{{ header }}
<div id="account-voucher" class="container">
    <ul class="breadcrumb">
        {% for breadcrumb in breadcrumbs %}
            <li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
        {% endfor %}
    </ul>
    {% 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-sm-6' %}
        {% elseif column_left or column_right %}
            {% set class = 'col-sm-9' %}
        {% else %}
            {% set class = 'col-sm-12' %}
        {% endif %}
        <div id="content" class="{{ class }}">{{ content_top }}
            <p>{{ text_description }}</p>
            <form action="{{ action }}" method="post" enctype="multipart/form-data">
                <div class="form-group required">
                    <label for="input-to-name">{{ entry_to_name }}</label>
                    <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 class="form-group required">
                    <label for="input-to-email">{{ entry_to_email }}</label>
                    <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 class="form-group required">
                    <label for="input-from-name">{{ entry_from_name }}</label>
                    <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 class="form-group required">
                    <label for="input-from-email">{{ entry_from_email }}</label>
                    <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 class="form-group required">
                    <label>{{ entry_theme }}</label>
                    {% 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 class="form-group">
                    <label for="input-message"><span data-toggle="tooltip" title="{{ help_message }}">{{ entry_message }}</span></label>
                    <textarea name="message" cols="40" rows="5" id="input-message" class="form-control">{{ message }}</textarea>
                </div>
                <div class="form-group">
                    <label for="input-amount"><span data-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
                    <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 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>
            {{ content_bottom }}
        </div>
        {{ column_right }}
    </div>
</div>
{{ footer }}