{load_language_text section="withdrawal"}
{load_language_text section="account" name="account_txt"}
{load_language_text section="buttons" name="button"}

{block name="withdrawal_web_form"}
	{if $content_data.success}
		{block name="withdrawal_web_form_success"}
			<h1>{$txt.withdrawal}{if $content_data.order && $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}</h1>
			{include file="get_usermod:{$tpl_path}alert_message.html" message=$txt.send_withdrawal_success type="success"}
		{/block}
	{else}
		{block name="withdrawal_web_form_form"}
			<form action="{$content_data.FORM_ACTION_URL}" method="post" enctype="application/x-www-form-urlencoded" name="withdrawal_form" class="form-horizontal">

				{block name="withdrawal_web_form_title"}
					<h1>{$txt.withdrawal}{if $content_data.order && $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}</h1>
				{/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"}
					<h3>{$txt.to}</h3>

					<p class="space-0">
						{$smarty.const.COMPANY_NAME}<br /> {$smarty.const.TRADER_FIRSTNAME} {$smarty.const.TRADER_NAME}<br />
						{$smarty.const.TRADER_STREET} {$smarty.const.TRADER_STREET_NUMBER}<br />
						{$smarty.const.TRADER_ZIPCODE} {$smarty.const.TRADER_LOCATION}<br />
						{$smarty.const.STORE_COUNTRY_NAME}<br />
						<br />
						{if $smarty.const.TRADER_FAX != ''}
							{$txt.fax}: {$smarty.const.TRADER_FAX}<br /> {/if} {if $smarty.const.STORE_OWNER_EMAIL_ADDRESS != ''}
							{$txt.mail}: <a href="mailto:{$smarty.const.STORE_OWNER_EMAIL_ADDRESS}" class="linkNorm">{$smarty.const.STORE_OWNER_EMAIL_ADDRESS}</a>
						{/if}
					</p>
				{/block}


				{block name="withdrawal_web_form_orders_display"}
					{if isset($content_data.order_list_for_display) && $content_data.order_list_for_display|@count > 0}
						<fieldset class="withdrawal-orders-display">
							{block name="withdrawal_web_form_orders_display_title"}
								<legend aria-label="{$account_txt.title_orders}">
									{$account_txt.title_orders}
								</legend>
							{/block}
							<table class="table table-responsive">
								<thead>
									<tr>
										<th>&nbsp;</th>
										<th>{$account_txt.text_date|replace:":":""}</th>
										<th>{$account_txt.order_nr|replace:":":""}</th>
										<th>{$account_txt.order_status|replace:":":""}</th>
										<th>{$account_txt.order_total|replace:":":""}</th>
										<th>&nbsp;</th>
									</tr>
								</thead>
								<tbody>
									{foreach from=$content_data.order_list_for_display item=order_row}
										<tr{if $content_data.order_number_prefill == $order_row.ORDER_ID} class="active"{/if}>
											<td>
												{if $order_row.ORDER_PICK_URL}
													<input type="radio"
													       class="withdrawal-order-pick-radio"
													       id="order_choice_{$order_row.ORDER_ID}"
													       value="{$order_row.ORDER_ID}"
													       data-redirect-url="{$order_row.ORDER_PICK_URL|escape:'html'}"
													       {if $content_data.order_number_prefill == $order_row.ORDER_ID} checked="checked"{/if} />
												{/if}
											</td>
											<td><label for="order_choice_{$order_row.ORDER_ID}">{$order_row.ORDER_DATE}</label></td>
											<td><label for="order_choice_{$order_row.ORDER_ID}">{$order_row.ORDER_ID}</label></td>
											<td><label for="order_choice_{$order_row.ORDER_ID}">{$order_row.ORDER_STATUS|escape:'html'}</label></td>
											<td><label for="order_choice_{$order_row.ORDER_ID}">{$order_row.ORDER_TOTAL}</label></td>
											<td><a href="{$order_row.ORDER_LINK}" class="btn btn-xs btn-default pull-right">{$button.show}</a></td>
										</tr>
									{/foreach}
								</tbody>
							</table>
							{if $content_data.order_list_has_more}
								<div class="row">
									<div class="col-xs-12">
										<button type="button"
										        id="withdrawal-load-more-btn"
										        class="btn btn-xs btn-default pull-right"
										        data-endpoint-url="withdrawal_orders.php"
										        data-offset="{$content_data.order_list_for_display|@count}"
										        data-show-label="{$button.show|escape:'html'}"
										        data-active-order-id="{if $content_data.order_number_prefill}{$content_data.order_number_prefill|escape:'html'}{/if}">
											{$txt.show_more_orders}
										</button>
									</div>
								</div>
							{/if}
							<script src="JSEngine/widgets/withdrawal_orders.js" defer></script>
						</fieldset>
					{/if}
				{/block}

