<section class="screen_1">
    <form id="creditfairForm" action="javascript:" method="POST">
        <input type="hidden" name="_token" value="<?php echo e(csrf_token()); ?>" />
        <?php if(isset($callback_url) && $callback_url): ?>
        <input type="hidden" name="c_url" value="<?php echo $callback_url ?? ''; ?>" />
        <?php endif; ?>
        <?php if(isset($merchant_id) || isset($selectedMerchantID)): ?>
            <input type="hidden" name="merchant_id" value="<?php echo $merchant_id ?? ($selectedMerchantID ?? ''); ?>" class="merchant_id">
        <?php endif; ?>
        <?php if(isset($api_init)): ?>
        <input type="hidden" name="api_init" value="web-api"/>
        <?php endif; ?>
        <?php if(isset($merchant_location_id)): ?>
            <input type="hidden" name="merchant_location_id" value="<?php echo e($merchant_location_id); ?>" class="merchant_location_id">
        <?php endif; ?>
        <div class="row">
            <div class="col-md-12 mt-3">
                <?php if(!isset($bill_id)): ?>
                <?php if(isset($selectedMerchantID) && ($selectedMerchantID > 0)): ?>
                    <h4 class="text-center mb-4"><strong>Welcome to <?php echo e($merchant_details[0]['merchant_name']); ?></strong></h4>
                <?php if(isset($merchantLocation->name) && $merchantLocation->name): ?>
                    <h6 class="text-center" style="padding-bottom: 9px;">(<?php echo ucfirst($merchantLocation->name); ?>)</h6>
                <?php endif; ?>
                    <h6 class="text-center">You can apply for Easy EMI plans in just a few minutes!</h6>
                    <h6 class="text-center">Powered by Credit Fair<sup>TM</sup></h6>
                <?php else: ?>
                
                <div class="text-center">
                    <span class="font-weight-bold" style="font-size: 24px">Welcome to Credit Fair</span><br />
                    <span class="mt-3" style="font-size: 19px">You can apply for Easy EMI plans in just a few minutes!</span>
                </div>
                    <?php endif; ?>
                <?php endif; ?>
            </div>
        </div>

        <div class="row">
                <div class="col-12 mt-4 mb-2">
                    <strong class="font-weight-bold" style="font-size: 19px">Personal Details</strong>
                </div>
                <div class="col-12 col-md-4 mt-4">
                    <div class="md-form mt-0 mb-0">
                        <input type="text" class="form-control" <?php if(isset($name) && $name): ?> readonly disabled="disabled" value="<?php echo isset($name) ? $name : ''; ?>" <?php endif; ?> name="name">
                        <label class="font-weight-normal" for="">Name as per Pan Card <span class="required">*</span></label>
                    </div>
                </div>
                <div class="col-12 col-md-4 mt-4">
                    <div class="md-form mt-0 mb-0">
                        <input type="text" class="form-control" <?php if(isset($pan_card) && $pan_card): ?> readonly disabled="disabled" value="<?php echo isset($pan_card) ? $pan_card : ''; ?>" <?php endif; ?> name="pan_card" onkeyup="this.value = this.value.toUpperCase()">
                        <label class="font-weight-normal" for="">Pan Card ID <span class="required">*</span></label>
                    </div>
                </div>
            <div class="col-12 col-md-4 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="text" class="form-control" <?php if(isset($aadhaar_card) && $aadhaar_card): ?> readonly disabled="disabled" value="<?php echo isset($aadhaar_card) ? $aadhaar_card : ''; ?>" <?php endif; ?> name="aadhaar_card" min="0">
                    <label class="font-weight-normal" for="">Aadhaar Card ID</label>
                </div>
            </div>
        </div>
        <div class="row">
            <div class="col-12 mt-5 mb-2">
                <strong class="font-weight-bold" style="font-size: 19px">Contact Details</strong>
            </div>
            <div class="col-12 col-md-5 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="email" class="form-control" <?php if(isset($email) && $email): ?> readonly disabled="disabled" value="<?php echo isset($email) ? $email : ''; ?>" <?php endif; ?> name="email">
                    <label class="font-weight-normal" for="">Email Address  <span class="required">*</span></label>
                </div>
            </div>
            <?php if(Auth::check() && trim(Auth::user()->mobile_number)): ?>
            <div class="col-12 col-md-5 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="number" class="form-control" id="mobile_number" name="mobile_number" value="<?php echo e(Auth::user()->mobile_number); ?>" readonly="" min="0">
                    <label class="font-weight-normal" for="">Mobile Number <span class="required">*</span></label>
                </div>
                <a href="javascript:void(0)" disabled class="verify_number verified">Verified</a>
            </div>
            <?php else: ?>
            <div class="col-12 col-md-5 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="number" class="form-control" id="mobile_number" <?php if(isset($phone) && $phone): ?> readonly disabled="disabled" value="<?php echo isset($phone) ? $phone : ''; ?>" <?php endif; ?> name="mobile_number" min="0">
                    <label class="font-weight-normal" for="">Mobile Number <span class="required">*</span></label>
                </div>
                <a href="javascript:void(0)" class="verify_number">Verify</a>
            </div>
            <?php endif; ?>
            <input type="text" class="form-control" id="request_id" name="request_id" value="" id="request_id" style="display: none">

