{{header}}
{{column_left}}
<div id="content">
	<div class="page-header">
		<div class="container-fluid">
			<div class="pull-right">
				<button type="submit" form="form-review" data-toggle="tooltip" title="{{button_save}}" class="btn btn-primary"><i class="fa fa-save"></i></button>
				<a href="{{cancel}}" data-toggle="tooltip" title="{{button_cancel}}" class="btn btn-default"><i class="fa fa-reply"></i></a>
			</div>
			<h1>{{heading_title}}</h1><br />
			<ul class="breadcrumb">
				{% for breadcrumb in breadcrumbs %}
					<li><a href="{{breadcrumb.href}}">{{breadcrumb.text}}</a></li>
				{% endfor %}
			</ul>
		</div>
	</div>
	<div class="container-fluid">
		{% if error_warning %}
			<div class="alert alert-danger">
				<i class="fa fa-exclamation-circle"></i> {{error_warning}}<button type="button" class="close" data-dismiss="alert">&times;</button>
			</div>
		{% endif %}
		{% if success %}
			<div class="alert alert-success">
				<i class="fa fa-check-circle"></i> {{success}}<button type="button" class="close" data-dismiss="alert">&times;</button>
			</div>
		{% endif %}
		<div class="panel panel-default">
			<div class="panel-heading">
				<h3 class="panel-title"><i class="fa fa-pencil"></i> {{text_form}}</h3>
			</div>
			<div class="panel-body">
				<form action="{{action}}" method="post" enctype="multipart/form-data" id="form-review" class="form-horizontal">
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-type">{{entry_type}}</label>
						<div class="col-sm-10">
							<input type="text" name="type" value="{{type}}" placeholder="" id="input-type" class="form-control" />
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-name">{{entry_name}}</span></label>
						<div class="col-sm-10">
							<input type="text" name="name" value="{{name}}" placeholder="" id="input-name" class="form-control" />
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-phone">{{entry_phone}}</span></label>
						<div class="col-sm-10">
							<input type="text" name="phone" value="{{phone}}" placeholder="{{entry_phone}}" id="input-phone" class="form-control" />
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-mail">{{entry_mail}}</span></label>
						<div class="col-sm-10">
							<input type="text" name="mail" value="{{mail}}" placeholder="" id="input-mail" class="form-control" />
						</div>
					</div>
					{% if product_name and product_href %}
						<div class="form-group">
							<label class="col-sm-2 control-label" for="input-mail">{{entry_product}}</span></label>
							<div class="col-sm-10">
								<a href="{{product_href}}" style="display:inline-block;height:26px;margin-top:9px;text-decoration:underline" target="_blank">{{product_name}} <i class="fa fa-clone" aria-hidden="true"></i></a>
							</div>
						</div>
					{% endif %}
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-comment">{{entry_comment}}</label>
						<div class="col-sm-10">
							<textarea name="comment" cols="60" rows="8" placeholder="" id="input-comment" class="form-control">{{comment}}</textarea>
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-admin_comment">{{entry_admin_comment}}</label>
						<div class="col-sm-10">
							<textarea name="admin_comment" cols="60" rows="8" placeholder="" id="input-admin_comment" class="form-control">{{admin_comment}}</textarea>
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-status">{{entry_request_list}}</label>
						<div class="col-sm-10">
							<select name="request_list" class="form-control">
								<option value="0" {{request_list == 0 ? 'selected="selected"'}}>{{text_off}}</option>
								<option value="1" {{request_list == 1 ? 'selected="selected"'}}>{{text_on}}</option>
							</select>
						</div>
					</div>
					<div class="form-group">
						<label class="col-sm-2 control-label" for="input-status">{{entry_status}}</label>
						<div class="col-sm-10">
							<select name="status" id="input-status" class="form-control">
								<option value="1" {{status == 1 ? 'selected="selected"'}}>{{text_status_1}}</option>
								<option value="2" {{status == 2 ? 'selected="selected"'}}>{{text_status_2}}</option>
								<option value="3" {{status == 3 ? 'selected="selected"'}}>{{text_status_3}}</option>
							</select>
						</div>
					</div>
					<input type="hidden" name="date_added" value="{{date_added}}" />
				</form>
			</div>
		</div>
	</div>
</div>
{{footer}}