@extends('layout.base')

@section('content')
	<section class="registro-section col-md-6 col-md-offset-3 col-sm-10 col-sm-offset-1 col-xs-12">
		<div class="registro-secction-inner">
			<form>
				<div class="form-section">
					<div class="side-pipe">
						<div class="side-pipe-number blue">1</div>
					</div>
					<div class="form-section-title">
						<h3>Acceso</h3>
					</div>
					<div class="form-group">
						<label for="exampleInputEmail1">Email</label>
						<input type="email" class="form-control" id="exampleInputEmail1" placeholder="nombre@ejemplo.com">
					</div>
					<div class="form-group">
						<label for="exampleInputPassword1">Password</label>
						<input type="password" class="form-control" id="exampleInputPassword1" placeholder="Al menos 6 caracteres">
					</div>
				</div>
				<div class="form-section">
					<div class="side-pipe">
						<div class="side-pipe-number">2</div>
					</div>
					<div class="form-section-title">
						<h3>Datos Personales</h3>
					</div>
					<div class="form-group">
						<label for="exampleInputEmail1">Nombre Completo</label>
						<div class="row">
							<div class=" col-md-6 col-xs-12">
								<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Nombre(s)">
							</div>
							<div class=" col-md-6 col-xs-12">
								<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Apellidos">
							</div>
						</div>
					</div>
					<div class="form-group">
						<label for="exampleInputEmail1">Celular</label>
						<input type="email" class="form-control" id="exampleInputEmail1" placeholder="(55) 12 34 56 78">
					</div>
					<div class="form-group">
						<label for="exampleInputPassword1">Fecha de nacimiento</label>
						<div class="row">
							<div class="col-md-4 col-xs-12">
								<select class="form-control">
									<option>Día</option>
									<option>2</option>
									<option>3</option>
									<option>4</option>
									<option>5</option>
								</select>
							</div>
							<div class="col-md-4 col-xs-12">
								<select class="form-control">
									<option>Mes</option>
									<option>2</option>
									<option>3</option>
									<option>4</option>
									<option>5</option>
								</select>
							</div>
							<div class="col-md-4 col-xs-12">
								<select class="form-control">
									<option>Año</option>
									<option>2</option>
									<option>3</option>
									<option>4</option>
									<option>5</option>
								</select>
							</div>
						</div>
						
					</div>
				</div>
				<div class="form-section">
					<div class="side-pipe">
						<div class="side-pipe-number">3</div>
					</div>
					<div class="form-section-title">
						<h3>Dirección</h3>
					</div>
					<div class="form-group">
						<label for="exampleInputEmail1">Calle y Número</label>
						<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Calle #1">
					</div>
					<div class="form-group">
						<label for="exampleInputPassword1">Colonia</label>
						<select class="form-control">
							<option>Polanco</option>
							<option>2</option>
							<option>3</option>
							<option>4</option>
							<option>5</option>
						</select>
					</div>
					<div class="form-group">
						<label for="exampleInputPassword1">Estado</label>
						<select class="form-control">
							<option>CDMX</option>
							<option>2</option>
							<option>3</option>
							<option>4</option>
							<option>5</option>
						</select>
					</div>
				</div>
				<div class="form-section">
					<div class="side-pipe">
						<div class="side-pipe-number">4</div>
					</div>
					<div class="form-section-title">
						<h3>Forma de Pago</h3>
					</div>
					<div class="form-group">
						<div class="row">
							<div class="col-md-9 col-xs-12">
								<label for="exampleInputEmail1">Número de Tarjeta</label>
								<input type="email" class="form-control" id="exampleInputEmail1" placeholder="1234 5678 9012 3456">
							</div>
							<div class="col-md-3 col-xs-12">
								<label for="exampleInputEmail1">CVV</label>
								<input type="email" class="form-control" id="exampleInputEmail1" placeholder="123">
							</div>
						</div>
					</div>
					<div class="form-group">
						<div class="row">
							<div class="col-md-8 col-xs-12">
								<label for="exampleInputEmail1">Fecha de Expiración</label>
								<div class="row">
									<div class="col-md-6 col-xs-12">
										<select class="form-control">
											<option>mes</option>
											<option>2</option>
											<option>3</option>
											<option>4</option>
											<option>5</option>
										</select>
									</div>
									<div class="col-md-6 col-xs-12">
										<select class="form-control">
											<option>año</option>
											<option>2</option>
											<option>3</option>
											<option>4</option>
											<option>5</option>
										</select>
									</div>
								</div>
							</div>
							<div class="col-md-4 col-xs-12">
								<label for="exampleInputEmail1">CP</label>
								<input type="email" class="form-control" id="exampleInputEmail1" placeholder="12345">
							</div>
						</div>
					</div>
				</div>
				<div class="form-section">
					<div class="side-pipe">
						<div class="side-pipe-number submit"></div>
					</div>
					<div class="form-group">
						<button type="submit" class="btn btn-primary btn-block disabled">Crear Cuenta</button>
					</div>
				</div>
			</form>
		</div>
	</section>
@endsection