            <div class="col-12 col-md-4 mt-4" id="otp_wrap">
                <div class="md-form mt-0 mb-0">
                    <input type="text" class="form-control" id="otp">
                    <label class="font-weight-normal" for="">Enter your OTP</label>
                </div>
                <a href="javascript:void(0)" id="verify_otp" class="submit_otp btn-sm btn btn-primary">SUBMIT</a>
            </div>
        </div>

        <div class="row">
        <div class="col-12 mt-5 mb-2">
            <strong class="font-weight-bold" style="font-size: 19px">Product Details</strong>
        </div>

        <div class="col-12 col-md-4 mt-4 ">
            <div class="md-form mt-0 mb-0">
                <select class="" name="purpose" id="purpose" <?php if(isset($selectedMerchantCategoryID) && $selectedMerchantCategoryID > 0): ?> disabled <?php endif; ?>>
                    <option value="">CHOOSE PURPOSE <span class="required">*</span></option>
                    <?php $__currentLoopData = $merchant_category; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $category): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <option value="<?php echo $category->id; ?>" <?php if(isset($selectedMerchantCategoryID) && $selectedMerchantCategoryID > 0 && $selectedMerchantCategoryID == $category->id): ?> selected <?php endif; ?>><?php echo $category->name; ?></option>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </select>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4" id="type_of_customer">
            <div class="md-form mt-0 mb-0">
                <select class="mdb-select" name="type_of_customer" id="type_of_customer">
                    <option value="">Type Of Customer <span class="required">*</span></option>
                    <option value="1">Residential</option>
                    <option value="2">Rural C&I MSME ( Attachakki, Oil Expeller etc)</option>
                    <option value="3">Urban C&I MSME (Factories, Hospitals, Hotels, Offices, etc)</option>
                    <option value="4">Housing Society</option>
                    <option value="5">Schools & Universities</option>
                </select>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4" id="inverter">
            <div class="md-form mt-0 mb-0">
                <select class="mdb-select" name="inverter" id="inverter">
                    <option value="">INVERTER TO BE INSTALLED <span class="required">*</span></option>
                    <?php $__currentLoopData = $inverter_list; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $inverter): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <option value="<?php echo strtolower($inverter); ?>" ><?php echo $inverter; ?></option>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </select>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="other_inverter">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="other_inverter" id='other_inverter'>
                <label class="font-weight-normal">OTHER INVERTER NAME</label>
            </div>
        </div>

        <div class="col-12 col-md-4 mt-4" id="panel">
            <div class="md-form mt-0 mb-0">
                <select class="mdb-select" name="panel" id="panel">
                    <option value="">PANEL TO BE INSTALLED <span class="required">*</span></option>
                    <?php $__currentLoopData = $panel_list; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $panel): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <option value="<?php echo strtolower($panel); ?>" ><?php echo $panel; ?></option>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </select>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="other_panel">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="other_panel" id='other_panel'>
                <label class="font-weight-normal">OTHER PANEL NAME</label>
            </div>
        </div>

        <div class="col-12 col-md-4 mt-4 " id="model_description">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control " name="model_description" id='model_description'>
                <label class="font-weight-normal">MODEL DESCRIPTION</label>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="monthly_power_bill">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control field_validation1" name="monthly_power_bill" id='monthly_power_bill' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                <label class="font-weight-normal">MONTHLY POWER BILL</label>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="KW_installation">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control field_validation1" name="KW_installation" id='KW_installation' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                <label class="font-weight-normal">KW INSTALLATION</label>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="gross_project_amount">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control field_validation1" name="gross_project_amount" id='gross_project_amount' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                <label class="font-weight-normal">GROSS PROJECT AMOUNT</label>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="subsidy_amount">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control field_validation1" name="subsidy_amount" id='subsidy_amount' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                <label class="font-weight-normal">SUBSIDY AMOUNT</label>
            </div>
        </div>
        <div class="col-12 col-md-4 mt-4 " id="power_savings">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="power_savings" id='power_savings' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')" readonly="readonly">
                <label class="font-weight-normal">POWER SAVINGS(Estimated)</label>
            </div>
        </div>

