Office Name * @error('company_name') @enderror

First Name * @error('first_name') @enderror

Last Name * @error('last_name') @enderror

Email Address * @error('email_address') @enderror

Phone Number * @error('phone_number') @enderror

EIN (Employee Identification Number) @error('tax_id') @enderror

Total Loss (Max Amount) Maximum total loss amount this franchise can handle @error('max_total_loss') @enderror

Office Code @error('franchisecode') @enderror

Street @error('street') @enderror

City @error('city') @enderror

State Select State @foreach($states as $state) {{ $state->name }} @endforeach @error('state_id') @enderror

Postal Code @error('postcode') @enderror