<?php
$page_title = "請款申請";
include_once('template/base_head.php');
?>
			<!-- サイドバー -->
			<aside id="colLeft">
				<h1><a href="/tc/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>
						<p class="mb30 respM pleft40">對方同意您的請款後，該筆金額會即時反應到您的iWallet帳戶內。<br>
						請輸入對方的iWallet帳戶號碼或者電子信箱。</p>
						<div class="pleft40 mb10"><?php $this -> echoMessage(); ?></div>
						<div class="pleft40">
						<form id="acForm" action="" method="post">
							<div class="clearfix shelfD">
								<div class="dt150 font14">對方帳號</div>
								<?php $this -> echoUserAccount(); ?> <?php $this -> echoName(); ?>
							</div>
							<div class="clearfix shelfD">
								<div class="dt150 font14">選擇幣種</div>
										<select name="currency" class="px80">
											<?php $this -> dispCurrency(); ?>
										</select>
							</div>
							<div class="clearfix shelfD">
								<div class="dt150 font14">請求金額</div>
										<input type="text" name="amount" value="<?php $this -> echoAmount(); ?>" class="px180 ralign">
							</div>
							<div class=" shelfD">
								<div class="dt150 font14">備註</div>
										<textarea name="message" rows="5" class="px280"><?php $this -> echoRequestMessage(); ?></textarea>
							</div>
							<input type="hidden" value="" id="type" name="type" />

							<input type="hidden" value="<?php $this -> echoUserAccount(); ?>" id="account" name="account" />
						</form>
							<div class="dt150 noborder"></div>
						<p class="pb30"><input type="button" id="btnConfirm" value="下一步" class="btn bg-parent px180"></p>
						</div>
					</article>
				</div>
			</div>
			<!-- /メインカラム -->
		</div>
<?php include_once('template/base_foot.php'); ?>
	</div>
	<script src="../js/request.js"></script>
</body>
</html>
