1. {{trans('messages.home')}}
  2. Orders
  3. New Order

{{ Form::open(array('url' => 'cphlorder', 'id' => 'form-facilityrequest', 'method' => 'POST')) }}

{{ HTML::image(Config::get('kblis.organization-logo'), Config::get('kblis.country') . trans('messages.court-of-arms'), array('width' => '150px')) }}
{{ strtoupper(Config::get('constants.FACILITY_REQUEST_FORM_HEADER')) }}
{{Config::get('kblis.address-info')}}




Please Fill this form properly and submit to UNHLS as per the NMS Distribution Schedule

{{ Form::label('facility_id', 'Name:', array('class'=>'col-sm-2')) }} {{ Form::select('facility_id', $facility, Input::old('facility_id'), array('class' => 'form-control col-sm-4')) }} @if ($errors->has('facility_id')) {{ $errors->first('facility_id') }} @endif
{{ Form::label('district_id', 'District:', array('class'=>'col-sm-2')) }} {{ Form::select('district_id', $district, Input::old('district_id'), array('class' => 'form-control col-sm-4')) }}
{{ Form::label('start_date', 'Start Date:', array('class'=>'col-sm-2')) }} {{ Form::text('start_date', Input::old('start_date'),array('class' => 'form-control standard-datepicker-nofuture','required'=>'required','id'=>'start_date')) }} {{ Form::label('end_date', 'End Date:', array('class'=>'col-sm-2')) }} {{ Form::text('end_date', Input::old('end_date'),array('class' => 'form-control standard-datepicker-nofuture','required'=>'required','id'=>'_date')) }}
{{ Form::label('requested_by', 'Prepared By:', array('class' =>'col-sm-2 ')) }} {{ Form::text('requested_by', Auth::user()->name,array('class' => 'form-control col-sm-4', 'readonly')) }} {{ Form::label('date_submitted', 'Date Prepared:', array('class' =>'col-sm-2 ')) }} {{ Form::text('date_submitted', Input::old('date_submitted'),array('class' => 'form-control standard-datepicker-nofuture','required'=>'required','id'=>'expiry_date')) }}
Product Description Pack Size Opening Balance Qty Received
During the period		 Consumption
during the period		 Losses / Adjustments
(-/+)		 Quantity Required Total Cost Comments
{{ Form::button(" ".trans('messages.save'), array('class' => 'btn btn-primary', 'onclick' => 'submit()')) }}