@section('adhoc_styles')
    <style>
        .row {
            margin-top: -.6em;
        }
        .form-control {
            font-size: .9rem;
            line-height: 1.2;
        }
    </style>
@endsection
<div class="row mt-1">
    <div class="col-md-6 text-center">
        <span class="block titulo">Información del Remitente</span>
    </div>
    <div class="col-md-6 text-center">
        <span class="block titulo">Información del Destinatario</span>
    </div>
</div>
<div class="row mt-1">
    <div class="col-md-6">
        <!----------------------->
        <!--     Remitente     -->
        <!----------------------->
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="numero" class="control-label">@lang('Nro Guia') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="numero" type="text" class="form-control" id="numero"
                       placeholder="@lang('Nro Guia')" disabled="disabled">
                @error('numero') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="created_at" class="control-label">@lang('F.Creacion') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="created_at" type="text" class="form-control" id="created_at"
                       placeholder="@lang('Creada El')" disabled="disabled">
                @error('created_at') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="cedula_rif" class="control-label">@lang('Cedula/RIF') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="cedula_rif" type="text" class="form-control" id="cedula_rif"
                       placeholder="">
                @error('cedula_rif') <span class="my_red">({{ $message }})</span> @enderror
            </div>
            <div class="col mt-2">
                <span class="small">Ej: 18235147/J40675821</span>
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="nombre_remitente" class="control-label">@lang('Nombre') </label>
            </div>
            <div class="col-md-7">
                <input wire:model="nombre_remitente" type="text" class="form-control" id="nombre_remitente"
                       placeholder="@lang('del Remitente')">
                @error('nombre_remitente') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="telefono_fijo" class="control-label">@lang('Tlf. Fijo') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="telefono_fijo" type="text" class="form-control" id="telefono_fijo"
                       placeholder="" title="Solo numeros">
                @error('telefono_fijo') <span class="my_red">({{ $message }})</span> @enderror
            </div>
            <div class="col mt-2">
                <span class="small">Ej: 02125764836</span>
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="telefono_movil" class="control-label">@lang('Tlf. Movil') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="telefono_movil" type="text" class="form-control" id="telefono_movil"
                       placeholder="" title="Solo numeros">
                @error('telefono_movil') <span class="my_red">({{ $message }})</span> @enderror
            </div>
            <div class="col mt-2">
                <span class="small">Ej: 04245764836</span>
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="direccion" class="control-label">@lang('Direccion') </label>
            </div>
            <div class="col-md-7">
                <textarea wire:model="direccion" class="form-control" id="direccion" rows="2"
                          placeholder="" title=""></textarea>
                @error('direccion') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
    </div>
    <div class="col-md-6">
        <!----------------------->
        <!--   Destinatario    -->
        <!----------------------->
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="destino_id" class="control-label">@lang('Sucursal') </label>
            </div>
            <div class="col-md-6">
                <select wire:model="destino_id" class="form-control" id="origen_id" placeholder=@lang('Sucursal') {{$read}}>
                    <option value="">@lang('Seleccione Una') (@php  echo count($sucursales)@endphp)</option>
                    @foreach ($sucursales as $key => $value)
                        <option value="{{$key}}">{{$value}}</option>
                    @endforeach
                </select>
                @error('destino_id') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="servicio" class="control-label">@lang('Servicio') </label>
            </div>
            <div class="col-md-6">
                <select class="form-control" id="servicio" placeholder=@lang('Servicio') {{$read}}>
                    <option value="">@lang('Seleccione Uno') (@php  echo count($servicios)@endphp)</option>
                    @foreach ($servicios as $key => $value)
                        <option value="{{$key}}">{{$value}}</option>
                    @endforeach
                </select>
                @error('servicio') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="servicio" class="control-label">@lang('Receptoria') </label>
            </div>
            <div class="col-md-6">
                <select class="form-control" id="servicio" placeholder=@lang('Receptoria') {{$read}}>
                    <option value="">@lang('Seleccione Una') (@php  echo count($receptorias)@endphp)</option>
                    @foreach ($receptorias as $key => $value)
                        <option value="{{$key}}">{{$value}}</option>
                    @endforeach
                </select>
                @error('receptoria_id') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="cedula_destinatario" class="control-label">@lang('Cedula/RIF') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="cedula_destinatario" type="text" class="form-control" id="cedula_destinatario"
                       placeholder="">
                @error('cedula_destinatario') <span class="my_red">({{ $message }})</span> @enderror
            </div>
            <div class="col mt-2">
                <span class="small">Ej: 18235147/J40675821</span>
            </div>

        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="nombre_destinatario" class="control-label">@lang('Nombre') </label>
            </div>
            <div class="col-md-7">
                <input wire:model="nombre_destinatario" type="text" class="form-control" id="nombre_destinatario"
                       placeholder="@lang('del Destinatario')">
                @error('nombre_destinatario') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="telefono_destinatario" class="control-label">@lang('Tlf. Movil') </label>
            </div>
            <div class="col-md-4">
                <input wire:model="telefono_destinatario" type="text" class="form-control" id="telefono_destinatario"
                       placeholder="" title="Solo numeros">
                @error('telefono_destinatario') <span class="my_red">({{ $message }})</span> @enderror
            </div>
            <div class="col mt-2">
                <span class="small">Ej: 04245764836</span>
            </div>
        </div>
        <div class="row mt-1">
            <div class="col-md-3 text-right">
                <label for="direccion_destinatario" class="control-label">@lang('Direccion') </label>
            </div>
            <div class="col-md-7">
                <textarea wire:model="direccion_destinatario" class="form-control" id="direccion_destinatario" rows="2"
                          placeholder="" title=""></textarea>
                @error('direccion_destinatario') <span class="my_red">({{ $message }})</span> @enderror
            </div>
        </div>
    </div>
</div>

<div class="form-row" style="margin-top: .3em;">
    <div class="col-md-6 text-center">
        <span class="block titulo">Información del Envío</span>
    </div>
    <div class="col-md-3 text-center">
        <span class="block titulo">Costos del Servicio</span>
    </div>
    <div class="col-md-3 text-center">
        <span class="block titulo">Facturación</span>
    </div>
</div>