{load_language_text section="contact_us"}
{load_language_text section="buttons" name="button"}

{block name="module_gm_callback_service"}
	{if $CONTENT_TEXT}
		{block name="module_gm_callback_service_content"}
			<p>
				{$CONTENT_TEXT}
			</p>
		{/block}
	{/if}

	{block name="module_gm_callback_service_form"}
		<form id="callback-service"
			  class="form-horizontal"
			  data-gambio-widget="callback_service">
			
			{block name="module_gm_callback_service_alert_danger"}
				{include file="get_usermod:{$tpl_path}snippets/alert_message.html" message=$error type="danger" hidden=true}
			{/block}
			
			{block name="module_gm_callback_service_alert_success"}
				{include file="get_usermod:{$tpl_path}snippets/alert_message.html" message=$error type="success" hidden=true}
			{/block}
			
			{block name="module_gm_callback_service_fieldset"}
				<fieldset>
					{block name="module_gm_callback_service_mandatory"}
						<p class="mandatory-info">
							{$txt.text_required}
						</p>
					{/block}
					
					{block name="module_gm_callback_service_name"}
						<div class="form-group">
							{block name="module_gm_callback_service_name_label"}
								<label for="name" class="control-label col-sm-3">
									{$NAME}
								</label>
							{/block}
							
							{block name="module_gm_callback_service_name_container"}
								<div class="col-sm-9 col-lg-6 input-container">
									{block name="module_gm_callback_service_name_input"}
										<input type="text"
											   placeholder="{$NAME}"
											   id="name"
											   name="name"
											   class="form-control"
											   value="" />
									{/block}
								</div>
							{/block}
						</div>
					{/block}
					
					{block name="module_gm_callback_service_email"}
						<div class="form-group">
							{block name="module_gm_callback_service_email_label"}
								<label for="email" class="control-label col-sm-3">
									{$EMAIL}
								</label>
							{/block}
							
							{block name="module_gm_callback_service_email_container"}
								<div class="col-sm-9 col-lg-6 input-container">
									{block name="module_gm_callback_service_email_input"}
										<input placeholder="{$EMAIL}"
											   id="email"
											   name="email"
											   type="email"
											   class="form-control"
											   value="" />
									{/block}
								</div>
							{/block}
						</div>
					{/block}
					
					{block name="module_gm_callback_service_telephone"}
						<div class="form-group mandatory">
							{block name="module_gm_callback_service_telephone_label"}
								<label for="telephone" class="control-label col-sm-3">
									{$TELEPHONE}
								</label>
							{/block}
							
							{block name="module_gm_callback_service_telephone_container"}
								<div class="col-sm-9 col-lg-6 input-container">
									{block name="module_gm_callback_service_telephone_input"}
										<input type="tel"
											   placeholder="{$TELEPHONE}"
											   id="telephone"
											   name="telephone"
											   class="form-control"
											   value="" />
									{/block}
								</div>
							{/block}
						</div>
					{/block}
					
					{block name="module_gm_callback_service_time"}
						<div class="form-group">
							{block name="module_gm_callback_service_time_label"}
								<label for="time" class="control-label col-sm-3">
									{$TIME}
								</label>
							{/block}
							
							{block name="module_gm_callback_service_time_container"}
								<div class="col-sm-9 col-lg-6 input-container">
									{block name="module_gm_callback_service_time_input"}
										<input type="text"
											   placeholder="{$TIME}"
											   id="time"
											   name="time"
											   class="form-control form-type-datetime"
											   value="" />
									{/block}
								</div>
							{/block}
						</div>
					{/block}
					
					{block name="module_gm_callback_service_message"}
						<div class="form-group">
							{block name="module_gm_callback_service_message_label"}
								<label for="{$id}" class="control-label col-sm-3">
									{$MESSAGE}
								</label>
							{/block}
							
							{block name="module_gm_callback_service_message_container"}
								<div class="col-sm-9 input-container">
									{block name="module_gm_callback_service_message_input"}
										<textarea placeholder="{$MESSAGE}" id="message" name="message" class="form-control">{$INPUT_TEXT_VALUE}</textarea>
									{/block}
								</div>
							{/block}
						</div>
					{/block}
			
					{if $VALIDATION_ACTIVE == 'true'}
						{block name="module_gm_callback_service_captcha"}
							<div class="form-group mandatory">
								{block name="module_gm_callback_service_captcha_label"}
									<label for="captcha" class="control-label col-sm-3">
										{$VALIDATION}
									</label>
								{/block}
								
								{block name="module_gm_callback_service_captcha_container"}
									<div class="col-sm-9 col-lg-6 input-container">
										{block name="module_gm_callback_service_captcha_input"}
											{$GM_CAPTCHA}
										{/block}
									</div>
								{/block}
							</div>
						{/block}
					{/if}
			
				</fieldset>
			{/block}
		
			{if $GM_PRIVACY_LINK != '0'}
				{block name="module_gm_callback_service_privacy"}
					<fieldset>
						{if $show_privacy_checkbox}
							{block name="module_gm_callback_service_privacy_checkbox"}
								<input id="privacy_accepted" type="checkbox" name="privacy_accepted" value="1" />
								<label for="privacy_accepted">{$GM_PRIVACY_LINK}</label>
							{/block}
						{else}
							{block name="module_gm_callback_service_privacy_link"}
								<span>{$GM_PRIVACY_LINK}</span>
							{/block}
						{/if}
					</fieldset>
				{/block}
			{/if}
			
			{block name="module_gm_callback_service_buttons"}
				<div class="row">
					<div class="col-xs-6 col-sm-4 col-md-3">
						{block name="module_gm_callback_service_buttons_back"}
							<a class="btn btn-default btn-block history-back" href="{page_url}#" title="{$button.back}">
								{$button.back}
							</a>
						{/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="lastname" value="">
						
						{block name="module_gm_callback_service_buttons_submit"}
							<button type="submit" class="btn btn-primary btn-block" title="{$button.send}">
								{$button.send}
							</button>
						{/block}
					</div>
				</div>
			{/block}
		</form>
	{/block}
{/block}