@extends('layouts.default-home') 
@section('content')

    <!-- intro section
    ================================================== -->

    <div class="banner-page">
        <img src="/images/orcamento/orcamento-banner.jpg">             
    </div> 
    <form action="" method="GET" id="form-orcamento"> 
        <div class="container" style="margin-top: 30px;">
            <div class="col-md-12">
                <div class="form-group">
                    Assunto  <span class="red">*</span> 
                    <select name="AssuntoContatoCliente" class="AssuntoContatoCliente form-control">
                        <option value="Preciso de advogado">Preciso de advogado</option>
                        <option value="Quero esclarecer dúvidas">Quero esclarecer dúvidas</option>
                        <option value="Como está meu processo">Como está meu processo</option>
                        <option value="Preciso de auxílio com documentos">Preciso de auxílio com documentos</option>
                    </select>
                </div>
            </div>
            <div class="col-sm-12"> 
                <div class="form-group">
                    Conte-nos seu problema  <span class="red">*</span>
                    <textarea name="TextoProblemaCliente" class="form-control TextoProblemaCliente" rows="6"></textarea>
                </div>
            </div>
            <div class="col-sm-12"> 
                <p>Faça seu cadastro</p>
                <p>Os campos marcados com <span class="red">*</span> devem ser completos</p>
                <p class="text-justify">Preencha seus dados de forma exata para que possamos lhe orientar. Os mesmos dados serão utilizados na verificação da sua conta.</p>
            </div>
            
            <hr class="linha-orcamento">
            <div class="">
                <div class="col-sm-6 "> 
                    <div class="form-group">
                        Primeiro nome  <span class="red">*</span>
                        <input type="text" name="PrimeiroNomeCliente" class="form-control PrimeiroNomeCliente">
                    </div>
                </div>
                <div class="col-sm-6"> 
                    <div class="form-group">
                        Sobrenome  <span class="red">*</span>
                        <input type="text" name="SobrenomeCliente" class="form-control">
                    </div>
                </div>
                <div class="col-sm-6 data-nascimento "> 
                    <div class="form-group">
                        <label class="data-nascimento">Data de nascimento<span class="red">*</span></label>
                        <div class="col-sm-4 data-nascimento">
                            <div class="form-group">
                                
                                <select name="AnoNascimentoCliente" class="form-control AnoNascimentoCliente">
                                    <option value="">Dia</option>
                                    <option value="1">1</option>
                                    <option value="2">2</option>
                                    <option value="3">3</option>
                                    <option value="4">4</option>
                                    <option value="5">5</option>
                                    <option value="6">6</option>
                                    <option value="7">7</option>
                                    <option value="8">8</option>
                                    <option value="9">9</option>
                                    <option value="10">10</option>
                                    <option value="11">11</option>
                                    <option value="12">12</option>
                                    <option value="13">13</option>
                                    <option value="14">14</option>
                                    <option value="15">15</option>
                                    <option value="16">16</option>
                                    <option value="17">17</option>
                                    <option value="18">18</option>
                                    <option value="19">19</option>
                                    <option value="20">20</option>
                                    <option value="21">21</option>
                                    <option value="22">22</option>
                                    <option value="23">23</option>
                                    <option value="24">24</option>
                                    <option value="25">25</option>
                                    <option value="26">26</option>
                                    <option value="27">27</option>
                                    <option value="28">27</option>
                                    <option value="29">29</option>
                                    <option value="30">30</option>
                                    <option value="31">31</option>                                    
                                </select>
                            </div>
                        </div>
                        <div class="col-sm-4 data-nascimento">
                            <div class="form-group">
                                <select name="AnoNascimentoCliente" class="form-control AnoNascimentoCliente">
                                    <option value="">Mês</option>
                                    <option value="1">Janeiro</option>
                                    <option value="2">Favereiro</option>
                                    <option value="3">Março</option>
                                    <option value="4">Abril</option>
                                    <option value="5">Maio</option>
                                    <option value="6">Junho</option>
                                    <option value="7">Julho</option>
                                    <option value="8">Agosto</option>
                                    <option value="9">Setembro</option>    
                                    <option value="10">Outubro</option>
                                    <option value="11">Novembro</option>
                                    <option value="12">Dezembro</option>                              
                                </select>
                            </div>
                        </div>
                        <div class="col-sm-4 data-nascimento">
                            <select name="AnoNascimentoCliente" class="form-control AnoNascimentoCliente">
                                <option value="">Ano</option>
                                <option value=1900>1900</option><option value=1901>1901</option><option value=1902>1902</option><option value=1903>1903</option><option value=1904>1904</option><option value=1905>1905</option><option value=1906>1906</option><option value=1907>1907</option><option value=1908>1908</option><option value=1909>1909</option><option value=1910>1910</option><option value=1911>1911</option><option value=1912>1912</option><option value=1913>1913</option><option value=1914>1914</option><option value=1915>1915</option><option value=1916>1916</option><option value=1917>1917</option><option value=1918>1918</option><option value=1919>1919</option><option value=1920>1920</option><option value=1921>1921</option><option value=1922>1922</option><option value=1923>1923</option><option value=1924>1924</option><option value=1925>1925</option><option value=1926>1926</option><option value=1927>1927</option><option value=1928>1928</option><option value=1929>1929</option><option value=1930>1930</option><option value=1931>1931</option><option value=1932>1932</option><option value=1933>1933</option><option value=1934>1934</option><option value=1935>1935</option><option value=1936>1936</option><option value=1937>1937</option><option value=1938>1938</option><option value=1939>1939</option><option value=1940>1940</option><option value=1941>1941</option><option value=1942>1942</option><option value=1943>1943</option><option value=1944>1944</option><option value=1945>1945</option><option value=1946>1946</option><option value=1947>1947</option><option value=1948>1948</option><option value=1949>1949</option><option value=1950>1950</option><option value=1951>1951</option><option value=1952>1952</option><option value=1953>1953</option><option value=1954>1954</option><option value=1955>1955</option><option value=1956>1956</option><option value=1957>1957</option><option value=1958>1958</option><option value=1959>1959</option><option value=1960>1960</option><option value=1961>1961</option><option value=1962>1962</option><option value=1963>1963</option><option value=1964>1964</option><option value=1965>1965</option><option value=1966>1966</option><option value=1967>1967</option><option value=1968>1968</option><option value=1969>1969</option><option value=1970>1970</option><option value=1971>1971</option><option value=1972>1972</option><option value=1973>1973</option><option value=1974>1974</option><option value=1975>1975</option><option value=1976>1976</option><option value=1977>1977</option><option value=1978>1978</option><option value=1979>1979</option><option value=1980>1980</option><option value=1981>1981</option><option value=1982>1982</option><option value=1983>1983</option><option value=1984>1984</option><option value=1985>1985</option><option value=1986>1986</option><option value=1987>1987</option><option value=1988>1988</option><option value=1989>1989</option><option value=1990>1990</option><option value=1991>1991</option><option value=1992>1992</option><option value=1993>1993</option><option value=1994>1994</option><option value=1995>1995</option><option value=1996>1996</option><option value=1997>1997</option><option value=1998>1998</option><option value=1999>1999</option><option value=2000>2000</option><option value=2001>2001</option><option value=2002>2002</option><option value=2003>2003</option><option value=2004>2004</option><option value=2005>2005</option><option value=2006>2006</option><option value=2007>2007</option><option value=2008>2008</option><option value=2009>2009</option><option value=2010>2010</option><option value=2011>2011</option><option value=2012>2012</option><option value=2013>2013</option><option value=2014>2014</option><option value=2015>2015</option><option value=2016>2016</option><option value=2017>2017</option><option value=2018>2018</option><option value=2019>2019</option><option value=2020>2020</option><option value=2021>2021</option><option value=2022>2022</option><option value=2023>2023</option><option value=2024>2024</option><option value=2025>2025</option>                            </select>
                        </div>
                    </div>
                </div>
                
