<?php
$page_title = "卡-儲值申請";
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="pleft40 mb30 respM">iWallet卡是美金單幣種預付卡。<br>
						<span class="fontX red">※非美金交易也會以美金結算。</span></p>
						<form id="acForm" action="" method="post">
							<table class="table sep default odd withdrawT fontM mb20">
								<tr>
									<td class="r">請選擇需要儲值的卡號</td>
									<td>
										<input type="radio" name="card" value="**** **** **** 1234" id="card1"><label for="card1">**** **** **** 1234</label>&nbsp;
										<input type="radio" name="card" value="**** **** **** 1234" id="card2"><label for="card2">**** **** **** 1234</label>
									</td>
								</tr>
								<tr>
									<td class="r">請選擇支出幣種</td>
									<td>
										<select name="" class="px70">
											<option value="">USD</option>
											<option value="">JPY</option>
											<option value="">EUR</option>
											<option value="">GBP</option>
											<option value="">HKD</option>
											<option value="">SGD</option>
										</select>&emsp;
										<input type="button" name="" value="查詢餘額" class="btn bg-default px100">
									</td>
								</tr>
								<tr>
									<td class="r">請填寫儲值金額</td>
									<td>
										<p>
											<label><input type="radio" name="" value="">匯出幣種</label>&emsp;
											<label><input type="radio" name="" value="">USD</label>
										</p>
										<input type="text" name="" value="" class="w70p ralign">
									</td>
								</tr>
							</table>

							<input type="hidden" value="" id="type" name="type" />
						</form>
						<p class="withdrawT calign"><input type="button" id="btnCardConfirm" name="btnCardConfirm" value="下一步" class="btn bg-grad px180"></p>
					</article>
				</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>
