<%= form_with model: @form, url: employer_setup_index_path, local: true do |f| %>
<%= f.text_field :name, label: { text: "Employer Name" }, class: "w-full" %>
<%= f.text_field :group_number, label: { text: "Group/Medical Number" }, class: "w-full" %>
<%= f.text_field :pl_plan_key, label: { text: "Pl Plan Key" }, class: "w-full" %>
<%= f.text_field :effective_date, label: { text: "Effective Date" }, class: "w-full" %>
<%= f.select :network, options_for_select(["Cigna", "Cigna+Regional", "Medcost"]), label: { text: "Provider Network" }, data: { controller: "form-toggle", action: "change->form-toggle#toggleDivs" }, class: "w-full" %>
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<%= f.file_field :employer_logo, class: "hidden", id: "file_upload_input" %>
<%= f.submit "Continue to Plans" %>