				{block name="withdrawal_web_form_order"}
					<fieldset>

						{block name="withdrawal_web_form_order_title"}
							<legend aria-label="{$txt.withdrawal}">
								{$txt.withdrawal}
							</legend>
						{/block}

						{block name="withdrawal_web_form_order_number_input"}
							<div class="form-group mandatory{if $content_data.errors.order_number} has-feedback has-error{/if}">
								<label for="withdrawal_form_order_number" class="control-label col-sm-3">
									{$txt.contract_identification}
								</label>
								<div class="col-sm-9 col-lg-6 input-container">
									<input type="text"
									       id="withdrawal_form_order_number"
									       name="withdrawal_data[order_number]"
									       class="form-control"
									       required
									       placeholder="{$txt.contract_identification_placeholder}"
									       value="{if $smarty.post.withdrawal_data.order_number}{$smarty.post.withdrawal_data.order_number|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{elseif $content_data.order && $content_data.order->info.orders_id}{$content_data.order->info.orders_id|escape:'html'}{/if}" />
									{if $content_data.errors.order_number}
										<span class="help-block">{$txt.input_error}</span>
									{/if}
								</div>
							</div>
						{/block}
					</fieldset>
				{/block}

				{block name="withdrawal_web_form_personal"}
					<fieldset>
						{block name="withdrawal_web_form_personal_legend"}
							<legend aria-label="{$txt.first_last_name}">
								{$txt.first_last_name}
							</legend>
						{/block}

						{block name="withdrawal_web_form_personal_firstname"}
							<div class="form-group mandatory{if $content_data.errors.customer_firstname} has-feedback has-error{/if}">
								{block name="withdrawal_web_form_personal_firstname_label"}
									<label for="withdrawal_form_customer_firstname" class="control-label col-sm-3">
										{$txt.firstname}
									</label>
								{/block}

								{block name="withdrawal_web_form_personal_firstname_container"}
									<div class="col-sm-9 col-lg-6 input-container">
										{block name="withdrawal_web_form_personal_firstname_input"}
											<input type="text"
												   id="withdrawal_form_customer_firstname"
												   name="withdrawal_data[customer_firstname]"
												   class="form-control"
												   required
												   value="{if $smarty.post.withdrawal_data.customer_firstname}{$smarty.post.withdrawal_data.customer_firstname|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{elseif $content_data.order}{$content_data.order->customer.firstname|escape:'html'}{/if}" />
										{if $content_data.errors.customer_firstname}
											<span class="help-block">{$txt.input_error}</span>
										{/if}
										{/block}
									</div>
								{/block}
							</div>
						{/block}

						{block name="withdrawal_web_form_personal_lastname"}
							<div class="form-group mandatory{if $content_data.errors.customer_lastname} has-feedback has-error{/if}">
								{block name="withdrawal_web_form_personal_lastname_label"}
									<label for="withdrawal_form_customer_lastname" class="control-label col-sm-3">
										{$txt.lastname}
									</label>
								{/block}

								{block name="withdrawal_web_form_personal_lastname_container"}
									<div class="col-sm-9 col-lg-6 input-container">
										{block name="withdrawal_web_form_personal_lastname_input"}
											<input type="text"
												   id="withdrawal_form_customer_lastname"
												   name="withdrawal_data[customer_lastname]"
												   class="form-control"
												   required
												   value="{if $smarty.post.withdrawal_data.customer_lastname}{$smarty.post.withdrawal_data.customer_lastname|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{elseif $content_data.order}{$content_data.order->customer.lastname|escape:'html'}{/if}" />
										{if $content_data.errors.customer_lastname}
											<span class="help-block">{$txt.input_error}</span>
										{/if}
										{/block}
									</div>
								{/block}
							</div>
						{/block}
					</fieldset>
				{/block}

