{{ header }}
<div class="breadbg">
  <div class="container">
    <div class="row">
      <ul class="breadcrumb">
    {% for breadcrumb in breadcrumbs %}
    <li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
    {% endfor %}
    </ul>
  </div>
</div>
</div>
<div id="account-voucher" class="container acpage">
  {% if error_warning %}
  <div class="alert alert-danger alert-dismissible"><i class="fa fa-exclamation-circle"></i> {{ error_warning }}</div>
  {% endif %}
  <div class="row">{{ column_left }}
    {% if column_left and column_right %}
    {% set class = 'col-lg-8 col-sm-5 col-md-6 col-xs-12' %}
    {% elseif column_left or column_right %}
    {% set class = 'col-sm-8 col-md-9 col-xs-12 colright' %}
    {% else %}
    {% set class = 'col-sm-12' %}
    {% endif %}
    <div id="content" class="{{ class }}">{{ content_top }}
<div class="infobg">
      <div class="borbutt">
        <h1 class="text-center">{{ cheading_title }}</h1>
      </div>
      <p>{{ text_description }}</p>
      <form action="{{ action }}" method="post" enctype="multipart/form-data" class="form-horizontal">
        <div class="form-group required">
          <label class="col-sm-3 col-xs-12 control-label" for="input-to-name">{{ entry_to_name }}</label>
          <div class="col-sm-9 col-xs-12">
            <input type="text" name="to_name" value="{{ to_name }}" id="input-to-name" class="form-control" />
            {% if error_to_name %}
            <div class="text-danger">{{ error_to_name }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group required">
          <label class="col-sm-3 col-xs-12 control-label" for="input-to-email">{{ entry_to_email }}</label>
          <div class="col-sm-9 col-xs-12">
            <input type="text" name="to_email" value="{{ to_email }}" id="input-to-email" class="form-control" />
            {% if error_to_email %}
            <div class="text-danger">{{ error_to_email }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group required">
          <label class="col-sm-3 col-xs-12 control-label" for="input-from-name">{{ entry_from_name }}</label>
          <div class="col-sm-9 col-xs-12">
            <input type="text" name="from_name" value="{{ from_name }}" id="input-from-name" class="form-control" />
            {% if error_from_name %}
            <div class="text-danger">{{ error_from_name }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group required">
          <label class="col-sm-3 col-xs-12 control-label" for="input-from-email">{{ entry_from_email }}</label>
          <div class="col-sm-9 col-xs-12">
            <input type="text" name="from_email" value="{{ from_email }}" id="input-from-email" class="form-control" />
            {% if error_from_email %}
            <div class="text-danger">{{ error_from_email }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group required">
          <label class="col-sm-3 col-xs-12 control-label">{{ entry_theme }}</label>
          <div class="col-sm-9 col-xs-12">
           {% for voucher_theme in voucher_themes %}
            {% if voucher_theme.voucher_theme_id == voucher_theme_id %}
            <div class="radio">
              <label>
                <input type="radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" checked="checked" />
                {{ voucher_theme.name }}</label>
            </div>
            {% else %}
            <div class="radio">
              <label>
                <input type="radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" />
                {{ voucher_theme.name }}</label>
            </div>
            {% endif %}
            {% endfor %}
            {% if error_theme %}
            <div class="text-danger">{{ error_theme }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 col-xs-12 control-label" for="input-message"><span data-toggle="tooltip" title="{{ help_message }}">{{ entry_message }}</span></label>
          <div class="col-sm-9 col-xs-12">
            <textarea name="message" cols="40" rows="5" id="input-message" class="form-control">{{ message }}</textarea>
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 col-xs-12 control-label" for="input-amount"><span data-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
          <div class="col-sm-9 col-xs-12">
            <input type="text" name="amount" value="{{ amount }}" id="input-amount" class="form-control" size="5" />
            {% if error_amount %}
            <div class="text-danger">{{ error_amount }}</div>
            {% endif %}
          </div>
        </div>
        <div class="buttons clearfix">
          <div class="pull-right"> {{ text_agree }}
            {% if agree %}
            <input type="checkbox" name="agree" value="1" checked="checked" />
            {% else %}
            <input type="checkbox" name="agree" value="1" />
            {% endif %}
            &nbsp;
            <input type="submit" value="{{ button_continue }}" class="btn btn-primary" />
          </div>
        </div>
      </form>
      </div></div>
    {{ column_right }}</div>
</div>
{{ content_bottom }}
{{ footer }}