<html lang="ja">
	<head>
		<meta charset="utf-8">
		<script src="../js/jquery.js"></script>
		<script src="../js/common.js"></script>
		<script src="../js/withdraw.js"></script>
	</head>
	<body onload="toggleIntermediaries();">
		<form action="" method="post" id="acForm" enctype="multipart/form-data">
			<?php require_once('base_head.php'); ?>
			<?php $this -> echoMessage(); ?>
			銀行情報の入力<br/>

			<table>
				<tr>
					<th>アカウント名</th>
					<td><?php $this -> echoUserName(); ?></td>
				</tr>
				<tr>
					<th>引出通貨</th>
					<td><?php $this -> echoDrawCurrency(); ?></td>
				</tr>
				<tr>
					<th>出金額</th>
					<td><input type="text" id="amount" name="amount" value="<?php $this -> echoAmount(); ?>" />&nbsp;<?php $this -> echoCurrency(); ?></td>
				</tr>
				<tr>
					<th>口座名義</th>
					<td><input type="text" id="account_name" name="account_name" value="<?php $this -> echoAccountName(); ?>" /></td>
				</tr>
				<tr>
					<th>受取人国</th>
					<td><?php $this -> echoReceiptCountry(); ?></td>
				</tr>
				<tr>
					<th>住所1</th>
					<td><input type="text" id="receipt_address_1" name="receipt_address_1" value="<?php $this -> echoReceiptAddress1(); ?>" /></td>
				</tr>
				<tr>
					<th>住所2</th>
					<td><input type="text" id="receipt_address_2" name="receipt_address_2" value="<?php $this -> echoReceiptAddress2(); ?>" /></td>
				</tr>
				<tr>
					<th>メッセージ</th>
					<td><input type="text" id="receipt_message" name="receipt_message" value="<?php $this -> echoReceiptMessage(); ?>" /></td>
				</tr>
				<tr>
					<th>受取銀行名</th>
					<td><input type="text" id="receipt_bank_name" name="receipt_bank_name" value="<?php $this -> echoReceiptBankName(); ?>" /></td>
				</tr>
				<tr>
					<th>SWIFTコード</th>
					<td><input type="text" id="receipt_bank_swift" name="receipt_bank_swift" value="<?php $this -> echoReceiptBankSwift(); ?>" /></td>
				</tr>
				<tr>
					<th>受取銀行国</th>
					<td><?php $this -> echoReceiptBankCountry(); ?></td>
				</tr>
				<tr>
					<th>受取銀行住所1</th>
					<td><input type="text" id="receipt_bank_address_1" name="receipt_bank_address_1" value="<?php $this -> echoReceiptBankAddress1(); ?>" /></td>
				</tr>
				<tr>
					<th>受取銀行住所2</th>
					<td><input type="text" id="receipt_bank_address_2" name="receipt_bank_address_2" value="<?php $this -> echoReceiptBankAddress2(); ?>" /></td>
				</tr>
				<tr>
					<th>口座番号</th>
					<td><input type="text" id="account_number" name="account_number" value="<?php $this -> echoAccountNumber(); ?>" /></td>
				</tr>
				<tr>
					<td colspan="2"><?php $this -> echoIntermediaryFlg(); ?></td>
				</tr>
			</table>
			<div id="intermediaries">
				<table>
					<tr>
						<th>中継銀行名</th>
						<td><input type="text" id="intermediary_bank_name" name="intermediary_bank_name" value="<?php $this -> echoIntermediaryBankName(); ?>" /></td>
					</tr>
					<tr>
						<th>SWIFTコード</th>
						<td><input type="text" id="intermediary_bank_swift" name="intermediary_bank_swift" value="<?php $this -> echoIntermediaryBankSwift(); ?>" /></td>
					</tr>
					<tr>
						<th>受取銀行国</th>
						<td><?php $this -> echoIntermediaryBankCountry(); ?></td>
					</tr>
					<tr>
						<th>受取銀行住所1</th>
						<td><input type="text" id="intermediary_bank_address_1" name="intermediary_bank_address_1" value="<?php $this -> echoIntermediaryBankAddress1(); ?>" /></td>
					</tr>
					<tr>
						<th>受取銀行住所2</th>
						<td><input type="text" id="intermediary_bank_address_2" name="intermediary_bank_address_2" value="<?php $this -> echoIntermediaryBankAddress2(); ?>" /></td>
					</tr>
					<tr>
						<th>中継銀行メッセージ</th>
						<td><input type="text" id="intermediary_bank_message" name="intermediary_bank_message" value="<?php $this -> echoIntermediaryBankMessage(); ?>" /></td>
					</tr>
				</table>
			</div>
			<input type="button" value="確認する" id="confirm" name="confirm" onclick="actionConfirm();" />

			<input type="hidden" value="<?php $this -> echoUserAccount(); ?>" id="user_account" name="user_account" />
			<input type="hidden" value="confirm" id="type" name="type" />
			<input type="hidden" value="withdraw" name="action" />
		</form>
	</body>
</html>