{!! Form::open(array('url'=>secure_url('/review'),'class'=>'review-submit','method'=>'post','id'=>'review-submit')) !!}
{!! Form::hidden('request_page_type','Review details') !!}
{!! Form::hidden('request_page',!empty($request_page)?$request_page: '') !!}
{!! Form::hidden('request_type',!empty($request_type)?$request_type: '') !!}
    <div class="row">
      <div class="col-xl-6">
        <div class="utf-no-border">
          <input class="form-control utf-with-border" type="text" name="name" placeholder="Name" onkeypress="return allowOnlyLetters(event,this);" />
        </div>
      </div>
      <div class="col-xl-6">
        <div class="utf-no-border">
          <input class="form-control utf-with-border" type="text" name="email_id" placeholder="Email Address">
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-xl-6">
        <div class="utf-no-border">
          <input class="form-control utf-with-border" type="text" name="mob_number" maxlength="10" placeholder="Phone Number"onkeypress="return onlyNumberKey(event)"/>
        </div>
      </div>
      <div class="col-xl-6">
        <div class="utf-no-border">
          <input class="form-control utf-with-border" type="text" name="subject" placeholder="Subject" />
        </div>
      </div>
    </div>

    <div class="row">
     <div class="col-xl-12">
      <div class="utf-no-border">
    <textarea class="form-control utf-with-border" name="comment" cols="30" rows="3"
      placeholder="Comment"></textarea>
       </div>
    </div>
  </div>
  <div class="row">
     <div class="col-xl-5">
        <div class="utf-no-border">
          {!! NoCaptcha::renderJs() !!}
          {!! NoCaptcha::display() !!}
        <div id="js-error-cap"></div>
    </div>
     </div>
    </div>
    <button class="button margin-bottom-40 review_message_submit" type="submit" style="margin-top: 10px;">Submit Comment</button>
{!! Form::close() !!}
<script type="text/javascript">
  function allowOnlyLetters(e, t){    
       if (window.event){    
          var charCode = window.event.keyCode;    
       }    
       else if (e){    
          var charCode = e.which;    
       }    
       else { return true; }    
       if ((charCode > 64 && charCode < 91) || (charCode > 96 && charCode < 123) || (charCode == 32))    
           return true;    
       else{    
          return false;    
       }           
  }
  function onlyNumberKey(evt) {
      var ASCIICode = (evt.which) ? evt.which : evt.keyCode
      if (ASCIICode > 31 && (ASCIICode < 48 || ASCIICode > 57))
          return false;
      return true;
  }
</script>