<div class="modal fade bs-modal-lg" id="payoff" tabindex="-1" role="dialog" aria-hidden="true">
	<div class="modal-dialog">
		<div class="modal-content">
			<div class="modal-header">
				<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
				<h4 class="modal-title">Pay Off</h4>
			</div>
			<br/>
			<form class="form-horizontal" role="form" action="{{ route('set_client_payment_payoff') }}" method="post">
            {{ csrf_field() }}
				<input type="hidden" name="payoff_loan_id" id="payoff_loan_id">
				<div class="row">
					<div class="col-md-10">
						<div class="col-md-12 ">
						  <div class="form-group">
								<label class="col-md-4 required control-label">Pay Date </label>
							   	<div class="col-md-8">
									<input type="text" class="form-control date_picker" value="{{date('d-m-Y')}}" name="payoff_date" id="pay_off_current_date" required>
							   	</div>
						  </div> 
						</div>
						<div class="col-md-12 ">
						  <div class="form-group">
								<label class="col-md-4  control-label">Principle Amount </label>
							   <div class="col-md-8">
							   		<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="payoff_amount" class="form-control"  id="payoff_amount" readonly="readonly">
									</div>
							   </div>
						  </div> 
						</div>
						<div class="form-group">
							<label class="col-md-4 required control-label">Interest Amount </label>
							<div class="col-md-8">
								<div class="input-group">
									<span class="input-group-addon"><i class=""></i>$</span>
									<input type="text" name="interest" class="form-control"  id="interest" readonly="readonly">
								</div>
							</div>
						</div>
						<div class="form-group" id="bank-list-condition">
							<label class="required col-md-4 control-label">Bank Name</label>
							<div class="col-md-8">
								{!! Form::select('bank_id', $bank_data, null, ['id' => 'bank-list','required', 'class' => 'form-control select2']) !!}
							</div>
						</div>
					</div>
				</div>
				<div class="modal-footer">
					<button type="button" data-dismiss="modal" class="button_warning">Close</button>
					<button title="Pay Off" type="submit" class="button_success" data-toggle="modal">Pay Off</button>
				</div>
			</form>
		</div>
		<!-- /.modal-content -->
	</div>
	<!-- /.modal-dialog -->
</div>