<div class=" text-left">
    {form->start name="formSummaryContactInfo" method="post" action=""}     
	{form->hidden name="productID" value=$selectedProductID}
  {form->hidden name="productTitle" value=$resultProductProduct[0]['productTitle']}
  {form->hidden name="brandID" value=$resultProductProduct[0]['brandID']}
    <h4 class="font-weight-bold mb-0">{$language.lblCalculateEligibility}</h4>
    <p class="font-family-primary text-muted mb-lg-5 mb-4">{$language.lblCalculateEligibilityNote}</p>
    <div class="contact-information form-blk col-md-9 col-12 p-0">
        <div class="row">
            <div class="col-lg-7 col-12 mb-4">
                <label class="font-family-secondary">{$language.lblFirstName}<sup class="mndty font-normal font-weight-normal">*</sup></label>
				 <div class="row"> 
                    <div class="col-lg-4 col-4">
                    {form->select tabindex="1"
                    id="subtitle"
                    name="subtitle"
                    class="form-control" 
                    options="{$language.lblMr}->{$language.lblMr}~*{$language.lblMrs}->{$language.lblMrs}~*{$language.lblMiss}->{$language.lblMiss}~*{$language.lblDr}->{$language.lblDr}"
                    }
                    </div>
                    <div class="col-lg-8 col-8">{form->textbox autocomplete="off" name="firstname" class="form-control" tabindex="2" maxlength="100" validate="required~*isAlphaNumericWithSpace" error=$language.errFirstName|cat:"~*"|cat:$language.errFirstNameValid}</div>
                </div>
            </div>
            <div class="col-lg-5 col-12 mb-4">
                <label class="font-family-secondary">{$language.lblLastName}<sup class="mndty font-normal font-weight-normal">*</sup></label>
                {form->textbox autocomplete="off" name="lastname" class="form-control" tabindex="3" maxlength="100" validate="required~*isAlphaNumericWithSpace" error=$language.errLastName|cat:"~*"|cat:$language.errLastNameValid}
            </div>
            <div class="col-12 mb-4">
            <label class="font-normal text-secondary mb-1 font-weight-bold">{$language.lblPhoneNumber}<sup class="mndty font-normal font-weight-normal">*</sup></label>
            <div class="row">
            <div class="col-4 col-lg-3 pr-0">
            {form->select tabindex="4"
            id="payCountrycode"
            name="payCountrycode"
            class="form-control  primary text-secondary" 
            options=$resOTPCountry
            }
            {*<select id="payCountrycode" class="form-control">
            <option value="971">+971</option>
            </select>*}</div>
            <div class="col-8 col-lg-9">
            {form->textbox name="phone" maxlength='10' class="form-control text-secondary"  tabindex="5" validate="required~*isNumber" error=$language.errPhone|cat:"~*"|cat:$language.errValidPhone}  
            </div>
            <span class="col-12 font-small mt-2">{$language.lblPhoneSubText}</span>
            </div>
            </div>
            <div class="col-12 mb-4">
            <label class="font-normal text-secondary mb-1 font-weight-bold">{$language.lblEmailAddress}<sup class="mndty font-normal font-weight-normal">*</sup></label>
            {form->textbox name="emailID" class="form-control text-secondary"  tabindex="6" validate="required~*email" error=$language.errInvalidEmail} 
            </div>
            <div class="col-12 mb-4">
            <label class="font-family-secondary">{$language.lblLocation}</label>
            {form->textbox autocomplete="off" name="location" class="form-control" tabindex="7" validate="isAlphaNumericWithSpace" error=$language.errLocValid}
            </div>
            <div class="col-12 mb-4">
            <label class="font-family-secondary">{$language.lblTypeEmployment}</label>
            {form->select tabindex="8"
            id="employmenttype"
            name="employmenttype"
            class="form-control" 
            options="{$language.lblSalaried}->{$language.lblSalaried}~*{$language.lblNonSalaried}->{$language.lblNonSalaried}~*{$language.lblPermanent}->{$language.lblPermanent}~*{$language.lblFixed}->{$language.lblFixed}"
            }
            </div>
            <div class="col-12 mb-4">
            <label class="font-family-secondary">{$language.lblMonthlyIncome}</label>
            {form->textbox autocomplete="off" name="monthlyincome" class="form-control" tabindex="9"}
            </div>
            <div class="col-12 mb-4">
            <label class="font-family-secondary">{$language.lblTotalLimitCreditCard}</label>
            {form->textbox autocomplete="off" name="totalcreditcardlimit" class="form-control" tabindex="10"}
            </div>
            <div class="col-12 mb-4">
                <label class="font-family-secondary m-0">{$language.lblTotalMonthPaymentExistLoan}</label>
                <p class="mb-2 font-small">{$language.lblLoanOptions}</p>
                {form->textbox autocomplete="off" name="loanmonthlyPayment" class="form-control" tabindex="11"}
            </div>
            <div class="col-12 mb-4">
            {form->checkbox class="pos-abs chkbx1"  name="payagreeloan" value="1" tabindex="12"}    
            <label for="payagreeloan"  class="font-normal text-secondary mb-1 font-weight-bold">{$language.lblSummaryLoanContent}</label>
            <div> {form->validate name="payvalidateAgreeLoan" validate="payagreeloan->required"  error=$language.errAgreement} </div>

            </div>
            <div class="col-12 mb-4">{form->submit name="submitSummaryForm" tabindex="13" class="btn btn-primary btn btn-primary font-weight-bold px-4 py-2 mt-3  mt-lg-0 " value={$language.lblApplyandContinue}}</div>
        </div>
    </div>
    {form->close} 
</div>          
{form->validate_script form="formSummaryContactInfo"}
<div class="modal fade show" id="loanThx" tabindex="-1" role="dialog" aria-labelledby="exampleModalCenterTitle" aria-hidden="true">
      <div class="modal-dialog modal-dialog-centered summary-apply-modal-dialog" role="document">
        <div class="modal-content summary-apply-modal-content rounded-0">
          <div class="modal-header p-0 border-bottom-0">
            <div class="col-lg-12 col-12 text-right font-weight-bold pt-3"><i class="icon-close cb-close cursor-pointer" data-dismiss="modal" aria-label="Close"></i></div>
          </div>
          <div class="modal-body px-5">
              
              {form->hidden name="hiddenfname"}
              {form->hidden name="hiddenlname"}
              {form->hidden name="hiddensubtitle"}
              {form->hidden name="hiddenphone"} 
              {form->hidden name="hiddenemail"}
              {form->hidden name="hiddenphonecode"}
            <div class="request-callback-form-blk text-left pb-4">
                <div class="text-secondary font-weight-bold h3">Dear <span id="contactName"></span>,</div>
                <p class="h4 mb-5">{$language.lblThanks}</p>
                <p class="h5 mb-0">{$language.lblReceiveOnlineApplication}</p>
                <p  class="h5 mb-4">{$language.lblContactSoon}</p>
                <!--  {form->button tabindex="10" value="{$language.lblSubmit}"  tabindex="6" name="submit" id="summaryReqCallBack" class="btn btn-primary font-small font-weight-bold w-50" form="formRequestCallback"} -->
                <button id="loan-continue" class="btn btn-lg btn-primary continue-btn cursor-pointer border-0 font-weight-bold">{$language.lblContinue}</button>
            </div>    
          </div>
        </div>
      </div>
    </div>
           
 
    