{{ header }}
<div class="breadcrumb-container">
  <h1 class="page-title">{{ heading_title }}</h1>
  <ul class="breadcrumb">
    {% for breadcrumb in breadcrumbs %}
    <li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
    {% endfor %}
  </ul>
</div>
<div id="account-voucher" class="container">
  {% if error_warning %}
    <div class="alert alert-danger alert-dismissible"><i class="fa-solid fa-circle-exclamation"></i> {{ error_warning }}</div>
  {% endif %}
  <div class="row row-responsive">{{ column_left }}
    <div id="content" class="col">{{ content_top }}
      <h3>{{ text_voucher }}</h3>
      <p>{{ text_description }}</p>
      <form id="form-voucher" action="{{ save }}" method="post" data-oc-toggle="ajax">
        <div class="row mb-3 required">
          <div class="col-sm-12 form-floating">
            <input type="text" name="to_name" value="{{ to_name }}" placeholder="{{ entry_to_name }}" id="input-to-name" class="form-control"/>
            <label for="input-to-name" class="col-sm-4 col-form-label">{{ entry_to_name }}</label>
            <div id="error-to-name" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="row mb-3 required">
          
          <div class="col-sm-12 form-floating">
            <input type="text" name="to_email" value="{{ to_email }}" placeholder="{{ entry_to_email }}" id="input-to-email" class="form-control"/>
            <label for="input-to-email" class="col-sm-4 col-form-label">{{ entry_to_email }}</label>
            <div id="error-to-email" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="row mb-3 required">
          <div class="col-sm-12 form-floating">
            <input type="text" name="from_name" value="{{ from_name }}" placeholder="{{ entry_from_name }}" id="input-from-name" class="form-control"/>
            <label for="input-from-name" class="col-sm-2 col-form-label">{{ entry_from_name }}</label>
            <div id="error-from-name" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="row mb-1 required">
          <div class="col-sm-12 form-floating">
            <input type="text" name="from_email" value="{{ from_email }}" placeholder="{{ entry_from_email }}" id="input-from-email" class="form-control"/>
            <label for="input-from-email" class="col-sm-2 col-form-label">{{ entry_from_email }}</label>
            <div id="error-from-email" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="row mb-1 required">
          <label class="col-sm-4 col-form-label">{{ entry_theme }}</label>
          <div class="col-sm-12 form-floating">
            <div id="input-theme">
              {% for voucher_theme in voucher_themes %}
                <div class="form-check">
                  <input type="radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" id="input-theme-{{ voucher_theme.voucher_theme_id }}" class="form-check-input"{% if voucher_theme.voucher_theme_id == voucher_theme_id %} checked{% endif %}/>
                  <label for="input-theme-{{ voucher_theme.voucher_theme_id }}" class="form-check-label">{{ voucher_theme.name }}</label>
                </div>
              {% endfor %}
            </div>
            <div id="error-theme" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="row mb-3">
          <div class="col-sm-12 form-floating">
            <textarea name="message" cols="40" rows="5" placeholder="{{ entry_message }}" id="input-message" class="form-control form_detail">{{ message }}</textarea>
             <label for="input-message" class="col-sm-2 col-form-label"><span data-bs-toggle="tooltip" title="{{ help_message }}" class="col-sm-2 col-form-label certificate-massage">{{ entry_message }}</span></label>
          </div>
        </div>
        <div class="row mb-3 required ">
          <div class="col-sm-12 form-floating">
            <input type="text" name="amount" value="{{ amount }}" placeholder="{{ entry_amount }}" id="input-amount" class="form-control" size="5"/>
            <label for="input-amount" class="col-sm-2 col-form-label"><span data-bs-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
            <div id="error-amount" class="invalid-feedback"></div>
          </div>
        </div>
        <div class="d-inline-block pt-1 pd-2 w-100 ">
          <div class="float-end">
            <div class="form-check form-check-inline">
              <label class="form-check-label" style="font-size: 13px;">{{ text_agree }}</label>
              <input type="checkbox" name="agree" value="1" style="height: 12px; width: 12px;" class="form-check-input"/>
              &nbsp;
            </div>
            <button type="submit" class="btn btn-primary">{{ button_continue }}</button>
          </div>
        </div>
      </form>
      {{ content_bottom }}</div>
    {{ column_right }}</div>
</div>
{{ footer }}