@extends('layouts.transform')

@section('content')
<div class="container">
    <div class="row justify-content-center">
        <div class="col-md-8">
            <div class="card">
                <div class="card-header">Account Reset</div>
                <div class="card-body">
                    <form method="POST" action="{{ route('phonereset-save') }}">
                        @csrf
                        <div class="form-group row">
                          <label for="phone_num" class="col-sm-4 col-form-label text-md-right">Phone Number:</label>
                            <div class="col-md-6">
                                <input id="phone_num" class="form-control" name="phone_num" required autofocus>
                            </div>
                        </div>
                        <div class="form-group row">
                            <label for="sent_msg" class="col-sm-4 col-form-label text-md-right">Message:</label>
                            <div class="col-md-6">
                                <textarea class="form-control" id="sent_msg" rows="3" name="sent_msg" required></textarea>
                            </div>
                        </div>
                      <div class="form-group row">
                          <label for="email_addr" class="col-sm-4 col-form-label text-md-right">POC Receiving Email:</label>
                            <div class="col-md-6">
                                <input id="email_addr" class="form-control" name="email_addr" required>
                            </div>
                        </div>
                        <div class="form-group row mb-0">
                            <div class="col-md-8 offset-md-4">
                                <button type="submit" class="btn btn-primary">
                                    Send Text
                                </button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>
@endsection