        <?php if(!isset($bill_id)): ?>
        <div class="col-12 col-md-4 mt-4">
            <div class="md-form mt-0 mb-0">
                <select class="" name="merchant_id" id="src_merchant_name" <?php if(isset($selectedMerchantID) && $selectedMerchantID > 0): ?> disabled <?php endif; ?>>
                    <option value="" disabled selected>NAME OF MERCHANT <span class="required">*</span></option>
                    <?php if(isset($selectedMerchantID) && $selectedMerchantID > 0): ?>
                        <option value="<?php echo $selectedMerchantID; ?>" selected><?php echo e($merchant_details[0]['merchant_name']); ?></option>
                    <?php endif; ?>
                </select>
            </div>
        </div>
        <?php endif; ?>
        <?php if(isset($bill_id)): ?>
        <div id='bill_id_number_block' class="col-12 col-md-4 mt-4">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="unique_id_number" id='unique_id_number' <?php if(isset($bill_id) && $bill_id): ?> value="<?php echo e($bill_id); ?>" readonly="" <?php endif; ?>>
                <label class="font-weight-normal" for="">Bill ID</label>
            </div>
        </div>
        <?php endif; ?>
        <?php if(!isset($bill_id)): ?>
        <?php if(isset($merchantLocation) && $merchantLocation): ?>
            <div class="col-12 col-md-4 mt-4">
                <div class="md-form1 mt-0 mb-0">
                    <select class="" name="center_id" id="src_merchant_center_name" required="required" disabled>
                        <option value="">Name of Center <span class="required">*</span></option>
                        <option value="<?php echo $merchantLocation->id; ?>" selected><?php echo ucfirst($merchantLocation->name); ?></option>
                    </select>
                </div>
            </div>
        <?php else: ?>
            <div class="col-12 col-md-4 mt-4">
                <div class="md-form1 mt-0 mb-0">
                    <select class="" name="center_id" id="src_merchant_center_name" disabled>
                        <option value="">Name of Center</option>
                    </select>
                </div>
            </div>
        <?php endif; ?>
        <div class="col-12 col-md-4 mt-4 other_merchant_name">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="src_merchant_name" <?php if(isset($merchant_location_name) && $merchant_location_name): ?> value="<?php echo e($merchant_location_name); ?>" readonly="" <?php endif; ?>>
                <label class="font-weight-normal" for="">Name of Merchant</label>
            </div>
        </div>
        <div id='product_name_block' class="col-12 col-md-4 mt-4">
            <div class="md-form mt-0 mb-0">
                <input type="text" class="form-control" name="product_name" id='product_name' <?php if(isset($product_name) && $product_name): ?> value="<?php echo e($product_name); ?>" readonly="" <?php endif; ?>>
                <label class="font-weight-normal"><?php if(isset($selectedMerchantIDCat) && $selectedMerchantIDCat === 4): ?> Course Name <?php elseif($selectedMerchantIDCat === 7): ?> Vehicle Model Name <?php elseif($selectedMerchantIDCat === 16 || $selectedMerchantIDCat === 19 || $selectedMerchantIDCat === 20 || $selectedMerchantIDCat === 21 || $selectedMerchantIDCat === 25): ?> Treatment Name <?php else: ?> Product/Treatment/Course Name <?php endif; ?></label>
            </div>
        </div>
        <div id='unique_id_number_block' class="col-12 col-md-4 mt-4">
            <div class="md-form mt-0 mb-0">
                <i class="fa fa-info-circle" title="This number can be invoice number or Bill ID or student ID or any other unique number given by the merchant" style="position: absolute;left: -17px;"></i>
                <input type="text" class="form-control" name="unique_id_number" id='unique_id_number' <?php if(isset($bill_id) && $bill_id): ?> value="<?php echo e($bill_id); ?>" readonly="" <?php elseif(isset($unique_id_number) && $unique_id_number): ?> value="<?php echo e($unique_id_number); ?>" readonly="" <?php endif; ?>>
                <label class="font-weight-normal" for=""><?php if(isset($bill_id)): ?> Bill ID <?php else: ?> Unique ID Number <?php endif; ?></label>
            </div>
        </div>
        <?php endif; ?>
        <?php if(isset($merchant_email)): ?>
            <input type="hidden" class="form-control" name="lead_src_email" value="<?php echo e($merchant_email); ?>" >
        <?php endif; ?>
        <?php if(isset($merchant_phone)): ?>
            <input type="hidden" class="form-control" name="lead_src_phone" value="<?php echo e($merchant_phone); ?>" >
        <?php endif; ?>
        </div>

