{@ include(common/header) @}
      <h2>新規顧客様作成</h2>
{@ if (!empty($err)) @}
      <p class="errormes">
{@ foreach ($err as $e) @}
        {{ $e }}<br />
{@ endforeach @}
      </p>
{@ endif @}
      <p>
        <form method="POST" action="/openprovider/createcustomer">
          <h3>会社情報</h3>
          <p>個人の場合、入力が不要です。</p>
          <table>
            <tbody>
              <tr>
                <td><label for="company_name">会社名</label></td>
                <td><input type="text" name="company_name" value="{{ $data['company_name'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="company_registration_number">法人番号</label></td>
                <td><input type="text" name="company_registration_number" value="{{ $data['additional_data']['company_registration_number'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="company_url">ウェブサイト</label></td>
                <td><input type="text" name="company_url" value="{{ $data['additional_data']['company_url'] ?? '' }}" /></td>
              </tr>
            </tbody>
          </table>
          <h3>個人情報</h3>
          <table>
            <tbody>
              <tr>
                <td><label for="last_name">姓名（ローマ字）*</label></td>
                <td>
                  <input type="text" name="last_name" placeholder="Taro" value="{{ $data['name']['last_name'] ?? '' }}" />
                  <input type="text" name="first_name" placeholder="Yamada" value="{{ $data['name']['first_name'] ?? '' }}" />
                </td>
              </tr>
              <tr>
                <td><label for="phone.country_code">電話番号*</label></td>
                <td>
                  <input type="text" name="phone.country_code" placeholder="+81" value="{{ $data['phone']['country_code'] ?? '' }}" />
                  <input type="number" name="phone.area_code" placeholder="43" value="{{ $data['phone']['area_code'] ?? '' }}" />
                  <input type="number" name="phone.subscriber_number" placeholder="0000000" value="{{ $data['phone']['subscriber_number'] ?? '' }}" />
                </td>
              </tr>
              <tr>
                <td><label for="fax.country_code">FAX</label></td>
                <td>
                  <input type="text" name="fax.country_code" placeholder="+81" value="{{ $data['fax']['country_code'] ?? '' }}" />
                  <input type="number" name="fax.area_code" placeholder="43" value="{{ $data['fax']['area_code'] ?? '' }}" />
                  <input type="number" name="fax.subscriber_number" placeholder="0000000" value="{{ $data['fax']['subscriber_number'] ?? '' }}" />
                </td>
              </tr>
              <tr>
                <td><label for="email">メールアドレス*</label></td>
                <td><input type="text" name="email" placeholder="taro@076.co.jp" value="{{ $data['email'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="birth_year">生年月日</label></td>
                <td>
                  <input type="number" name="birth_year" placeholder="1970" value="{{ $data['birth']['year'] ?? '' }}" />年
                  <input type="number" name="birth_month" placeholder="12" value="{{ $data['birth']['month'] ?? '' }}" />月
                  <input type="number" name="birth_day" placeholder="31" value="{{ $data['birth']['day'] ?? '' }}" />日
                </td>
              </tr>
            </tbody>
          </table>
          <h3>住所情報</h3>
          <table>
            <tbody>
              <tr>
                <td><label for="address_zipcode">郵便番号*（ハイフン付き）</label></td>
                <td>〒<input type="number" name="address_zipcode" value="{{ $data['address']['zipcode'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="address_state">都道府県*</label></td>
                <td><input type="text" name="address_state" value="{{ $data['address']['state'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="address_city">市区町村*</label></td>
                <td><input type="text" name="address_city" value="{{ $data['address']['city'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="address_street">町名*</label></td>
                <td><input type="text" name="address_street" value="{{ $data['address']['street'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="address_number">番地*</label></td>
                <td><input type="text" name="address_number" value="{{ $data['address']['number'] ?? '' }}" /></td>
              </tr>
              <tr>
                <td><label for="address_country">国</label></td>
                <td>
                  <select name="address_country">
                    <option value="JP" selected="selected">日本</option>
                    <option value="NL">オランダ</option>
                  </select>
                </td>
              </tr>
              <tr>
                <td><label for="comments">メモ</label></td>
                <td><input type="text" name="comments" value="{{ $data['comments'] ?? '' }}" /></td>
              </tr>
            </tbody>
          </table>
          <button>送信</button>
        </form>
      </p>
{@ include(common/footer) @}