{!! Form::text('fullname', 0, ['id'=>'fullname', 'class'=>'validate','required','readonly']) !!} Name

{!! Form::text('description', '1 D-Egg Set', ['id' => 'description', 'class'=>'validate','required','readonly']) !!} Item Description

{!! Form::text('document_no', null , ['class'=>'validate','required','readonly']) !!} Transaction No.

{!! Form::text('phone_number', 0, ['id'=>'phone_number', 'class'=>'validate','required','readonly']) !!} Phone

Bank {!! Form::text('bank_name', 0, ['id'=>'bank_name','class'=>'validate','required','readonly']) !!}

{!! Form::text('account_number', 0, ['id'=>'account_number','class'=>'validate','required','readonly']) !!} Account No.

{!! Form::text('amount', 0, ['id'=>'amount', 'class'=>'validate','required','readonly']) !!} Amount