        <div class="row">
            <div id='product_id_block' class="col-12 col-md-4 mt-4" style="display: none">
                <div class="md-form mt-0 mb-0">
                    <input type="text" class="form-control" name="product_id" id='product_id' value="">
                    <label class="font-weight-normal">Product ID</label>
                </div>
            </div>
        </div>
        <?php if(!isset($bill_id)): ?>
        <div class="row">
            <div class="col-12 mt-4 mb-2">
                <strong class="we_just_txt"><?php if(isset($selectedMerchantIDCat) && $selectedMerchantIDCat === 4): ?> Duration of course <?php elseif(isset($selectedMerchantIDCat) && $selectedMerchantIDCat === 7): ?> Warranty Period of the vehicle <?php elseif(isset($selectedMerchantIDCat) && ($selectedMerchantIDCat === 16 || $selectedMerchantIDCat === 19 || $selectedMerchantIDCat === 20 || $selectedMerchantIDCat === 21 || $selectedMerchantIDCat === 25)): ?> Duration of Treatment <?php else: ?> Warranty Period/Duration of your Product/Treatment/Course <?php endif; ?></strong>
            </div>
            <div id='duration_year_block' class="col-12 col-md-4 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="number" class="form-control field_validation" name="duration_year" <?php if(isset($duration_year) && $duration_year): ?> readonly disabled="disabled" value="<?php echo isset($duration_year) ? $duration_year : ''; ?>" <?php else: ?> value="" <?php endif; ?> id='duration_year' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                    <label class="font-weight-normal">Years</label>
                </div>
            </div>
            <div id='duration_month_block' class="col-12 col-md-4 mt-4">
                <div class="md-form mt-0 mb-0">
                    <input type="number" class="form-control field_validation" name="duration_month" <?php if(isset($duration_month) && $duration_month): ?> readonly disabled="disabled" value="<?php echo isset($duration_month) ? $duration_month : ''; ?>" <?php else: ?> value="" <?php endif; ?> id='duration_month' min="0" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')">
                    <label class="font-weight-normal">Months</label>
                </div>
            </div>
        </div>
            <?php endif; ?>
        <div class="row">
            <div class="col-12 col-md-4  mt-4 mb-2">
                <div class="md-form mt-0 mb-0 amount_wrap">
                    <div class="col-12 mt-4 mb-2">
                        
                    </div>
                    <div style="position: relative;">
                        <i class="fa fa-inr prefix"></i>
                        <input type="text" class="form-control" <?php if(isset($loan_amount) && $loan_amount > 0): ?> readonly
                               disabled="disabled" required='required' value="<?php echo isset($loan_amount) ? $loan_amount : ''; ?>" <?php endif; ?> name="loan_amount">
                               <label  class="font-weight-normal" for="">AMOUNT NEEDED?<span class="required">*</span></label>
                    </div>
                    
                </div>
            </div>
            <div class="col-12 col-md-4  mt-4 mb-2" <?php if(isset($selectedMerchantID) && $selectedMerchantID > 0): ?> style="display: none;" <?php endif; ?>>
                <div class="md-form mt-0 mb-0">
                    <div class="col-12 mt-4 mb-2">
                        
                    </div>
                    <select class="mdb-select" name="tenure" id="tenure_select">
                        <option value="">FOR HOW LONG(MONTHS)?</option>

                        <?php if(isset($selectedMerchantID) && ($selectedMerchantID > 0)): ?>
                            <?php $__currentLoopData = $selectedMerchantOffers; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $offer): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                <option value="<?php echo $offer->tenure; ?>"><?php echo $offer->tenure; ?> Months</option>
                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                        <?php else: ?>
                            <?php for($i=3;$i <= 24; $i=$i+3): ?>
                                <option value="<?php echo e($i); ?>"><?php echo e($i); ?> Months</option>
                            <?php endfor; ?>
                        <?php endif; ?>
                    </select>
                </div>
            </div>
            <?php if(isset($selectedMerchantID) && ($selectedMerchantID > 0)): ?>
            <div class="col-12 col-md-4  mt-4 mb-2">
                <div class="md-form mt-0 mb-0">
                    <div class="col-12 mt-4 mb-2">
                        <strong>How long would you need to borrow for? <span class="required">*</span></strong>
                    </div>
                    <div class="view-offer-data"><span class="v-title">Select Offer</span> <span><img style="display:none;width: 16px;float: right;" src="/assets/front/img/loading.gif"/></span></div>
                </div>
            </div>
            <?php endif; ?>
        </div>
        <div class="col-12 mt-4">
            <strong class="font-weight-bold" style="font-size: 19px">Other Details</strong>
        </div>
        <div class="row">
            <div class="col-12 col-md-4">
                <div class="md-form mt-0 mb-0">
                     <div class="col-12 mt-3 mb-2">
                        
