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{load_language_text section="withdrawal"}
{block name="module_withdrawal_web_form"}
{if $content_data.success}
{block name="module_withdrawal_web_form_success"}
<h1>{$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}</h1>
{include file="get_usermod:{$tpl_path}snippets/alert_message.html" message=$txt.send_withdrawal_success type="success"}
{/block}
{else}
{block name="module_withdrawal_web_form_form"}
<form action="{$content_data.FORM_ACTION_URL}" method="post" enctype="application/x-www-form-urlencoded" name="withdrawal_form" class="form-horizontal">
{block name="module_withdrawal_web_form_title"}
<h1>{$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}</h1>
{/block}
{block name="module_withdrawal_web_form_alert"}
{include file="get_usermod:{$tpl_path}snippets/alert_message.html" message=$txt.webform_info type="info"}
{/block}
{block name="module_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="module_withdrawal_web_form_order"}
<fieldset>
{block name="module_withdrawal_web_form_order_title"}
<legend>
{$txt.withdrawal}
</legend>
{/block}
{block name="module_withdrawal_web_form_order_withdrawal"}
<div class="form-group{if $content_data.errors.withdrawal_content} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_order_withdrawal_label"}
<label for="withdrawal_data[withdrawal_content]" class="control-label col-sm-3">
{$txt.withdrawal}
</label>
{/block}
{block name="module_withdrawal_web_form_order_withdrawal_container"}
<div class="col-sm-9 input-container">
{block name="module_withdrawal_web_form_order_withdrawal_input"}
<textarea placeholder="{$txt.withdrawal}"
rows="10"
id="withdrawal_data[withdrawal_content]"
name="withdrawal_data[withdrawal_content]"
class="form-control">
{* keep this code aligned to the left *}{if $smarty.post.withdrawal_data.withdrawal_content}{$smarty.post.withdrawal_data.withdrawal_content|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$txt.withdrawal_textarea_default|escape:'html'}
{foreach from=$content_data.order->products item=product}
{$product.qty} x {$product.name|escape:'html'} {if $product.model}({$product.model|escape:'html'}){/if}{foreach from=$product.attributes item=attribute}
{if $attribute.option != ''} / {$attribute.option|escape:'html'}: {$attribute.value|escape:'html'}{/if}{/foreach}{foreach from=$product.properties item=property}{if $property.properties_name != '' } / {$property.properties_name|escape:'html'}: {$property.values_name|escape:'html'}{/if}{/foreach}{/foreach}{/if}
{* keep this code aligned to the left *}
</textarea>
{/block}
{if $txt.withdrawal_textarea_hint}
{block name="module_withdrawal_web_form_order_withdrawal_hint"}
<span class="help-block">
{$txt.withdrawal_textarea_hint|escape:'html'}
</span>
{/block}
{/if}
{if $content_data.errors.withdrawal_content}
{block name="module_withdrawal_web_form_order_withdrawal_error"}
<span class="help-block">
{$txt.input_error}
</span>
{/block}
{/if}
</div>
{/block}
</div>
{/block}
{block name="module_withdrawal_web_form_order_order_get_on"}
<div class="form-group switch-text-input{if $error && $error != ''} has-feedback has-error{/if}"
data-gambio-widget="withdrawal">
<div class="col-sm-4 radio-block">
{block name="module_withdrawal_web_form_order_order"}
<div class="row">
{block name="module_withdrawal_web_form_order_order_label"}
<label for="withdrawal_form_withdrawal_date_orderd_on" class="col-sm-8 control-label">{$txt.order}</label>
{/block}
{block name="module_withdrawal_web_form_order_order_input"}
<input id="withdrawal_form_withdrawal_date_orderd_on"
class="col-sm-4 withdrawal_form_switcher"
type="radio"
value="ordered_on"
name="withdrawal_form_switcher"
{if !$smarty.post.withdrawal_data.delivery_date || $content_data.errors.order_date} checked="checked"{/if} />
{/block}
</div>
{/block}
{block name="module_withdrawal_web_form_order_get_on"}
<div class="row">
{block name="module_withdrawal_web_form_order_get_on_label"}
<label for="withdrawal_form_withdrawal_date_get_on" class="col-sm-8 control-label">{$txt.get_on}</label>
{/block}
{block name="module_withdrawal_web_form_order_get_on_input"}
<input id="withdrawal_form_withdrawal_date_get_on"
