{{ Form::open(array('url' => 'auth/signup','id'=>'signup')) }} @if (Session::has('notification')) {{ Session::get('notification') }} @endif @if (Session::has('notification_success'))

{{Session::get('notification_success')}}

@endif

*{{ Form::label('regType', 'Register as') }} {{ Form::select('regType',array( "FirmAdministrator" => "Firm Administrator", "Individual" => "Individual User" ),Input::old('regType'),array('class'=>'custom-select'))}} @if($errors->has('regType'))

{{ $errors->first('regType')}}

@endif

   Individual User registration is for non-law firm filers such as Pro Se or Court Reporting Services.

Filing Information

* {{ Form::label('filingFrequency', 'Filing frequency') }} ? {{ Form::select('filingFrequency', $frequencies, array('class'=>'custom-select'))}} @if($errors->has('filingFrequency'))

{{$errors->first('filingFrequency')}}

@endif

Personal Information

* {{ Form::label('email', 'Email') }} {{ Form::text('email', Input::old('email'),array('class'=>'inputStyle','style'=>'text-transform:lowercase;')) }} @if($errors->has('email'))

{{$errors->first('email')}}

@endif

* {{ Form::label('password', 'Password') }} {{ Form::password('password','',array('class'=>'inputStyle')) }} @if($errors->has('password'))

{{$errors->first('password')}}

@endif

* {{ Form::label('password_confirmation', 'Confirm Password') }} {{ Form::password('password_confirmation') }}

* {{ Form::label('firstName', 'First Name') }} {{ Form::text('firstName', Input::old('firstName'),array('class'=>'inputStyle')) }} @if($errors->has('firstName'))

{{$errors->first('firstName')}}

@endif

   {{ Form::label('middleName', 'Middle Name') }} {{ Form::text('middleName', Input::old('middleName'),array('class'=>'inputStyle')) }}

* {{ Form::label('lastName', 'Last Name') }} {{ Form::text('lastName', Input::old('lastName'),array('class'=>'inputStyle')) }} @if($errors->has('lastName'))

{{ $errors->first('lastName')}}

@endif

* {{ Form::label('passwordQuestion', 'Security Question') }} {{ Form::text('passwordQuestion', Input::old('passwordQuestion')) }} @if($errors->has('passwordQuestion'))

{{$errors->first('passwordQuestion')}}

@endif

* {{ Form::label('passwordAnswer', ' Answer') }} {{ Form::text('passwordAnswer','') }} @if($errors->has('passwordAnswer'))

{{$errors->first('passwordAnswer')}}

@endif

Contact Information

* {{ Form::label('phoneNumber', 'Phone Number') }} {{ Form::text('phoneNumber', Input::old('phoneNumber'),array('class'=>'inputStyle')) }} @if($errors->has('phoneNumber'))

{{$errors->first('phoneNumber')}}

@endif

* {{ Form::label('streetAddressLine1', 'Street Address') }} {{ Form::text('streetAddressLine1', Input::old('streetAddressLine1'),array('class'=>'inputStyle')) }} @if($errors->has('streetAddressLine1'))

{{ $errors->first('streetAddressLine1')}}

@endif

   {{ Form::label('streetAddressLine2', 'Address line 2') }} {{ Form::text('streetAddressLine2', Input::old('streetAddressLine2'),array('class'=>'inputStyle')) }} @if($errors->has('streetAddressLine2'))

{{$errors->first('streetAddressLine2')}}

@endif

* {{ Form::label('city', 'City') }} {{ Form::text('city', Input::old('city'),'',array('class'=>'inputStyle')) }} @if($errors->has('city'))

{{$errors->first('city')}}

@endif

* {{ Form::label('stateCode', 'State') }} {{ Form::select('stateCode',$state, $state_code,array('class'=>'custom-select'))}} @if($errors->has('stateCode'))

{{$errors->first('stateCode')}}

@endif

* {{ Form::label('zipCode', 'Zip Code') }} {{ Form::text('zipCode', Input::old('zipCode'),array('class'=>'inputStyle')) }} @if($errors->has('zipCode'))

{{$errors->first('zipCode')}}

@endif

{{ Form::checkbox('chck1', 'firmadmin') }} Allow MFR Customer Service to be a Firm Admin on your behalf

{{ Form::checkbox('chck1', 'filecourts') }} Allow MFR Customer Service to File to the courts on your behalf

{{ Form::checkbox('tnc', 'tnc') }} I agree to the Terms and Conditions

   {{ Form::submit('Register', array('class'=>'btn btn-medium reg-btn')) }} Cancel

{{ Form::close() }}