<?php $__env->startSection('content'); ?>

    
<div class="row margin-top-55">
    <div class="col-xs-2">
        <?php echo $__env->make('offerings.registration.left_nav', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
    </div>
	<div class="col-xs-10">
		<div id="application-form-field">
			<div class="row">
				<?php if(empty($folio)): ?>
					<?php echo Form::open(); ?>
				<?php else: ?>
					<?php echo Form::open(array('method' => 'put')); ?>	
				<?php endif; ?>
				
				<?php if($errors->has()): ?>
					<div class="alert alert-danger">
					<?php foreach ($errors->all() as $row): ?>
					  <div><?php echo $row; ?></div>
					<?php endforeach; ?>
					</div>
				<?php endif; ?>
				<div class="col-md-12">
					<h1><span>Open an Account:</span> Personal Information</h1>
					<h5>All fields are required, unless marked <span>(optional).</span></h5>
				</div>
                
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="user-title" class="col-sm-12 control-label">Title <span>(optional)</span></label>
							<div class="col-sm-2">
                            	<?php if(empty($folio)): ?>
								<?php echo Form::select('title', array('Dr.' => 'Dr.', 'Ms.' => 'Ms.', 'Miss' => 'Miss', 'Mr.' => 'Mr.', 'Mrs.' => 'Mrs.'), null, array('id' => 'user-title', 'class' => 'form-control')); ?>
                                <?php else: ?>
                                	<?php echo $folio->title; ?>
                                <?php endif; ?>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12">
					<div class="row">
						<div class="col-md-4 no-pad">
							<div class="form-group">
								<label for="user-name" class="col-sm-12 control-label">First Name</label>
								<div class="col-sm-12">
                                	<?php if(empty($folio)): ?>
									<input type="text" maxlength="20" name="firstName" value="<?php echo (Input::old('firstName'))?Input::old('firstName'):Auth::user()->firstname; ?>" class="form-control" id="first-name" placeholder="First Name">
                                    <?php else: ?>
                                		<?php echo $folio->firstName; ?>
                                	<?php endif; ?>
								</div>
							</div>
						</div>
                        <?php if(empty($folio) || !empty($folio->middleName)): ?>
						<div class="col-md-4 no-pad left-margin">
							<div class="form-group left-margin">
								<label for="user-name" class="col-sm-12 control-label">Middle Initial</label>
								<div class="col-sm-5">
                                <?php if(empty($folio->middleName)): ?>
									<?php echo Form::text('middleName', null, array('maxlength' => '1', 'class' => 'form-control', 'id' => 'first-name')); ?>
                                 <?php else: ?>
                                 	<?php echo $folio->middleName; ?>
                                 <?php endif; ?>
								</div>
							</div>
						</div>
                        <?php endif; ?>
					</div>
				</div>
				<div class="col-md-12">
					<div class="row">
						<div class="col-md-4 no-pad">
							<div class="form-group">
								<label for="last-name" class="col-sm-12 control-label">Last Name</label>
								<div class="col-sm-12">
                                <?php if(empty($folio)): ?>
									<?php echo Form::text('lastName', null, array('maxlength' => '35', 'class' => 'form-control', 'id' => 'last-name', 'placeholder' => 'Last Name')); ?>
                                <?php else: ?>
                                	<?php echo $folio->lastName; ?>
                                <?php endif; ?>
								</div>
							</div>
						</div>
                        <?php if(empty($folio) || !empty($folio->suffix)): ?>
						<div class="col-md-4 no-pad left-margin">
							<div class="form-group left-margin">
								<label for="suffix" class="col-sm-12 control-label">Suffix <span>(optional)</span></label>
								<div class="col-sm-4">
                                <?php if(empty($folio->suffix)): ?>
									<?php echo Form::select('suffix', array('' => '--', 'Jr.' => 'Jr.', 'Sr.' => 'Sr.', 'II' => 'II', 'III' => 'III', 'IV' => 'IV'), null, array('id' => 'suffix', 'class' => 'form-control')); ?>
                                <?php else: ?>
                                	<?php echo $folio->suffix; ?>
                                <?php endif; ?>	
								</div>
							</div>
						</div>
                        <?php endif; ?>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="date-of-birth" class="col-sm-12 control-label">Date of birth</label>
							<div class="col-sm-6" style="margin-left:15px">
								<div class="row">
                                	<?php if(empty($folio->dateOfBirth)): ?>
									<div class="col-sm-3 no-pad"><?php echo Form::text('month', null, array('maxlength' => '2', 'class' => 'form-control', 'id' => 'month', 'placeholder' => 'MM')); ?></div>
									<div class="col-sm-1">/</div>
									<div class="col-sm-3 no-pad"><?php echo Form::text('day', null, array('maxlength' => '2', 'class' => 'form-control', 'id' => 'day', 'placeholder' => 'DD')); ?></div>
