['class' => 'form-control', 'maxlength' => 20]) !!}
    </div>    
</div>
      
<div class = "form-group">        
    {!! Form::label('address1', 'Address:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
        {!! Form::text('address1', null, ['class' => 'form-control margin-bottom', 'maxlength' => 40]) !!}
        {!! Form::text('address2', null, ['class' => 'form-control', 'maxlength' => 40]) !!}
        {!! Form::text('address3', null, ['class' => 'form-control', 'maxlength' => 40]) !!}
    </div>    
</div>
    
<div class = "form-group">  
    {!! Form::label('postalcode', 'Post Code:', ['class' => 'control-label col-sm-2', 'maxlength' => 20]) !!}
     <div class="col-sm-10">
        {!! Form::text('postalcode', null, ['class' => 'form-control']) !!}
    </div>    
</div>
    
<div class = "form-group">
    {!! Form::label('phone', 'Phone:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
    {!! Form::text('phone', null, ['class' => 'form-control', 'maxlength' => 20]) !!}
    </div>
</div>
    
<div class = "form-group">
    {!! Form::label('email', 'Email:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
    {!! Form::email('email', null, ['class' => 'form-control', 'maxlength' => 50, 'email']) !!}
     </div>
</div>
    
<div class = "form-group">
    {!! Form::label('contact', 'Contact:', ['class' => 'control-label col-sm-2']) !!}
    <div class="col-sm-10">
    {!! Form::text('contact', null, ['class' => 'form-control', 'maxlength' => 50]) !!}
    </div>
</div>