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'))
{{ $errors->first('bank_account_deposit_date') }}
@endif
Status
status === 'INCOMPLETE' ? 'selected' : '' }}>Incomplete
status === 'OUTSTANDING' ? 'selected' : '' }}>Outstanding
status === 'INVOICE SENT' ? 'selected' : '' }}>Invoice Sent
status === 'PAID' ? 'selected' : '' }}>Paid
@if ($errors->has('status'))
{{ $errors->first('status') }}
@endif
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