									<div class="col-sm-1">/</div>
									<div class="col-sm-4 no-pad"><?php echo Form::text('year', null, array('maxlength' => '4', 'class' => 'form-control', 'id' => 'year', 'placeholder' => 'YYYY')); ?></div>
                                    <?php else: ?>
                                    	<?php echo date("m/d/Y", strtotime($folio->dateOfBirth)); ?>
                                    <?php endif; ?>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="social-security-number" class="col-sm-12 control-label">Social Security Number</label>
							<div class="col-sm-6" style="margin-left:15px">
								<div class="row">
                                	<?php if(empty($folio->tid)): ?>
									<div class="col-sm-3 no-pad"><?php echo Form::text('ssn1', null, array('maxlength' => '3', 'class' => 'form-control', 'id' => 'ssn1', 'placeholder' => 'XXX')); ?></div>
									<div class="col-sm-1">-</div>
									<div class="col-sm-3 no-pad"><?php echo Form::text('ssn2', null, array('maxlength' => '2', 'class' => 'form-control', 'id' => 'ssn2', 'placeholder' => 'XX')); ?></div>
									<div class="col-sm-1">-</div>
									<div class="col-sm-4 no-pad"><?php echo Form::text('ssn3', null, array('maxlength' => '4', 'class' => 'form-control', 'id' => 'ssn3', 'placeholder' => 'XXXX')); ?></div>
                                    <?php else: ?>
                                    	<?php echo $folio->tid; ?>
									<?php endif; ?>
                                </div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="evening-phone-number" class="col-sm-12 control-label">Evening Phone Number</span></label>
							<div class="col-sm-6">
								<div class="row">
									<div class="col-sm-8"><input type="text" name="eveningTelephone" value="<?php echo !empty($folio->eveningTelephone)?$folio->eveningTelephone:Input::old('eveningTelephone'); ?>" class="form-control"></div>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="evening-phone-number" class="col-sm-12 control-label">Daytime Phone Number</span></label>
							<div class="col-sm-6">
								<div class="row">
									<div class="col-sm-8"><input type="text" name="dayTelephone" value="<?php echo !empty($folio->dayTelephone)?$folio->dayTelephone:Input::old('dayTelephone'); ?>" class="form-control"></div>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<hr/>
							<label for="social-security-number" class="col-sm-12 control-label"><h2>Citizenship Status</h2></label>
							<div class="col-sm-6">
								<div class="controls">
									<label class="inline">Select one:</label>
									<?php if(!empty($folio->citizenship)): ?>	
										<label class="radio inline">
											<?php echo Form::radio('citizenship', 'C', $folio->citizenship == 'C'); ?>
											U.S Citizen
										</label>
										<label class="radio inline">
											<?php echo Form::radio('citizenship', 'R', $folio->citizenship == 'R'); ?>
											Resident Alien
										</label>
									<?php else: ?>
										<label class="radio inline">
										<?php echo Form::radio('citizenship', 'C'); ?>
										U.S Citizen
										</label>
										<label class="radio inline">
											<?php echo Form::radio('citizenship', 'R'); ?>
											Resident Alien
										</label>
									<?php endif; ?>
								</div>	
							</div>
						</div>
					</div>
					<hr/>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label"><h2>Primary Address <span>(U.S. Street addresses only; no P.O. Boxes)</span></h2></label>
							<label class="col-sm-12 control-label">Address 1</label>
							<div class="col-sm-6">
								<input type="text" maxlength="35" name="line1" class="form-control" id="address1" value="<?php echo !empty($folio->homeAddress->line1)?$folio->homeAddress->line1:Input::old('line1'); ?>">
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label">Address 2</label>
							<div class="col-sm-6">	
								<input type="text" maxlength="35" name="line2" id="address2" value="<?php echo !empty($folio->homeAddress->line2)?$folio->homeAddress->line2:Input::old('line2'); ?>" class="form-control">
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12">
					<div class="row">
						<div class="col-md-3 no-pad">
							<div class="form-group">
								<label for="city-name" class="col-sm-12 control-label">City</label>
								<div class="col-sm-12">
									<input type="text" name="city" value="<?php echo !empty($folio->homeAddress->city)?$folio->homeAddress->city:Input::old('city'); ?>" class="form-control" id="city-name">
								</div>
							</div>
						</div>
						<div class="col-md-4 no-pad left-margin">
							<div class="form-group left-margin">
								<label for="suffix" class="col-sm-12 control-label">State</label>
								<div class="col-sm-10">
									<?php if(!empty($folio->homeAddress->state)): ?>
										<?php echo Form::select('state', $states, $folio->homeAddress->state, array('class' => 'form-control')); ?>	
									<?php else: ?>	
										<?php echo Form::select('state', $states, null, array('class' => 'form-control')); ?>
