{load_language_text section="withdrawal"} {block name="withdrawal_web_form"} {if $content_data.success} {block name="withdrawal_web_form_success"}

{$txt.withdrawal}{if $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}

{include file="get_usermod:{$tpl_path}alert_message.html" message=$txt.send_withdrawal_success type="success"} {/block} {else} {block name="withdrawal_web_form_form"}
{block name="withdrawal_web_form_title"}

{$txt.withdrawal}{if $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}

{/block} {block name="withdrawal_web_form_alert"} {include file="get_usermod:{$tpl_path}alert_message.html" message=$txt.webform_info type="info"} {/block} {block name="withdrawal_web_form_trader"}

{$txt.to}

{$smarty.const.COMPANY_NAME}
{$smarty.const.TRADER_FIRSTNAME} {$smarty.const.TRADER_NAME}
{$smarty.const.TRADER_STREET} {$smarty.const.TRADER_STREET_NUMBER}
{$smarty.const.TRADER_ZIPCODE} {$smarty.const.TRADER_LOCATION}
{$smarty.const.STORE_COUNTRY_NAME}

{if $smarty.const.TRADER_FAX != ''} {$txt.fax}: {$smarty.const.TRADER_FAX}
{/if} {if $smarty.const.STORE_OWNER_EMAIL_ADDRESS != ''} {$txt.mail}: {$smarty.const.STORE_OWNER_EMAIL_ADDRESS} {/if}