				{block name="withdrawal_web_form_email"}
					<fieldset>
						{block name="withdrawal_web_form_email_legend"}
							<legend aria-label="{$txt.electronic_communication}">
								{$txt.electronic_communication}
							</legend>
						{/block}

						{block name="withdrawal_web_form_email_email"}
							<div class="form-group mandatory{if $content_data.errors.customer_email} has-feedback has-error{/if}">
								{block name="withdrawal_web_form_email_email_label"}
									<label for="withdrawal_form_customer_email" class="control-label col-sm-3">
										{$txt.electronic_communication_legend}
									</label>
								{/block}

								{block name="withdrawal_web_form_email_email_container"}
									<div class="col-sm-9 col-lg-6 input-container">
										{block name="withdrawal_web_form_email_email_input"}
											<input type="text"
												   id="withdrawal_form_customer_email"
												   name="withdrawal_data[customer_email]"
												   class="form-control"
												   required
												   value="{if $smarty.post.withdrawal_data.customer_email}{$smarty.post.withdrawal_data.customer_email|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{elseif $content_data.order}{$content_data.order->customer.email_address|escape:'html'}{/if}" />
										{/block}

										{if $content_data.errors.customer_email}
											{block name="withdrawal_web_form_email_email_error"}
												<span class="help-block">
													{$txt.input_error}
												</span>
											{/block}
										{/if}
									</div>
								{/block}
							</div>
						{/block}
					</fieldset>
				{/block}

				{block name="withdrawal_web_form_privacy_if"}
					{if $content_data.show_privacy}
						{block name="withdrawal_web_form_privacy"}
							<fieldset class="withdrawal-privacy{if $content_data.errors.privacy_accepted} has-feedback has-error{/if}">
								{block name="withdrawal_web_form_privacy_legend"}
									<legend aria-label="{$txt.title_privacy}">
										{$txt.title_privacy}
									</legend>
								{/block}

								{if $content_data.show_privacy_checkbox}
									{block name="withdrawal_web_form_privacy_checkbox"}
										<input id="privacy_accepted" type="checkbox" name="withdrawal_data[privacy_accepted]" value="1" required/>
										<label for="privacy_accepted" class="control-label">{$content_data.privacy_link}</label>
									{/block}
								{else}
									{block name="withdrawal_web_form_privacy_link"}
										<span>{$content_data.privacy_link}</span>
									{/block}
								{/if}

								{if $content_data.errors.privacy_accepted}
									{block name="withdrawal_web_form_withdrawal_privacy_error"}
										<span class="help-block">
											{$txt.privacy_error}
										</span>
									{/block}
								{/if}
							</fieldset>
						{/block}
					{/if}
				{/block}

				{block name="withdrawal_web_form_buttons"}
					<div class="row">
						<div class="col-xs-6 col-sm-4 col-md-3">
							{block name="withdrawal_web_form_buttons_empty"}
								&nbsp;
							{/block}
						</div>
						<div class="col-xs-6 col-sm-4 col-sm-offset-4 col-md-3 col-md-offset-6 text-right">
							{* ADD FAKE INPUT FIELD FOR ANTI SPAM BOT MECHANISM *}
							<label for="form-input" class="form-input"></label>
							<input id="form-input" type="text" name="message" value="">

							{block name="withdrawal_web_form_buttons_submit"}
								<button type="submit" class="btn btn-primary btn-block" title="{$txt.sendwithdrawalbutton}">
									{$txt.sendwithdrawalbutton}
								</button>
							{/block}
						</div>
					</div>
				{/block}

				{block name="withdrawal_web_form_mandatory"}
					<p class="mandatory-info">
						{$txt.mandatory_fields}
					</p>
				{/block}

				{block name="withdrawal_web_form_validation_script"}
					<script src="JSEngine/widgets/withdrawal_form_validation.js" defer></script>
				{/block}
			</form>
		{/block}
	{/if}
{/block}