									<?php endif; ?>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="date-of-birth" class="col-sm-12 control-label">Zip Code</label>
							<div class="col-sm-6" style="margin-left:15px">
								<div class="row">
									<div class="col-sm-4 no-pad"><input type="text" name="zipcode" class="form-control" id="zip-code1" value="<?php echo !empty($folio->homeAddress->zipcode)?$folio->homeAddress->zipcode:Input::old('zipcode'); ?>"></div>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<div class="col-sm-6">
								<label>Country: United States</label>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12">
					<h1><span>Open an Account:</span> Compliance Information</h1>
					<h5>Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. </h5>
				</div>
				<div class="col-md-12">
					<hr/>
					<h2>Employment Information</h2>
					<h5>Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s.</h5>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="status" class="col-sm-12 control-label">Status</label>
							<div class="col-sm-3">
								<?php if(!empty($folio->employmentStatus)): ?>
									<?php echo Form::select('employmentStatus', array('Employed' => 'Employed', 'Self-Employed' => 'Self-Employed', 'Retired' => 'Retired', 'Student' => 'Student', 'Unemployed' => 'Unemployed', 'Other' => 'Other'), $folio->employmentStatus, array('class' => 'form-control')); ?>
								<?php else: ?>
									<?php echo Form::select('employmentStatus', array('Employed' => 'Employed', 'Self-Employed' => 'Self-Employed', 'Retired' => 'Retired', 'Student' => 'Student', 'Unemployed' => 'Unemployed', 'Other' => 'Other'), null, array('class' => 'form-control')); ?>
								<?php endif; ?>	
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin" id="employerName">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label">The name of the employer</label>
							<div class="col-sm-6">	
								<input type="text" name="employerName" value="<?php echo !empty($folio->employerName)?$folio->employerName:Input::old('employerName'); ?>" class="form-control"> 
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin" id="employer_line1">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label">Address 1</label>
							<div class="col-sm-6">
								<input type="text" maxlength="35" name="employer_line1" value="<?php echo !empty($folio->employerAddress->line1)?$folio->employerAddress->line1:Input::old('employer_line1'); ?>" class="form-control">
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin" id="employer_line2">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label">Address 2 <span>(Optional)</span></label>
							<div class="col-sm-6">
								<input type="text" maxlength="35" name="employer_line2" value="<?php echo !empty($folio->employerAddress->line2)?$folio->employerAddress->line2:Input::old('employer_line2'); ?>" class="form-control">	
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12" id="employer_city">
					<div class="row">
						<div class="col-md-3 no-pad">
							<div class="form-group">
								<label for="city-name" class="col-sm-12 control-label">City</label>
								<div class="col-sm-12">
									  <input type="text" name="employer_city" value="<?php echo !empty($folio->employerAddress->city)?$folio->employerAddress->city:Input::old('employer_city'); ?>" class="form-control">
								</div>
							</div>
						</div>
						<div class="col-md-4 no-pad left-margin">
							<div class="form-group left-margin">
								<label for="suffix" class="col-sm-12 control-label">State</label>
								<div class="col-sm-10">
									<?php if(!empty($folio->employerAddress->state)): ?>
										<?php echo Form::select('employer_state', $states, $folio->employerAddress->state, array('class' => 'form-control')); ?>
									<?php else: ?>
										<?php echo Form::select('employer_state', $states, null, array('class' => 'form-control')); ?>	
									<?php endif; ?>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin" id="employer_zipcode">
					<div class="row">
						<div class="form-group">
							<label class="col-sm-12 control-label">Zip or Postal Code</label>
							<div class="col-sm-2">
								<input type="text" name="employer_zipcode" value="<?php echo !empty($folio->employerAddress->zipcode)?$folio->employerAddress->zipcode:Input::old('employer_zipcode'); ?>" class="form-control">	
							</div>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin" id="employer_country">
					<div class="row">
						<div class="form-group">
							<div class="col-sm-6">
								<label>Country: United States</label>
							</div>
						</div>
					</div>
				</div>
                <div class="col-md-12">
                	<hr/>
                	<h2>General Financial Information</h2>
              	</div>
              	<div class="col-md-12 bottom-margin">
                	<div class="row">
                		<div class="form-group">
                        	<label for="annual-income" class="col-sm-12 control-label">Annual Income</label>
                        	<div class="col-sm-4">