                <div class="col-sm-6">
                    <div class="form-group">
                        CPF  ou CNPJ <span class="red">*</span>
                        <input type="text" name="CpfCnpjCliente" class="CpfCnpj form-control CpfCnpjCliente">
                    </div>
                </div>
            </div>          
            <hr class="linha-orcamento">
            
            <div class="col-sm-6 data-nascimento "> 
                <div class="form-group">
                    <div class="col-sm-4 data-nascimento-zero">
                        <label class="data-nascimento">DDD<span class="red">*</span></label>
                        <div class="data-nascimento">
                            <input type="text" name="DddTelefoneCliente" class="form-control DddTelefoneCliente">
                        </div>
                    </div>
                    <div class="col-sm-8 data-nascimento-zero">
                        <label class="data-nascimento">Telefone<span class="red">*</span></label>
                        <div class="data-nascimento">
                            <input type="text" name="TelefoneCliente" class="form-control TelefoneCliente">
                        </div>
                    </div>
                </div>
            </div>
            <div class="col-sm-6">
                E-mail  <span class="red">*</span>
                <div class="form-group">
                    <input type="text" name="EmailCliente" class="EmailCliente form-control">
                </div>
            </div>
            <div class="col-sm-6">
                CEP  <span class="red">*</span>
                <div class="form-group">
                    <input type="text" name="NumeroCepCliente" class="NumeroCepCliente form-control">
                </div>
            </div>
            <div class="col-sm-6">
                <div class="form-group"> 
                    Rua  <span class="red">*</span> 
                    <input type="text" name="NomeLogradouroCliente" class="form-control NomeLogradouroCliente">
                </div>
            </div>
            <div class="col-md-6"> 
                <div class="form-group">
                    Número
                    <input type="text" name="NumeroCliente " class="form-control NumeroCliente">
                </div>
            </div>
            <div class="col-md-6"> 
                <div class="form-group">
                    Complemento
                    <input type="text" name="ComplementoCliente " class="form-control ComplementoCliente">
                </div>
            </div>
            <div class="col-md-6"> 
                <div class="form-group">
                    Bairro  <span class="red">*</span> 
                    <input type="text" name="NomeBairroCliente" class="form-control NomeBairroCliente">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                   Cidade  <span class="red">*</span> 
                   <input type="text" name="NomeCidadeCliente" class="form-control NomeCidadeCliente">
               </div>
           </div>         
           <div class="col-md-6">
            <div class="form-group">
                Estado  <span class="red">*</span> 
                <input type="text" name="NomeEstadoCliente" class="form-control NomeEstadoCliente">
            </div>
        </div>    
        
        
        <div class="col-md-12 text-center">
            <input type="submit"  data-toggle="modal" data-target="#orcamento-modal" name="" value="Cadastrar" class="btn-cadastro-site"/>  
        </div>
    </div>
</form>

</div>



@stop