<%!-- Header --%>

<.link navigate={PhoenixKit.Utils.Routes.path("/admin/billing/profiles")} class="btn btn-ghost btn-sm" > <.icon name="hero-arrow-left" class="w-4 h-4" />

{@page_title}

<%= if @profile do %> Edit billing profile details <% else %> Create a new billing profile for a user <% end %>

<.form for={@form} phx-change="validate" phx-submit="save" class="space-y-6"> <%!-- User Selection --%>

<.icon name="hero-user" class="w-5 h-5" /> User

Select User * <%= if @profile do %> User cannot be changed after creation <% end %>

<%!-- Profile Type --%>

<.icon name="hero-identification" class="w-5 h-5" /> Profile Type

Individual Personal billing profile Company Business billing profile (EU)

<%!-- Individual Fields --%> <%= if @profile_type == "individual" do %>

<.icon name="hero-user-circle" class="w-5 h-5" /> Personal Information

First Name * <.error :for={msg <- @form[:first_name].errors |> Enum.map(&elem(&1, 0))}> {msg}

Middle Name

Last Name * <.error :for={msg <- @form[:last_name].errors |> Enum.map(&elem(&1, 0))}> {msg}

Email Billing email (can differ from account email)

Phone

<% end %> <%!-- Company Fields --%> <%= if @profile_type == "company" do %>

<.icon name="hero-building-office" class="w-5 h-5" /> Company Information

Company Name * <.error :for={msg <- @form[:company_name].errors |> Enum.map(&elem(&1, 0))}> {msg}

VAT Number EU VAT format: Country code + number <.error :for={msg <- @form[:company_vat_number].errors |> Enum.map(&elem(&1, 0))}> {msg}

Registration Number

Legal Address

Contact

Contact Email

Phone

<% end %> <%!-- Billing Address --%>

<.icon name="hero-map-pin" class="w-5 h-5" /> Billing Address

Address Line 1

Address Line 2

City

{@subdivision_label}

Postal Code

Country

<%!-- Options --%>

<.icon name="hero-cog-6-tooth" class="w-5 h-5" /> Options

Set as default profile This profile will be used by default for new orders

Profile Name (Optional) Custom name to identify this profile

<%!-- Actions --%>

<.link navigate={PhoenixKit.Utils.Routes.path("/admin/billing/profiles")} class="btn btn-ghost" > Cancel