112 lines
2.8 KiB
HTML
112 lines
2.8 KiB
HTML
{{ template "rmo/layout/base.html" . }}
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{{ define "title" }}Confirm Address{{ end }}
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{{ define "extraheader" }}
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<style>
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body {
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background-color: #f8f9fa;
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}
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.progress-bar {
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background-color: #0d6efd;
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transition: width 0.3s ease;
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}
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.map-placeholder {
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width: 100%;
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height: 250px;
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background-color: #e9ecef;
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border: 2px dashed #6c757d;
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border-radius: 8px;
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display: flex;
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align-items: center;
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justify-content: center;
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color: #6c757d;
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font-size: 14px;
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}
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#address-input {
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font-size: 16px;
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}
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</style>
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{{ end }}
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{{ define "content" }}
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<div class="container-fluid px-3 py-3">
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<!-- Header -->
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<header class="text-center mb-4 pb-3 border-bottom">
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<div class="d-flex align-items-center justify-content-center mb-2">
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<img
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src="{{ .District.URLLogo }}"
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alt="{{ .District.Name }} logo"
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class="me-2"
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style="height: 40px; width: auto;"
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/>
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<h1 class="h5 mb-0">{{ .District.Name }}</h1>
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</div>
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<div class="text-muted small">
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<i class="bi bi-telephone"></i> {{ .District.OfficePhone }}
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</div>
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</header>
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<!-- Progress Bar -->
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<div class="mb-4">
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<div class="d-flex justify-content-between align-items-center mb-2">
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<span class="small text-muted">Step 2 of 10</span>
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</div>
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<div class="progress" style="height: 8px;">
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<div
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class="progress-bar"
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role="progressbar"
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style="width: 20%;"
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aria-valuenow="20"
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aria-valuemin="0"
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aria-valuemax="100"
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></div>
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</div>
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</div>
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<!-- Main Content -->
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<main>
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<h2 class="h4 mb-3">Confirm the property address</h2>
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<p class="text-muted mb-4">
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Please enter the address so we can match your response with our records.
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</p>
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<form id="address-form" method="POST" action="/compliance/address">
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<div class="mb-4">
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<label for="address-input" class="form-label fw-semibold">
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Property Address
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</label>
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<input
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type="text"
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class="form-control form-control-lg"
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id="address-input"
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name="address"
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placeholder="Start typing your address..."
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autocomplete="off"
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data-autocomplete="true"
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required
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/>
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<div class="form-text">
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Begin typing and select your address from the suggestions
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</div>
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</div>
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<!-- Map Placeholder -->
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<div class="mb-4">
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<label class="form-label fw-semibold">Location Preview</label>
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<div class="map-placeholder" id="map-container">
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<span>Map will appear here after address is selected</span>
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</div>
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</div>
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<!-- Navigation Buttons -->
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<div class="d-flex gap-2 mt-4">
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<a class="btn btn-outline-secondary" href="../compliance"> Back </a>
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<a class="btn btn-primary flex-grow-1" href="concern"> Continue </a>
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</div>
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</form>
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</main>
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</div>
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{{ end }}
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