                      			<?php if(!empty($folio->annualIncome)): ?>
									<?php echo Form::select('annualIncome', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 100K', '4' => 'K100 200K', '5' => 'K200 300K', '6' => 'K300 500K', '7' => 'OVER 500K'), $folio->annualIncome, array('class' => 'form-control', 'id' => 'annual-income')); ?>
								<?php else: ?>
									<?php echo Form::select('annualIncome', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 100K', '4' => 'K100 200K', '5' => 'K200 300K', '6' => 'K300 500K', '7' => 'OVER 500K'), null, array('class' => 'form-control', 'id' => 'annual-income')); ?>
								<?php endif; ?>	
                        	</div>
                      	</div>
                  	</div>
              	</div>
              	<div class="col-md-12 bottom-margin">
               		<div class="row">
                   		<div class="form-group">
                        	<label for="total-net-worth" class="col-sm-12 control-label">Total Net Worth</label>
                        	<div class="col-sm-4">
                           		<?php if(!empty($folio->netWorth)): ?>
									<?php echo Form::select('netWorth', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 200K', '4' => 'K200 500K', '5' => 'K500 1M', '6' => 'M1 2M', '7' => 'M2 3M', '8' => 'OVER 3M'), $folio->netWorth, array('class' => 'form-control', 'id' => 'total-net-worth')); ?>
								<?php else: ?>
									<?php echo Form::select('netWorth', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 200K', '4' => 'K200 500K', '5' => 'K500 1M', '6' => 'M1 2M', '7' => 'M2 3M', '8' => 'OVER 3M'), null, array('class' => 'form-control', 'id' => 'total-net-worth')); ?>
								<?php endif; ?> 
                                <span>(Excluding your home)</span>
                        	</div>
                      	</div>
                  	</div>
              	</div>
                <div class="col-md-12 bottom-margin">
              		<div class="row">
                    	<div class="form-group">
                        	<label for="liquid-net-worth" class="col-sm-12 control-label">Liquid Net Worth</label>
                        	<div class="col-sm-4">
                           		<?php if(!empty($folio->liquidNetWorth)): ?>
									<?php echo Form::select('liquidNetWorth', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 200K', '4' => 'K200 500K', '5' => 'K500 1M', '6' => 'M1 2M', '7' => 'M2 3M', '8' => 'OVER 3M'), $folio->liquidNetWorth, array('class' => 'form-control', 'id' => 'liquid-net-worth')); ?>
								<?php else: ?>
									<?php echo Form::select('liquidNetWorth', array('1' => 'ZERO 25K', '2' => 'K25 50K', '3' => 'K50 200K', '4' => 'K200 500K', '5' => 'K500 1M', '6' => 'M1 2M', '7' => 'M2 3M', '8' => 'OVER 3M'), null, array('class' => 'form-control', 'id' => 'liquid-net-worth')); ?>
								<?php endif; ?> 
								<span>(Cash, securities, etc.)</span>
                        	</div>
                      	</div>
                  	</div>
                </div>
				<div class="col-md-12  bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="social-security-number" class="col-sm-12 control-label no-bold">Are you interested in Private Placement opportunities?</label>
							<div class="col-sm-12">
								<div class="controls">
									<label class="radio inline">
                                    	<?php if(empty($folio)): ?>
											<input type="radio" name="private_placement" value="0" /> No
										<?php else: ?>
                                        	<input type="radio" name="private_placement" value="0" <?php echo !isset($folio->accreditedInvestorNetWorth)?'checked="checked"':'' ?> /> No	
                                        <?php endif; ?>
                                    </label>
									<label class="radio inline">
										<input type="radio" name="private_placement" value="1" <?php echo isset($folio->accreditedInvestorNetWorth)?'checked="checked"':'' ?> /> Yes
									</label>
								</div>	
							</div>
						</div>
					</div>
					<div class="row">
						<div class="col-sm-12">
							Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. 
						</div>
					</div>
				</div>
				<div class="col-md-12  bottom-margin hidden" id="private_placement">
					<div class="row">
						<div class="form-group">
							<label for="social-security-number" class="col-sm-12 control-label">Lorem Ipsum is simply dummy text of the printing and typesetting industry.</label>
							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1 col-pad">1.</div>
									<div class="col-sm-11">
										<label class="no-bold">Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?</label>
										<div class="controls">
											<label class="radio inline">
                                            	<?php echo Form::radio('accreditedInvestorNetWorth', '0', (isset($folio->accreditedInvestorNetWorth) && $folio->accreditedInvestorNetWorth === false) ); ?> 
                                                No
											</label>
											<label class="radio inline">
