{{ header }}
<div id="account-voucher" class="container">
	<ul class="breadcrumb">
		{% for key, breadcrumb in breadcrumbs %}
			{% if key+1 < breadcrumbs|length %}
				<li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
			{% else %}
				<li>{{ breadcrumb.text }}</li>
			{% endif %}
		{% 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-4 col-md-6 col-lg-6 col-xxl-12' %}
		{% elseif column_left or column_right %}
			{% set class = ' col-sm-8 col-md-9 col-lg-9 col-xxl-16' %}
		{% else %}
			{% set class = ' col-sm-12' %}
		{% endif %}
		<div id="content" class="{{ class }}">
			{{ content_top }}
			<div class="uni-wrapper">
				<div class="account-voucher uni-form form-horizontal">
					<div class="form-group">
						<div class="col-sm-2 hidden-xs"></div>
						<div class="col-sm-10">
							<h3 class="uni-form__heading">{{ heading_title }}</h3>
							<div class="account-voucher__description">{{ text_description }}</div>
						</div>
					</div>
					<form action="{{ action }}" method="post" enctype="multipart/form-data" class="form-horizontal">
						<div class="form-group required">
							<label class="col-sm-2 control-label" for="input-to-name">{{ entry_to_name }}</label>
							<div class="col-sm-10">
								<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-2 control-label" for="input-to-email">{{ entry_to_email }}</label>
							<div class="col-sm-10">
								<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-2 control-label" for="input-from-name">{{ entry_from_name }}</label>
							<div class="col-sm-10">
								<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-2 control-label" for="input-from-email">{{ entry_from_email }}</label>
							<div class="col-sm-10">
								<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-2 control-label">{{ entry_theme }}</label>
							<div class="col-sm-10">
								{% for voucher_theme in voucher_themes %}
									{% if voucher_theme.voucher_theme_id == voucher_theme_id %}
										<div class="radio">
											<label class="input"><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 class="input"><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-2 control-label" for="input-message"><span data-toggle="tooltip" title="{{ help_message }}">{{ entry_message }}</span></label>
							<div class="col-sm-10">
								<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-2 control-label" for="input-amount"><span data-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
							<div class="col-sm-10">
								<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="form-group">
							<label class="col-sm-2 control-label hidden-xs"></label>
							<div class="col-sm-10">
								<label class="input"><input type="checkbox" name="agree" value="1" /><span>{{ text_agree }}</span></label>
							</div>
						</div>
						<div class="form-group">
							<label class="col-sm-2 control-label hidden-xs"></label>
							<div class="col-sm-10">
								<button type="submit" class="account-voucher__submit btn btn-lg btn-primary" data-loading-text="{{ text_loading }}">{{ button_continue }}</button>
							</div>
						</div>
					</form>
				</div>
			</div>
			{{ content_bottom }}
		</div>
		{{ column_right }}
	</div>
</div>
{{ footer }}