{{ header }} 
{% include 'fastor/template/new_elements/wrapper_top.twig' %}

<p>{{ text_description }}</p>
<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>
          <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>
  <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="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>
      
{% include 'fastor/template/new_elements/wrapper_bottom.twig' %}
{{ footer }}