                    </div>
                    <select class="mdb-select" name="preferred_language" id="preferred_language" <?php if(isset($lang) && $lang): ?> readonly disabled="disabled" <?php endif; ?>>
                        <option value="">YOUR PREFFERED LANGUAGE</option>
                        <option <?php if(isset($lang) && $lang == 'ENGLISH'): ?> selected <?php endif; ?> value="ENGLISH">English</option>
                        <option <?php if(isset($lang) && $lang == 'HINDI'): ?> selected <?php endif; ?> value="HINDI">हिंदी</option>
                        <option <?php if(isset($lang) && $lang == 'MARATHI'): ?> selected <?php endif; ?> value="MARATHI">मराठी</option>
                        <option <?php if(isset($lang) && $lang == 'GUJARATI'): ?> selected <?php endif; ?> value="GUJARATI">ગુજરાતી</option>
                        <option <?php if(isset($lang) && $lang == 'BENGALI'): ?> selected <?php endif; ?> value="BENGALI">বাঙালি</option>
                        <option <?php if(isset($lang) && $lang == 'PUNJABI'): ?> selected <?php endif; ?> value="PUNJABI">ਪੰਜਾਬੀ</option>
                        <option <?php if(isset($lang) && $lang == 'TAMIL'): ?> selected <?php endif; ?> value="TAMIL">தமிழ்</option>
                        <option <?php if(isset($lang) && $lang == 'TELUGU'): ?> selected <?php endif; ?> value="TELUGU">తెలుగు</option>
                        <option <?php if(isset($lang) && $lang == 'KANNADA'): ?> selected <?php endif; ?> value="KANNADA">ಕನ್ನಡ</option>
                        <option <?php if(isset($lang) && $lang == 'MALAYALAM'): ?> selected <?php endif; ?> value="MALAYALAM">മലയാളം</option>
                        <option <?php if(isset($lang) && $lang == 'URDU'): ?> selected <?php endif; ?> value="URDU">اردو</option>
                        <option <?php if(isset($lang) && $lang == 'ODIA'): ?> selected <?php endif; ?> value="ODIA">ଓଡ଼ିଆ</option>
                    </select>
                </div>
            </div>
            <?php if(isset($selectedMerchantID) && $selectedMerchantID !== 6543): ?>
                <?php if(!isset($api_init)): ?>
            <div class="col-12 col-md-4 mt-3">
                <div class="md-form mt-0 mb-0">
            <div class="col-12 mb-2">
                
            </div>
                    
                    <select class="mdb-select" name="source" id="source" required="required" onchange="textSource(this.value);">
                        <option value="">HOW DID YOU HEAR ABOUT US?</option>
                        <option value="Social Media">Social Media</option>
                        <option value="Friend/Relative">Friend/Relative</option>
                        <option value="Paytm">Paytm</option>
                        <option value="Google Search">Google Search</option>
                        <option value="Other">Other</option>
                    </select>
                </div>
            </div>
            <div class="col-12 col-md-4 sc-rc-view-l">
                <div class="md-form mb-0">
                    
                    <input placeholder="ENTER SOURCE" type="text" name="source" id="txtSource" style="display: none;" class="form-control"/>
                </div>
            </div>
                    <?php endif; ?>
            <?php endif; ?>

            <?php if(isset($merchant_email)): ?>
                <input type="hidden" class="form-control" name="lead_src_email" value="<?php echo e($merchant_email); ?>" >
            <?php endif; ?>
            <?php if(isset($merchant_phone)): ?>
                <input type="hidden" class="form-control" name="lead_src_phone" value="<?php echo e($merchant_phone); ?>" >
            <?php endif; ?>
        </div>
        <div class="row">
            <div class="col-md-12 text-center" style="margin-bottom: 30px;">
                <button type="submit" class="btn apply_btn mt-4 mb-5 waves-effect waves-light button-logo-shade"
                        style="margin-bottom: 0 !important;">APPLY</button>
                <!-- <a href="javascript:;" id="create_application" class="btn btn-primary apply_btn mt-4 mb-5 waves-effect waves-light" style="margin-bottom: 0 !important;">APPLY</a><br/>
                <a href="javascript:;" id="check_eligibility" class="btn btn-primary eligibility_btn mt-4 mb-5 waves-effect waves-light">Check your eligibility</a> -->
            </div>
        </div>
    </form>
</section>
