Fill out billing information

@if(Session::has('success'))

Billing updated

@elseif(Session::has('error'))

Billing not updated

@endif

@csrf

Payee Details

Payee Name @if ($errors->has('payee_name')) {{ $errors->first('payee_name') }} @endif

Payee Address @if ($errors->has('payee_address1')) {{ $errors->first('payee_address1') }} @endif

Payee City @if ($errors->has('payee_city')) {{ $errors->first('payee_city') }} @endif

Payee State @if ($errors->has('payee_state')) {{ $errors->first('payee_state') }} @endif

Payee Zip Code @if ($errors->has('payee_state')) {{ $errors->first('payee_state') }} @endif

Payee Phone Number @if ($errors->has('payee_tel')) {{ $errors->first('payee_tel') }} @endif

General Details

Insurance Financial Code @if ($errors->has('insurance_financial_code')) {{ $errors->first('insurance_financial_code') }} @endif

Amount Billed ($) @if ($errors->has('amount_billed')) {{ $errors->first('amount_billed') }} @endif

Contractual Allowance @if ($errors->has('contractual_allowance')) {{ $errors->first('contractual_allowance') }} @endif

Net Amount Billed @if ($errors->has('net_amount_billed')) {{ $errors->first('net_amount_billed') }} @endif

Bank Account Name @if ($errors->has('bank_account_name')) {{ $errors->first('bank_account_name') }} @endif

Bank Account Number @if ($errors->has('bank_account_number')) {{ $errors->first('bank_account_number') }} @endif

{{--

--}} {{-- Bank Account Amount Collected--}} {{-- --}} {{-- --}} {{-- @if ($errors->has('bank_account_amount_collected'))--}} {{-- {{ $errors->first('bank_account_amount_collected') }}--}} {{-- @endif--}} {{--

--}}

Bank Account Deposited To @if ($errors->has('bank_account_deposited_to')) {{ $errors->first('bank_account_deposited_to') }} @endif

Bank Account Deposit Date @if ($errors->has('bank_account_deposit_date')) {{ $errors->first('bank_account_deposit_date') }} @endif

Status @if ($errors->has('status')) {{ $errors->first('status') }} @endif