class="col-sm-4 withdrawal_form_switcher"
type="radio"
value="get_on"
name="withdrawal_form_switcher"
{if $smarty.post.withdrawal_data.delivery_date || $content_data.errors.delivery_date} checked="checked"{/if} />
{/block}
</div>
</div>
{/block}
{block name="module_withdrawal_web_form_order_order_get_on_date"}
<div class="col-sm-8 input-text-switch">
<input id="withdrawal_form_withdrawal_date_orderd_on_input"
class="col-sm-12 form-control withdrawal-date active"
type="text"
name="withdrawal_data[order_date]"
value="{if $smarty.post.withdrawal_data.order_date}{$smarty.post.withdrawal_data.order_date|escape:'html'}{else}{$content_data.order->info.date_purchased|date_format:'%d.%m.%Y'}{/if}"/>
<input id="withdrawal_form_withdrawal_date_get_on_input"
class="col-sm-12 form-control withdrawal-date"
type="text"
name="withdrawal_data[delivery_date]"
value="{if $smarty.post.withdrawal_data.delivery_date}{$smarty.post.withdrawal_data.delivery_date|escape:'html'}{else}{$content_data.order->withdrawal_date|date_format:'%d.%m.%Y'}{/if}"
disabled />
</div>
{/block}
{if $content_data.errors.order_date || $content_data.errors.delivery_date}
{block name="module_withdrawal_web_form_order_order_get_on_error"}
<div class="help-block">
<span class="col-sm-offset-3 col-sm-9 help-block">
{$txt.input_error}
</span>
</div>
{/block}
{/if}
</div>
{/block}
</fieldset>
{/block}
{block name="module_withdrawal_web_form_personal"}
<fieldset>
{block name="module_withdrawal_web_form_personal_legend"}
<legend>
{$txt.first_last_name}
</legend>
{/block}
{block name="module_withdrawal_web_form_personal_gender"}
<div class="form-group{if $content_data.errors.customer_gender} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_personal_gender_label"}
<label class="control-label col-sm-3">
{$txt.salutation}
</label>
{/block}
{block name="module_withdrawal_web_form_personal_gender_container"}
<div class="col-sm-9 input-container">
{block name="module_withdrawal_web_form_personal_gender_m_span"}
<span class="radio-inline">
{block name="module_withdrawal_web_form_personal_gender_m_label"}
<label for="withdrawal_customer_gender-m">
{block name="module_withdrawal_web_form_personal_gender_m_input"}
<input type="radio" id="withdrawal_customer_gender-m" name="withdrawal_data[customer_gender]" value="{$txt.male}"{if $content_data.order->customer.gender =='m' || $smarty.post.withdrawal_data.customer_gender == $txt.male} checked="checked"{/if} />
{$txt.male}
{/block}
</label>
{/block}
</span>
{/block}
<span> </span>
{block name="module_withdrawal_web_form_personal_gender_f_span"}
<span class="radio-inline">
{block name="module_withdrawal_web_form_personal_gender_f_label"}
<label for="withdrawal_customer_gender-f">
{block name="module_withdrawal_web_form_personal_gender_f_input"}
<input type="radio" id="withdrawal_customer_gender-f" name="withdrawal_data[customer_gender]" value="{$txt.female}"{if $content_data.order->customer.gender =='f' || $smarty.post.withdrawal_data.customer_gender == $txt.female} checked="checked"{/if} />
{$txt.female}
{/block}
</label>
{/block}
</span>
{/block}
</div>
{/block}
{if $content_data.errors.customer_gender}
{block name="module_withdrawal_web_form_personal_gender_error"}
<div class="help-block">
<span class="col-sm-3">
</span>
<span class="col-sm-9 help-block">
{$txt.input_error}
</span>
</div>
{/block}
{/if}
</div>
{/block}
{block name="module_withdrawal_web_form_personal_firstname"}
<div class="form-group">
{block name="module_withdrawal_web_form_personal_firstname_label"}
<label for="withdrawal_form_customer_firstname" class="control-label col-sm-3">
{$txt.firstname}
</label>
{/block}
{block name="module_withdrawal_web_form_personal_firstname_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_personal_firstname_input"}
<input type="text"
placeholder="{$txt.firstname}"
id="withdrawal_form_customer_firstname"
name="withdrawal_data[customer_firstname]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_firstname}{$smarty.post.withdrawal_data.customer_firstname|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.firstname|escape:'html'}{/if}" />
{/block}
</div>
{/block}
</div>
{/block}
{block name="module_withdrawal_web_form_personal_lastname"}
