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Server: Apache/2.4.41 (Amazon) OpenSSL/1.0.2k-fips PHP/5.6.40
System: Linux ip-172-31-40-18 4.14.146-93.123.amzn1.x86_64 #1 SMP Tue Sep 24 00:45:23 UTC 2019 x86_64
User: apache (48)
PHP: 5.6.40
Disabled: NONE
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File: /var/www/html/punjabcabs/resources/views/admin/dispatch/create.blade.php
<div class="sidebar-chat animated fadeIn">
	<form action="" id="create_trip">
	<div class="sidebar-group">
		<h6>ADD NEW TRIP</h6>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="first_name" name="first_name" placeholder="First Name">
			<p class="error-field first_name">First name is required</p>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="last_name" name="last_name" placeholder="Last Name">
			<p class="error-field last_name">Last name is required</p>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="email" name="email" placeholder="Email">
			<p class="error-field email">Email id is required</p>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="mobile" name="mobile" placeholder="Phone Number">
			<p class="error-field mobile">Phone Number is required</p>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" onfocus="initrip()" id="s_address" name="s_address" placeholder="Pickup Location">
			<input type="hidden" name="s_latitude" id="s_latitude">
            <input type="hidden" name="s_longitude" id="s_longitude">
            <p class="error-field s_address">Pickup location required</p>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" onfocus="initrip()" id="d_address" name="d_address" placeholder="Drop Location">
			<input type="hidden" name="d_latitude" id="d_latitude">
            <input type="hidden" name="d_longitude" id="d_longitude">
            <input type="hidden" name="distance" id="distance">
            <p class="error-field d_address">Drop location required</p>
		</div>
		<div class="create-box text-black">
			<select class="form-control" id="trip_types" name="trip_types">
				<option value="1">Ride Now</option>
                <option value="2">Scheduled Ride</option>
			</select>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="schedule_time" name="schedule_time" placeholder="Schedule Time">
		</div>
		<div class="create-box text-black">
			<select name="service_type" id="service_type" class="form-control">
				@foreach($services as $service)
				    <option value="{{ $service->id }}">{{ $service->name }}</option>
				@endforeach
			</select>
		</div>
		<div class="create-box text-black">
			<input type="text" class="form-control" id="driver_message" name="driver_message" placeholder="Remarks">
		</div>
		<div class="create-box text-black">
			<div class="text-truncate">Auto Assign Driver</div>
			<div class="ss-checkbox"><input type="checkbox" id="provider_auto_assign" name="provider_auto_assign" class="js-switch" data-color="#f59345" checked /></div>
		</div>
		<div class="create-box text-black">
			<button type="button" id="clear" class="btn btn-sm btn-info waves-effect waves-light" onclick=>CLEAR</button>
			<button type="submit" id="submit" class="btn btn-sm pull-right btn-success waves-effect waves-light submitter" onclick=>SUBMIT</button>
			<button type="button" id="cancel" class="btn btn-sm pull-right btn-danger waves-effect waves-light" onclick=>CANCEL</button>
		</div>
	</div>
	</form>
</div>