<?php $__env->startSection('content'); ?>

<div id="appCapsule">
    <div class="container py-5">
            <div class="section mt-2 text-center">
            <h1><?php echo e($pageTitle); ?></h1>
        </div>
        <div class="row justify-content-center">
            <div class="col-lg-8">
                <div class="card">
                    <div class="card-body">
                        <form method="POST" action="<?php echo e(route('user.data.submit')); ?>">
                            <?php echo csrf_field(); ?>
                            <div class="row">
                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('First Name'); ?></label>
                                    <input type="text" class="form-control form-control" name="firstname" value="<?php echo e(old('firstname')); ?>" required>
                                </div>

                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('Last Name'); ?></label>
                                    <input type="text" class="form-control form-control" name="lastname" value="<?php echo e(old('lastname')); ?>" required>
                                </div>
                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('Address'); ?></label>
                                    <input type="text" class="form-control form-control" name="address" value="<?php echo e(old('address')); ?>">
                                </div>
                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('State'); ?></label>
                                    <input type="text" class="form-control form-control" name="state" value="<?php echo e(old('state')); ?>">
                                </div>
                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('Zip Code'); ?></label>
                                    <input type="text" class="form-control form-control" name="zip" value="<?php echo e(old('zip')); ?>">
                                </div>

                                <div class="form-group basic col-sm-6">
                                    <label class="label"><?php echo app('translator')->get('City'); ?></label>
                                    <input type="text" class="form-control form-control" name="city" value="<?php echo e(old('city')); ?>">
                                </div>
                            </div>
                            <div class="form-group mt-2" >
                                <button type="submit" class="btn btn--base text-white w-100">
                                    <?php echo app('translator')->get('Submit'); ?>
                                </button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<?php $__env->stopSection(); ?>

<?php echo $__env->make($activeTemplate.'layouts.frontend', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/lotteryx/public_html/shopx.77lottery.xyz/core/resources/views/templates/smartlab/user/user_data.blade.php ENDPATH**/ ?>