{{$title}}

Make the necessary changes on the form below then click Submit.

{{ csrf_field() }}

@if (isset($contact_id)) @else @endif

RelationsShip *

First Name *

FirstName) ? "value=".$alternate->FirstName : ''}} required="required">

Last Name *

LastName) ? "value=".$alternate->LastName : ''}} required="required">

Address

Address) ? "value=".$alternate->Address : ''}} class="form-control">

City

City) ? "value=".$alternate->City : ''}} class="form-control">

State

ZipCode

ZipCode) ? "value=".$alternate->ZipCode : ''}} class="form-control">

Home Phone

HomePhone) ? "value=".$alternate->HomePhone : ''}} class="form-control phone">

Mobile Phone

MobilePhone) ? "value=".$alternate->MobilePhone : ""}} class="form-control phone">

Work Phone

WorkPhone) ? "value=".$alternate->WorkPhone : ""}} class="form-control phone">

Other

OtherPhone) ? "value=".$alternate->OtherPhone : ""}} class="form-control phone">

E-mail

Email) ? "value=".$alternate->Email : ""}} class="form-control">