<div class="form-group">
{block name="module_withdrawal_web_form_personal_lastname_label"}
<label for="withdrawal_form_customer_lastname" class="control-label col-sm-3">
{$txt.lastname}
</label>
{/block}
{block name="module_withdrawal_web_form_personal_lastname_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_personal_lastname_input"}
<input type="text"
placeholder="{$txt.lastname}"
id="withdrawal_form_customer_lastname"
name="withdrawal_data[customer_lastname]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_lastname}{$smarty.post.withdrawal_data.customer_lastname|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.lastname|escape:'html'}{/if}" />
{/block}
</div>
{/block}
</div>
{/block}
</fieldset>
{/block}
{block name="module_withdrawal_web_form_address"}
<fieldset>
{block name="module_withdrawal_web_form_address_legend"}
<legend>
{$txt.address}
</legend>
{/block}
{block name="module_withdrawal_web_form_address_street"}
<div class="form-group{if $content_data.errors.customer_street_address} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_address_street_label"}
<label for="withdrawal_form_customer_street_address" class="control-label col-sm-3">
{$txt.street_and_number}
</label>
{/block}
{block name="module_withdrawal_web_form_address_street_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_address_street_input"}
<input type="text"
placeholder="{$txt.street_and_number}"
id="withdrawal_form_customer_street_address"
name=withdrawal_data[customer_street_address]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_street_address}{$smarty.post.withdrawal_data.customer_street_address|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.street_address|escape:'html'}{/if}" />
{/block}
{if $content_data.errors.customer_street_address}
{block name="module_withdrawal_web_form_address_street_error"}
<span class="help-block">
{$txt.input_error}
</span>
{/block}
{/if}
</div>
{/block}
</div>
{/block}
{block name="module_withdrawal_web_form_address_postcode_city"}
<div class="element-set form-group{if $content_data.errors.customer_postcode || $content_data.errors.customer_city} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_address_postcode_city_label"}
<label for="withdrawal_customer_postcode" class="control-label col-sm-3">
{$txt.zipcode} / {$txt.city}
</label>
{/block}
{block name="module_withdrawal_web_form_address_postcode_container"}
<div class="col-sm-3 col-lg-2 input-container">
{block name="module_withdrawal_web_form_address_postcode_input"}
<input type="text"
placeholder="{$txt.zipcode}"
id="withdrawal_customer_postcode"
name="withdrawal_data[customer_postcode]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_postcode}{$smarty.post.withdrawal_data.customer_postcode|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.postcode|escape:'html'}{/if}" />
{/block}
{if $content_data.errors.customer_postcode}
{block name="module_withdrawal_web_form_address_postcode_error"}
<span class="help-block">{$txt.input_error}</span>
{/block}
{/if}
</div>
{/block}
{block name="module_withdrawal_web_form_address_city_container"}
<div class="col-sm-6 col-lg-4 input-container">
{block name="module_withdrawal_web_form_address_city_input"}
<input type="text"
placeholder="{$txt.city}"
id="withdrawal_customer_city"
name="withdrawal_data[customer_city]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_city}{$smarty.post.withdrawal_data.customer_city|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.city|escape:'html'}{/if}" />
{/block}
{if $content_data.errors.customer_city}
{block name="module_withdrawal_web_form_address_city_error"}
<span class="help-block">{$txt.input_error}</span>
{/block}
{/if}
</div>
{/block}
</div>
{/block}
{block name="module_withdrawal_web_form_address_country"}
<div class="form-group">
{block name="module_withdrawal_web_form_address_country_label"}
<label for="withdrawal_form_customer_country" class="control-label col-sm-3">
{$txt.country}
</label>
{/block}
{block name="module_withdrawal_web_form_address_country_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_address_country_input"}
<input type="text"
placeholder="{$txt.country}"
id="withdrawal_form_customer_country"