{/block} {block name="withdrawal_web_form_order"}
{block name="withdrawal_web_form_order_title"} {$txt.withdrawal} {/block} {block name="withdrawal_web_form_order_withdrawal"}
{block name="withdrawal_web_form_order_withdrawal_label"} {/block} {block name="withdrawal_web_form_order_withdrawal_container"}
{block name="withdrawal_web_form_order_withdrawal_input"} {/block} {if $txt.withdrawal_textarea_hint} {block name="withdrawal_web_form_order_withdrawal_hint"} {$txt.withdrawal_textarea_hint|escape:'html'} {/block} {/if} {if $content_data.errors.withdrawal_content} {block name="withdrawal_web_form_order_withdrawal_error"} {$txt.input_error} {/block} {/if}
{/block}
{/block} {block name="withdrawal_web_form_order_order_get_on"}
{block name="withdrawal_web_form_order_order"}
{block name="withdrawal_web_form_order_order_label"} {/block} {block name="withdrawal_web_form_order_order_input"} {/block}
{/block} {block name="withdrawal_web_form_order_get_on"}
{block name="withdrawal_web_form_order_get_on_label"} {/block} {block name="withdrawal_web_form_order_get_on_input"} {/block}
{/block} {block name="withdrawal_web_form_order_order_get_on_date"}
{/block} {if $content_data.errors.order_date || $content_data.errors.delivery_date} {block name="withdrawal_web_form_order_order_get_on_error"}
{$txt.input_error}
{/block} {/if}
{/block}
{/block} {block name="withdrawal_web_form_personal"}
{block name="withdrawal_web_form_personal_legend"} {$txt.first_last_name} {/block} {block name="withdrawal_web_form_personal_gender"}
{block name="withdrawal_web_form_personal_gender_label"} {/block} {block name="withdrawal_web_form_personal_gender_container"}
{block name="withdrawal_web_form_personal_gender_m_span"} {block name="withdrawal_web_form_personal_gender_m_label"} {/block} {/block}   {block name="withdrawal_web_form_personal_gender_f_span"} {block name="withdrawal_web_form_personal_gender_f_label"} {/block} {/block}
{/block} {if $content_data.errors.customer_gender} {block name="withdrawal_web_form_personal_gender_error"}
  {$txt.input_error}
{/block} {/if}
{/block} {block name="withdrawal_web_form_personal_firstname"}
{block name="withdrawal_web_form_personal_firstname_label"} {/block} {block name="withdrawal_web_form_personal_firstname_container"}
{block name="withdrawal_web_form_personal_firstname_input"} customer.firstname|escape:'html'}{/if}" /> {/block}
{/block}
{/block} {block name="withdrawal_web_form_personal_lastname"}
{block name="withdrawal_web_form_personal_lastname_label"} {/block} {block name="withdrawal_web_form_personal_lastname_container"}
{block name="withdrawal_web_form_personal_lastname_input"} customer.lastname|escape:'html'}{/if}" /> {/block}
{/block}
{/block}
{/block} {block name="withdrawal_web_form_address"}
{block name="withdrawal_web_form_address_legend"} {$txt.address} {/block} {block name="withdrawal_web_form_address_street"}
{block name="withdrawal_web_form_address_street_label"} {/block} {block name="withdrawal_web_form_address_street_container"}
{block name="withdrawal_web_form_address_street_input"} customer.street_address|escape:'html'}{/if}" /> {/block} {if $content_data.errors.customer_street_address} {block name="withdrawal_web_form_address_street_error"} {$txt.input_error} {/block} {/if}
{/block}
{/block} {block name="withdrawal_web_form_address_postcode_city"}
{block name="withdrawal_web_form_address_postcode_city_label"} {/block} {block name="withdrawal_web_form_address_postcode_container"}
{block name="withdrawal_web_form_address_postcode_input"} customer.postcode|escape:'html'}{/if}" /> {/block} {if $content_data.errors.customer_postcode} {block name="withdrawal_web_form_address_postcode_error"} {$txt.input_error} {/block} {/if}
{/block} {block name="withdrawal_web_form_address_city_container"}
{block name="withdrawal_web_form_address_city_input"} customer.city|escape:'html'}{/if}" /> {/block} {if $content_data.errors.customer_city} {block name="withdrawal_web_form_address_city_error"} {$txt.input_error} {/block} {/if}
{/block}
{/block} {block name="withdrawal_web_form_address_country"}
{block name="withdrawal_web_form_address_country_label"} {/block} {block name="withdrawal_web_form_address_country_container"}
{block name="withdrawal_web_form_address_country_input"} customer.country|escape:'html'}{/if}" /> {/block}
{/block}
{/block}
{/block} {block name="withdrawal_web_form_email"}
{block name="withdrawal_web_form_email_legend"} {$txt.ask_for_email} {/block} {block name="withdrawal_web_form_email_email"}
{block name="withdrawal_web_form_email_email_label"} {/block} {block name="withdrawal_web_form_email_email_container"}
{block name="withdrawal_web_form_email_email_input"} customer.email_address|escape:'html'}{/if}" /> {/block} {if $content_data.errors.customer_email} {block name="withdrawal_web_form_email_email_error"} {$txt.input_error} {/block} {/if}
{/block}
{/block}
{/block} {block name="withdrawal_web_form_withdrawal"}
{block name="withdrawal_web_form_withdrawal_legend"} {$txt.withdrawal_date} {/block} {block name="withdrawal_web_form_withdrawal_date"}
{block name="withdrawal_web_form_withdrawal_date_label"} {/block} {block name="withdrawal_web_form_withdrawal_date_container"}
{block name="withdrawal_web_form_withdrawal_date_input"} withdrawal_date|date_format:'%d.%m.%Y'}{/if}" /> {/block} {if $content_data.errors.withdrawal_date} {block name="withdrawal_web_form_withdrawal_date_error"} {$txt.input_error} {/block} {/if}
{/block}
{/block}
{/block} {block name="withdrawal_web_form_privacy_if"} {if $content_data.show_privacy} {block name="withdrawal_web_form_privacy"} {block name="withdrawal_web_form_privacy_legend"} {$txt.title_privacy} {/block} {if $content_data.show_privacy_checkbox} {block name="withdrawal_web_form_privacy_checkbox"} {/block} {else} {block name="withdrawal_web_form_privacy_link"} {$content_data.privacy_link} {/block} {/if} {if $content_data.errors.privacy_accepted} {block name="withdrawal_web_form_withdrawal_privacy_error"} {$txt.privacy_error} {/block} {/if} {/block} {/if} {/block} {block name="withdrawal_web_form_buttons"}
{block name="withdrawal_web_form_buttons_empty"}   {/block}
{* ADD FAKE INPUT FIELD FOR ANTI SPAM BOT MECHANISM *} {block name="withdrawal_web_form_buttons_submit"} {/block}
{/block} {block name="withdrawal_web_form_mandatory"}

{$txt.mandatory_fields}

{/block} {/block} {/if} {/block}