                                            	<?php echo Form::radio('accreditedInvestorNetWorth', '1', (isset($folio->accreditedInvestorNetWorth) && $folio->accreditedInvestorNetWorth === true) ); ?> 
												Yes
											</label>
										</div>
									</div>
								</div>
							</div>
							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1 col-pad">2.</div>
									<div class="col-sm-11">
										<label class="no-bold">Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?</label>
										<div class="controls">
											<label class="radio inline">
                                            	<?php echo Form::radio('accreditedInvestorAnnualIncome', '0', (isset($folio->accreditedInvestorAnnualIncome) && $folio->accreditedInvestorAnnualIncome === false) ); ?> 
												No
											</label>
											<label class="radio inline">
                                            	<?php echo Form::radio('accreditedInvestorAnnualIncome', '1', (isset($folio->accreditedInvestorAnnualIncome) && $folio->accreditedInvestorAnnualIncome === true) ); ?> 
												 Yes
											</label>
										</div>
									</div>
								</div>
							</div>
							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1 col-pad">3.</div>
									<div class="col-sm-11">
										<label class="no-bold">Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?</label>
										<div class="controls">
											<label class="radio inline">
                                            	<?php echo Form::radio('previousPrivatePlacementExperience', '0', (isset($folio->previousPrivatePlacementExperience) && $folio->previousPrivatePlacementExperience === false) ); ?>
												 No
											</label>
											<label class="radio inline">
                                            	<?php echo Form::radio('previousPrivatePlacementExperience', '1', (isset($folio->previousPrivatePlacementExperience) && $folio->previousPrivatePlacementExperience === true) ); ?>
												 Yes
											</label>
										</div>
									</div>
								</div>
							</div>
							<div class="col-sm-12 hidden" id="previousExperienceSector">
								<div class="row">
									<div class="col-sm-1"></div>
									<div class="col-sm-11">
										<div class="row border-line">
											<div class="form-group">
												<label class="col-sm-12 control-label">Loreum Ipsum ....</label>
												<div class="col-sm-6">
                                                	<?php echo Form::select('previousExperienceSector', array('AGR' => 'AGRICULTURE', 'BAN' => 'BANKING AND FINANCIAL SERVICES', 'COB' => 'COMMERCIAL BANKING', 'INS' => 'INSURANCE', 'INV' => 'INVESTING', 'INB' => 'INVESTMENT BANKING', 'PIF' => 'POOLED INVESTMENT FUND', 'HFU' => 'HEDGE FUND', 'PEQ' => 'PRIVATE EQUITY', 'VCF' => 'VENTURE CAPITAL FUND', 'OTF' => 'OTHER INVESTMENT FUND', 'OTB' => 'OTHER BANKING AND FINANCIAL SERVICES', 'BUS' => 'BUSINESS SERVICES', 'ENE' => 'ENERGY', 'ELE' => 'ELECTRIC UTILITIES', 'CON' => 'ENERGY CONSERVATION', 'COA' => 'COAL MINING', 'ENV' => 'ENVIRONMENTAL SERVICES', 'OGS' => 'OIL AND GAS', 'OTE' => 'OTHER ENERGY', 'HCA' => 'HEALTH CARE', 'BIO' => 'BIOTECHNOLOGY', 'HIS' => 'HEALTH INSURANCE', 'HOS' => 'HOSPITALS AND PHYSICIANS', 'PHA' => 'PHARMACEUTICALS', 'OTC' => 'OTHER HEALTH CARE', 'MAN' => 'MANUFACTURING', 'RES' => 'REAL ESTATE', 'COR' => 'COMMERCIAL', 'CST' => 'CONSTRUCTION', 'FIN' => 'REITS AND FINANCE', 'RDN' => 'RESIDENTIAL', 'OTS' => 'OTHER REAL ESTATE', 'RET' => 'RETAILING', 'RTA' => 'RESTAURANTS', 'TEC' => 'TECHNOLOGY', 'CPT' => 'COMPUTERS', 'TEL' => 'TELECOMMUNICATIONS', 'OTT' => 'OTHER TECHNOLOGY', 'TRA' => 'TRAVEL', 'AAL' => 'AIRLINES AND AIRPORTS', 'LDG' => 'LODGING AND CONVENTIONS', 'TOU' => 'TOURISM AND TRAVEL SERVICES', 'OTL' => 'OTHER TRAVEL', 'OTH' => 'OTHER'), !empty($folio->previousExperienceSector)?$folio->previousExperienceSector:null, array('class' => 'form-control')); ?>
												</div>
											</div>
										</div>
									</div>
								</div>
							</div>						
							<hr/>
						</div>
					</div>
				</div>
				<div class="col-md-12 bottom-margin">
					<div class="row">
						<div class="form-group">
							<label for="social-security-number" class="col-sm-12 control-label"><h2>Compliance Information</h2></label>
							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1 col-pad">1.</div>
									<div class="col-sm-11">
										<label class="no-bold">Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?</label>
										<div class="controls">
											<label class="radio inline">
												<?php echo Form::radio('directorOrTenPercentShareholder', '0', (isset($folio->directorOrTenPercentShareholder) && $folio->directorOrTenPercentShareholder === false) ); ?> No
											</label>
											<label class="radio inline">
												<?php echo Form::radio('directorOrTenPercentShareholder', '1', (isset($folio->directorOrTenPercentShareholder) && $folio->directorOrTenPercentShareholder === true) ); ?> Yes
											</label>
										</div>
									</div>
								</div>
							</div>
								