name=withdrawal_data[customer_country]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_country}{$smarty.post.withdrawal_data.customer_country|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.country|escape:'html'}{/if}" />
{/block}
</div>
{/block}
</div>
{/block}
</fieldset>
{/block}
{block name="module_withdrawal_web_form_email"}
<fieldset>
{block name="module_withdrawal_web_form_email_legend"}
<legend>
{$txt.ask_for_email}
</legend>
{/block}
{block name="module_withdrawal_web_form_email_email"}
<div class="form-group mandatory{if $content_data.errors.customer_email} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_email_email_label"}
<label for="withdrawal_form_customer_email" class="control-label col-sm-3">
{$txt.your_email}
</label>
{/block}
{block name="module_withdrawal_web_form_email_email_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_email_email_input"}
<input type="email"
placeholder="{$txt.your_email}"
id="withdrawal_form_customer_email"
name=withdrawal_data[customer_email]"
class="form-control"
value="{if $smarty.post.withdrawal_data.customer_email}{$smarty.post.withdrawal_data.customer_email|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->customer.email_address|escape:'html'}{/if}" />
{/block}
{if $content_data.errors.customer_email}
{block name="module_withdrawal_web_form_email_email_error"}
<span class="help-block">
{$txt.input_error}
</span>
{/block}
{/if}
</div>
{/block}
</div>
{/block}
</fieldset>
{/block}
{block name="module_withdrawal_web_form_withdrawal"}
<fieldset>
{block name="module_withdrawal_web_form_withdrawal_legend"}
<legend>
{$txt.withdrawal_date}
</legend>
{/block}
{block name="module_withdrawal_web_form_withdrawal_date"}
<div class="form-group{if $content_data.errors.withdrawal_date} has-feedback has-error{/if}">
{block name="module_withdrawal_web_form_withdrawal_date_label"}
<label for="withdrawal_form_withdrawal_date" class="control-label col-sm-3">
{$txt.withdrawal_date}
</label>
{/block}
{block name="module_withdrawal_web_form_withdrawal_date_container"}
<div class="col-sm-9 col-lg-6 input-container">
{block name="module_withdrawal_web_form_withdrawal_date_input"}
<input type="text"
placeholder="{$txt.withdrawal_date}"
id="withdrawal_form_withdrawal_date"
name="withdrawal_data[withdrawal_date]"
class="form-control withdrawal-date form-type-date"
value="{if $smarty.post.withdrawal_data.withdrawal_date}{$smarty.post.withdrawal_data.withdrawal_date|replace:'\"':'"'|replace:"\'":"'"|escape:'html'}{else}{$content_data.order->withdrawal_date|date_format:'%d.%m.%Y'}{/if}" />
{/block}
{if $content_data.errors.withdrawal_date}
{block name="module_withdrawal_web_form_withdrawal_date_error"}
<span class="help-block">
{$txt.input_error}
</span>
{/block}
{/if}
</div>
{/block}
</div>
{/block}
</fieldset>
{/block}
{block name="module_withdrawal_web_form_privacy_if"}
{if $content_data.show_privacy}
{block name="module_withdrawal_web_form_privacy"}
<fieldset{if $content_data.errors.privacy_accepted} class="has-feedback has-error"{/if}>
{block name="module_withdrawal_web_form_privacy_legend"}
<legend>
{$txt.title_privacy}
</legend>
{/block}
{if $content_data.show_privacy_checkbox}
{block name="module_withdrawal_web_form_privacy_checkbox"}
<input id="privacy_accepted" type="checkbox" name="withdrawal_data[privacy_accepted]" value="1"/>
<label for="privacy_accepted" class="control-label">{$content_data.privacy_link}</label>
{/block}
{else}
{block name="module_withdrawal_web_form_privacy_link"}
<span>{$content_data.privacy_link}</span>
{/block}
{/if}
{if $content_data.errors.privacy_accepted}
{block name="module_withdrawal_web_form_withdrawal_privacy_error"}
<span class="help-block">
{$txt.privacy_error}
</span>
{/block}
{/if}
</fieldset>
{/block}
{/if}
{/block}
{block name="module_withdrawal_web_form_buttons"}
<div class="row">
<div class="col-xs-6 col-sm-4 col-md-3">
{block name="module_withdrawal_web_form_buttons_empty"}
{/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="module_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="module_withdrawal_web_form_mandatory"}
<p class="mandatory-info">
{$txt.mandatory_fields}
</p>
{/block}
</form>
{/block}
{/if}
{/block}