<?php
$page_title = "Card Load";
include_once('template/base_head.php');
?>
			<!-- サイドバー -->
			<aside id="colLeft">
				<h1><a href="/id/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">Details of this Card Load</p>
						<form id="acForm" action="" method="post">
							<table class="table col bdr default odd withdrawT fontM mb30">
								<tr>
									<th>Target Card</th>
									<td>**** **** **** 1234</td>
								</tr>
								<tr>
									<th>Withdrawal amount</th>
									<td>JPY 9,999</td>
								</tr>
								<tr>
									<th>Exchange rate</th>
									<td>JPY 123.45</td>
								</tr>
								<tr>
									<th>Handling Charge</th>
									<td>USD 1.23</td>
								</tr>
								<tr>
									<th>Card load amount</th>
									<td>USD 999.99</td>
								</tr>
							</table>

							<input type="hidden" value="" id="type" name="type" />
						</form>
						<p class="withdrawT calign">
							<a href="#" id="btnCardInput" class="btn bg-default">&laquo; Back</a>&emsp;
							<input type="button" id="btnCardComplete" name="btnCardComplete" value="Submit" 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>