							<div class="col-sm-12 hidden" id="directorOrTenPercentShareholderCompany">
								<div class="row">
									<div class="col-sm-1"></div>
									<div class="col-sm-11">
										<div class="row border-line">
											<div class="form-group">
												<label for="liquid-net-worth" class="col-sm-12 control-label">Loreum Ipsum .... </label>
												<div class="col-sm-2">
                                                	<?php echo Form::text('directorOrTenPercentShareholderCompany[]', (!empty($folio->directorOrTenPercentShareholderCompany[0]))?$folio->directorOrTenPercentShareholderCompany[0]:null, array('class' => 'form-control')); ?>
												</div>
												<div class="col-sm-2">
                                                	<?php echo Form::text('directorOrTenPercentShareholderCompany[]',( !empty($folio->directorOrTenPercentShareholderCompany[1]))?$folio->directorOrTenPercentShareholderCompany[1]:null, array('class' => 'form-control')); ?>
												</div>
												<div class="col-sm-2">
                                                	<?php echo Form::text('directorOrTenPercentShareholderCompany[]', (!empty($folio->directorOrTenPercentShareholderCompany[2]))?$folio->directorOrTenPercentShareholderCompany[2]:null, array('class' => 'form-control')); ?>	
												</div>
												<div class="col-sm-2">
                                                	<?php echo Form::text('directorOrTenPercentShareholderCompany[]', (!empty($folio->directorOrTenPercentShareholderCompany[3]))?$folio->directorOrTenPercentShareholderCompany[3]:null, array('class' => 'form-control')); ?>	
												</div>
												<div class="col-sm-2">
                                                	<?php echo Form::text('directorOrTenPercentShareholderCompany[]',(!empty($folio->directorOrTenPercentShareholderCompany[4]))?$folio->directorOrTenPercentShareholderCompany[4]:null, array('class' => 'form-control')); ?>	
												</div>
											</div>
										</div>
									</div>
								</div>
							</div>

