<style>
    .layui-form-item {
        margin-bottom: 5px;
    }
</style>
<div class="layui-card">
    <div class="layui-card-body">
        <form class="layui-form" action="">
            <input type="hidden" name="supplier_id" value="{{request()->get('supplier_id')}}">
            <input type="hidden" name="receipt_id" value="{{request()->get('receipt_id')}}">
            <div class="layui-form-item">
                <label class="layui-form-label">银行类型 : </label>
                <div class="layui-input-block">
                    <input type="radio" name="receipt_type" value="1" title="国内" checked>
                    <input type="radio" name="receipt_type" value="2" title="港澳台和国外">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span class="require">*</span>开户名称 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="bank_name" id="bank_name"
                           placeholder="请输入开户名称,比如建设银行" class="layui-input"
                           value="{{$receipt['bank_name'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span class="require">*</span>开户行 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="bank_adderss" id="bank_adderss"
                           placeholder="请输入开户行,比如深圳建设银行" class="layui-input"
                           value="{{$receipt['bank_adderss'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span class="require">*</span>银行账号 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="account_no" id="account_no"
                           placeholder="请输入银行账号" class="layui-input"
                           value="{{$receipt['account_no'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">账户名称 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="account_name" id="account_name"
                           placeholder="请输入账户名称" class="layui-input"
                           value="{{$receipt['account_name'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">银行地址 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="account_adderss" id="account_adderss"
                           placeholder="请输入银行具体地址,精确到街道" class="layui-input"
                           value="{{$receipt['account_adderss'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span class="require">*</span>Swift Code : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="swift_code" id="Swift Code"
                           placeholder="请输入电汇号码" class="layui-input"
                           value="{{$receipt['swift_code'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">
                    <span class="require">*</span>供应商银行信息凭证：
                </label>
                <div class="layui-input-block">
                    <input type="hidden" name="certificate" id="certificate"
                           value="{{$receipt['certificate'] or ''}}">

                    <button type="button" class="layui-btn upload-img" preview="preview" data-obj="certificate">
                        <i class="layui-icon">&#xe67c;</i>上传图片
                    </button>
                    <img @if(!empty($receipt['certificate'])) src="{{$receipt['certificate'] or ''}}"
                         @endif class="layui-upload-img" width="50px" height="50px" id="preview">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">备注 : </label>
                <div class="layui-input-block block-42">
                    <input type="text" name="remark" id="remark"
                           placeholder="请输入备注" class="layui-input"
                           value="{{$receipt['remark'] or ''}}">
                </div>
            </div>
            <div class="layui-form-item">
                <div align="center" style="margin-top: 20px">
                    <button type="button" id="addSupplierReceipt" class="layui-btn layui-btn-info submit-loading" lay-submit
                            lay-filter="addSupplierReceipt">保存
                    </button>
                </div>
            </div>
        </form>
    </div>
</div>