extends ./admin-layout.jade
include ./includes/mixins.jade


block jumbo-desc
    p Admin Portal: New Agency Registration


block admin-content
    -
        var states = [
            "AL", "AK", "AZ", "AR", "CA", "CO", "CT", "DE", "DC", "FM", "FL",
            "GA", "HI", "ID", "IL", "IN", "IA", "KS", "KY", "LA", "ME", "MD",
            "MA", "MI", "MN", "MS", "MO", "MT", "NE", "NV", "NH", "NJ", "NM",
            "NY", "NC", "ND", "MP", "OH", "OK", "OR", "PW", "PA", "RI", "SC",
            "SD", "TN", "TX", "UT", "VT", "VI", "VA", "WA", "WV", "WI", "WY"
        ]

    - var route = '/admin/agency';
    - var form_action = '/create';

    p  Fill out the form and submit to create a new agency.

    form( action=( route + form_action ) enctype="multipart/form-data" method="post" )
        
        +input_text( "agency_id", "Agency ID", "", false, "" )
        +input_text( "name", "Agency Name", "", false, "" )
        +input_text( "address", "Address", "", false, "" )
        +input_text( "city", "City", "", false, "" )
        +select_options( "state", "State", states, false, "" )
        +input_text( "zip", "Zip Code", "", false,  "" )
        +input_text( "phone", "Phone Number", "", false, "" )

        .form-group
            label.control-label( for="image_upload" ) Logo Image Upload
            input( name="logo_upload" type="file" accept="image/*" )

        .form-group
            label.control-label( for="image_upload" ) Shield Image Upload
            input( name="shield_upload" type="file" accept="image/*" )

        .form-group
            button.btn.btn-primary( type="submit" value="save" ) Submit