							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1 col-pad">2.</div>
									<div class="col-sm-11">
										<label class="no-bold">Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?</label>
										<div class="controls">
											<label class="radio inline">
												<?php echo Form::radio('finraAffiliated', '0', (isset($folio->finraAffiliated) && $folio->finraAffiliated === false) ); ?> No
											</label>
											<label class="radio inline">
												<?php echo Form::radio('finraAffiliated', '1', (isset($folio->finraAffiliated) && $folio->finraAffiliated === true) ); ?> Yes
											</label>
										</div>
									</div>
								</div>
							</div>
								
							<div class="col-sm-12">
								<div class="row">
									<div class="col-sm-1"></div>
									<div class="col-sm-11">
										<div class="row border-line">
											<label for="liquid-net-worth" class="col-sm-12 control-label">Loreum Ipsum ....</label>
											<label class="no-bold padding-all">
											Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book?
											<br/><br/>
											Lorem Ipsum is simply dummy text of the printing and typesetting industry....
											</label>
										</div>
									</div>
								</div>
							</div>						
						</div>
					</div>
				</div>                                                        

				<div class="col-md-12 bottom-margin">
					<input type="submit" class="btn btn-continue" value="Continue">
				</div>
				<?php echo Form::close(); ?>
			</div> <!--End row-->
		</div>
	</div>
</div>

