{{ header }}
<div id="account-voucher" class="container account-container">
	{{ oct_breadcrumbs }}
	<div class="row">
		<div class="col-lg-12">
			<h1 class="rm-page-title">{{ heading_title }}</h1>
		</div>
	</div>
	<div class="content-top-box">{{ content_top }}</div>
	{% if error_warning %}
	<script>
	rmNotify('warning', '{{ error_warning }}');
	</script>
	{% endif %}
	<div id="content" class="row">
		{{ column_left }}
	    {% if column_left and column_right %}
	    {% set class = 'col-lg-6' %}
	    {% elseif column_left or column_right %}
	    {% set class = 'col-lg-9' %}
	    {% else %}
	    {% set class = 'col-lg-12' %}
	    {% endif %}
	    <div class="{{ class }}">
		    <div class="rm-content rm-account-content h-100">
		      <div class="rm-account-text mb-4">{{ text_description }}</div>
		      <form action="{{ action }}" method="post" enctype="multipart/form-data" class="form-horizontal">
				  <fieldset class="rm-account-form">
			        <div class="form-group">
			          <label class="rm-control-label" for="input-to-name"><span class="required">*</span> {{ entry_to_name }}</label>
			          {% if error_to_name %}
			            <script>
						rmNotify('warning', '{{ error_to_name }}');
						</script>
			          {% endif %}
			          <input type="text" name="to_name" value="{{ to_name }}" id="input-to-name" class="form-control" />
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label" for="input-to-email"><span class="required">*</span> {{ entry_to_email }}</label>
			          {% if error_to_email %}
			            <script>
						rmNotify('warning', '{{ error_to_email }}');
						</script>
			          {% endif %}
			          <input type="text" name="to_email" value="{{ to_email }}" id="input-to-email" class="form-control" />
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label" for="input-from-name"><span class="required">*</span> {{ entry_from_name }}</label>
			          {% if error_from_name %}
			            <script>
						rmNotify('warning', '{{ error_from_name }}');
						</script>
			          {% endif %}
			          <input type="text" name="from_name" value="{{ from_name }}" id="input-from-name" class="form-control" />
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label" for="input-from-email"><span class="required">*</span> {{ entry_from_email }}</label>
			          {% if error_from_email %}
			            <script>
						rmNotify('warning', '{{ error_from_email }}');
						</script>
			          {% endif %}
			          <input type="text" name="from_email" value="{{ from_email }}" id="input-from-email" class="form-control" />
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label"><span class="required">*</span> {{ entry_theme }}</label>
			          {% if error_theme %}
			            <script>
						rmNotify('warning', '{{ error_theme }}');
						</script>
			          {% endif %}
			          {% for voucher_theme in voucher_themes %}
			            {% if voucher_theme.voucher_theme_id == voucher_theme_id %}
			            <div class="radio mt-2">
			            	<label class="option">
				            	<input type="radio" id="voucher_theme_id{{ voucher_theme.voucher_theme_id }}" class="input-radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" checked="checked" />
				            	<span class="radio-box"></span>
								{{ voucher_theme.name }}
							</label>
			            </div>
			            {% else %}
			            <div class="radio mt-2">
			            	<label class="option">
				            	<input type="radio" id="voucher_theme_id{{ voucher_theme.voucher_theme_id }}" class="input-radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" />
				            	<span class="radio-box"></span>
								{{ voucher_theme.name }}
							</label>
			            </div>
			            {% endif %}
			          {% endfor %}
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label" for="input-message"><span data-toggle="tooltip" title="{{ help_message }}">{{ entry_message }}</span></label>
			          <textarea name="message" cols="40" rows="5" id="input-message" class="form-control">{{ message }}</textarea>
			        </div>
			        <div class="form-group">
			          <label class="rm-control-label" for="input-amount"><span data-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
			          {% if error_amount %}
			            <script>
						rmNotify('warning', '{{ error_amount }}');
						</script>
			          {% endif %}
			          <input type="text" name="amount" value="{{ amount }}" id="input-amount" class="form-control" size="5" />
			        </div>
			        {% if text_agree %}
			        <div class="form-checkbox-group">
			        	<div class="checkbox">
				        	<label>
					            {% if agree %}
					            <input type="checkbox" id="scales" class="rm-form-checkbox-input" name="agree" value="1" checked="checked" />
					            {% else %}
					            <input type="checkbox" id="scales" class="rm-form-checkbox-input" name="agree" value="1" />
					            {% endif %}
					            <span class="check-box"></span>
					            {{ text_agree }}
				            </label>
			        	</div>
			        </div>
			        {% endif %}
			        <div class="btn-group mt-4">
			          <input type="submit" value="{{ button_continue }}" class="rm-btn dark" />
			        </div>
				  </fieldset>
			  </form>
		    </div>
	    </div>
	    {{ column_right }}
	</div>
	{{ content_bottom }}
</div>
{{ footer }}