@include('agents._js_unique_name')
{{ Form::select('title', array('Mr' =>'Mr','Ms' =>'Ms','Miss' =>'Miss','Mrs' =>'Mrs'),'', array('id' => 'title', 'class' => 'form-control')) }}
{{ Form::text('name', null, array('id' => 'name', 'class' => 'form-control')) }}
{{ Form::text('middlename', null, array('id' => 'name', 'class' => 'form-control')) }}
{{ Form::text('lastname', null, array('id' => 'name', 'class' => 'form-control')) }}
{{ Form::text('guid', null, array('id' => 'unique_name', 'class' => 'form-control', 'readonly' => 'readonly')) }}
{{ Form::text('company', null, array('id' => 'company', 'class' => 'form-control')) }}
{{ Form::text('email', null, array('id' => 'email', 'class' => 'form-control')) }}
{{ Form::textarea('address', null, array('id' => 'address', 'class' => 'form-control', 'rows' => 4)) }}
{{ Form::text('country', null, array('id' => 'country', 'class' => 'form-control')) }}
{{ Form::textarea('note', null, array('id' => 'note', 'class' => 'form-control', 'rows' => 4)) }}
{{ Form::text('commision', null, array('id' => 'commision', 'class' => 'form-control')) }}
{{ Form::text('city', null, array('id' => 'city', 'class' => 'form-control')) }}
{{ Form::text('state', null, array('id' => 'state', 'class' => 'form-control')) }}
{{ Form::text('zip', null, array('id' => 'zip', 'class' => 'form-control')) }}
{{ Form::text('mobile', null, array('id' => 'mobile', 'class' => 'form-control')) }}
{{ Form::text('phone', null, array('id' => 'phone', 'class' => 'form-control')) }}