<?php $__env->startSection('scripts'); ?>
<script type="text/javascript">
	$(function() {
		$('.label-element').mouseover(function() {
			$(this).tooltip('show');
		});
		
		$('.label-element').mouseout(function() {
			$(this).tooltip('hide');
		});
		
		$( "select[name='employmentStatus']" ).change(function () {
			employmentStatus = $(this).val();
			if(employmentStatus == 'Employed' || employmentStatus == 'Self-Employed')
			{
				//$('#employer_address').removeClass("hidden");
				$('#employerName').removeClass("hidden");
				$('#employer_line1').removeClass("hidden");
				$('#employer_line2').removeClass("hidden");
				$('#employer_city').removeClass("hidden");
				$('#employer_state').removeClass("hidden");
				$('#employer_zipcode').removeClass("hidden");
				$('#employer_country').removeClass("hidden");
			}
			else
			{
				//$('#employer_address').addClass("hidden");
				$('#employerName').addClass("hidden");
				$('#employer_line1').addClass("hidden");
				$('#employer_line2').addClass("hidden");
				$('#employer_city').addClass("hidden");
				$('#employer_state').addClass("hidden");
				$('#employer_zipcode').addClass("hidden");
				$('#employer_country').addClass("hidden");	
			}	
		});
		
		$('input[name="directorOrTenPercentShareholder"]:radio').on("ifClicked", function () {
			value = $(this).val();
			if(value == '1')
				$("#directorOrTenPercentShareholderCompany").removeClass("hidden");
			else
				$("#directorOrTenPercentShareholderCompany").addClass("hidden");				
		});
		
		$('input[name="private_placement"]:radio').on("ifClicked", function () {
			value = $(this).val();
			if(value == '1')
				$("#private_placement").removeClass("hidden");
			else
				$("#private_placement").addClass("hidden");
		});
		
		$('input[name="previousPrivatePlacementExperience"]:radio').on("ifClicked", function () {
			value = $(this).val();
			if(value == '1')
				$("#previousExperienceSector").removeClass("hidden");
			else
				$("#previousExperienceSector").addClass("hidden");
		});
		
		var employmentStatus = $('select[name="employmentStatus"] option:selected').val();
		
		if(employmentStatus == 'Employed' || employmentStatus == 'Self-Employed')
		{
			$('#employer_address').removeClass("hidden");
			$('#employerName').removeClass("hidden");
			$('#employer_line1').removeClass("hidden");
			$('#employer_line2').removeClass("hidden");
			$('#employer_city').removeClass("hidden");
			$('#employer_state').removeClass("hidden");
			$('#employer_zipcode').removeClass("hidden");
			$('#employer_country').removeClass("hidden");	
		}
		else
		{
			$('#employer_address').addClass("hidden");
			$('#employerName').addClass("hidden");
			$('#employer_line1').addClass("hidden");
			$('#employer_line2').addClass("hidden");
			$('#employer_city').addClass("hidden");
			$('#employer_state').removeClass("hidden");
			$('#employer_zipcode').addClass("hidden");
			$('#employer_country').addClass("hidden");		
		}
		
		if($('input[name="directorOrTenPercentShareholder"]:checked').val() == '1')
			$("#directorOrTenPercentShareholderCompany").removeClass("hidden");	
			
		if($('input[name="private_placement"]:checked').val() == '1')
			$("#private_placement").removeClass("hidden");	
		
		if($('input[name="previousPrivatePlacementExperience"]:checked').val() == '1')
			$("#previousExperienceSector").removeClass("hidden");		
	});
</script>
<?php $__env->stopSection(); ?>

<?php $__env->stopSection(); ?>