<?php
$page_title = "収納代行サービス（日本）申請";
include_once('template/base_head.php');
?>
			<!-- サイドバー -->
			<aside id="colLeft">
				<h1><a href="/ja/menu"><img src="../img/logo.png" alt="iWallet"></a></h1>
<?php include_once('template/base_sidebar.php'); ?>
			</aside>
			<!-- /サイドバー -->
			<!-- メインカラム -->
			<div id="colMain">
				<div class="mainIn">
<?php include_once('template/base_nav.php'); ?>
					<article>
						<div class="article-heading">
							<h2><?php echo $page_title; ?></h2>
						</div>
						<div class="mb10"><?php $this -> echoMessage(); ?></div>
						<p class="respM pb30">以下の内容で申請します。</p>
						<form id="acForm" action="" method="post">
							<table class="table col bdr default odd withdrawT fontM mb30 ma90sp">
								<tr>
									<th>金額</th>
									<td><?php $this -> echoCurrency() ?> <?php $this -> dispAmount(); ?>(<?php $this -> echoDebitCurrency() ?> <?php $this -> dispDebitAmount(); ?>)</td>
								</tr>
								<tr>
									<th>手数料</th>
									<td><?php $this -> echoDrawFeeCurrency(); ?> <?php $this -> echoDrawFee(); ?></td>
								</tr>
								<tr>
									<th>口座番号またはIBAN</th>
									<td><?php $this -> echoAccountNumber(); ?></td>
								</tr>
								<tr>
									<th>口座名義</th>
									<td><?php $this -> echoAccountName(); ?></td>
								</tr>
								<tr>
									<th>受取人国</th>
									<td><?php $this -> dispReceiptCountry(); ?></td>
								</tr>
								<tr>
									<th>銀行名</th>
									<td><?php $this -> echoReceiptBankName(); ?></td>
								</tr>
                                <tr>
									<th>受取銀行コード</th>
									<td><?php $this -> echoReceiptBankCode(); ?></td>
								</tr>
								<tr <?php $this -> echoCssDisplay(); ?>>
									<th>支店コード</th>
									<td><?php $this -> echoReceiptBranchCode(); ?></td>
								</tr>
								<tr <?php $this -> echoCssDisplay(); ?>>
									<th>支店名</th>
									<td><?php $this -> echoReceiptBranchName(); ?></td>
								</tr>
								<tr>
									<th>銀行の所在国</th>
									<td><?php $this -> dispReceiptBankCountry(); ?></td>
								</tr>
								<tr>
									<th>受取人へのメッセージ</th>
									<td>収納代行サービス（日本）</td>
								</tr>
							</table>
							<input class="checkbox" type="checkbox" id="terms" name="terms" value="terms" >
							<label for="terms"><a target="blank" href="https://www.iwl.hk/files/pdf/Transfer_Service_Agency_Terms_and_Conditions_JP.pdf" class="termsa"><strong>利用規約</strong></a>に同意する。 </label>
                            <p id="termsError" class="red" style="display: none;" ><span class="fa fa-times-circle fa-lg"></span> 収納代行申請を行うには必ず利用規約をご確認の上、「利用規約に同意する」のボックスにチェックを入れていただく必要があります。 </p>

							<input type="hidden" value="<?php $this -> echoCurrency(); ?>" id="currency" name="currency" />
							<input type="hidden" value="<?php $this -> echoAmount(); ?>" id="amount" name="amount" />
							<input type="hidden" value="<?php $this -> echoAccountNumber(); ?>" id="account_number" name="account_number" />
							<input type="hidden" value="<?php $this -> echoAccountName(); ?>" id="account_name" name="account_name" />
							<input type="hidden" value="<?php echo $this -> getReceiptCountry(); ?>" id="receipt_country" name="receipt_country" />
							<input type="hidden" value="<?php $this -> echoReceiptAddress1(); ?>" id="receipt_address_1" name="receipt_address_1" />
							<input type="hidden" value="<?php $this -> echoTel(); ?>" id="tel" name="tel" />
							<input type="hidden" value="<?php $this -> echoReceiptBankName(); ?>" id="receipt_bank_name" name="receipt_bank_name" />
							<input type="hidden" value="<?php $this -> echoReceiptBranchCode(); ?>" id="receipt_branch_code" name="receipt_branch_code" />
							<input type="hidden" value="<?php $this -> echoReceiptBranchName(); ?>" id="receipt_branch_name" name="receipt_branch_name" />
							<input type="hidden" value="<?php $this -> echoReceiptBankCode(); ?>" id="receipt_bank_code" name="receipt_bank_code" />
							<input type="hidden" value="<?php echo $this -> getReceiptBankCountry(); ?>" id="receipt_bank_country" name="receipt_bank_country" />
							<input type="hidden" value="<?php $this -> echoReceiptBankAddress1(); ?>" id="receipt_bank_address_1" name="receipt_bank_address_1" />
							<input type="hidden" value="<?php $this -> echoReceiptMessage(); ?>" id="receipt_message" name="receipt_message" />
							<input type="hidden" value="<?php echo $this -> getIntermediaryFlg(); ?>" id="intermediary_flg" name="intermediary_flg" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankName(); ?>" id="intermediary_bank_name" name="intermediary_bank_name" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankSwift(); ?>" id="intermediary_bank_swift" name="intermediary_bank_swift" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankCountry(); ?>" id="intermediary_bank_country" name="intermediary_bank_country" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankAddress1(); ?>" id="intermediary_bank_address_1" name="intermediary_bank_address_1" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankAddress2(); ?>" id="intermediary_bank_address_2" name="intermediary_bank_address_2" />
							<input type="hidden" value="<?php $this -> echoIntermediaryBankMessage(); ?>" id="intermediary_bank_message" name="intermediary_bank_message" />

							<input type="hidden" value="<?php $this -> echoFromCurrency(); ?>" id="from_currency" name="from_currency" />
							<input type="hidden" value="<?php echo $this -> getAgent1Ex(); ?>" id="agent_code" name="agent_code" />
							<input type="hidden" value="<?php $this -> echoDebitCurrency(); ?>" id="debit_currency" name="debit_currency" />
							<input type="hidden" value="<?php $this -> echoDebitAmount(); ?>" id="debit_amount" name="debit_amount" />
							<input type="hidden" value="<?php echo $this -> getRateEx(); ?>" id="rate" name="rate" />
							<input type="hidden" value="<?php echo $this -> getFeeEx(); ?>" id="fee" name="fee" />

							<input type="hidden" value="" id="type" name="type" />
						</form>
                        <br>
						<p class="">
							<a href="#" id="btnFlat3Back" class="btn bg-default calign">&laquo; 戻る</a>&emsp;
							<input type="button"  id="btn2faSubmit" value="上記内容で出金申請" class="btn bg-grad px180 calign" onclick="create2fa('withdrawal_flat3','getbtnFlat3Complete','ja','<?php echo $page_title;?>','','');">
						</p>
					</article>
					<div class="" id="secondAuth"></div>
				</div>
			</div>
			<!-- /メインカラム -->
		</div>
<?php include_once('template/base_foot.php'); ?>
	</div>

	<script src="../js/withdraw.js"></script>
</body>
</html>
