{load_language_text section="withdrawal"} {if $content_data.success}

{$txt.withdrawal}{if $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}

{$txt.send_withdrawal_success}

{else}

{$txt.withdrawal}{if $content_data.order->info.date_purchased} ({$txt.your_order_from} {$content_data.order->info.date_purchased|date_format:$smarty.const.DATE_FORMAT_SHORT}){/if}

{$txt.webform_info}

{$txt.to}

{$smarty.const.COMPANY_NAME}
{$smarty.const.TRADER_FIRSTNAME} {$smarty.const.TRADER_NAME}
{$smarty.const.TRADER_STREET} {$smarty.const.TRADER_STREET_NUMBER}
{$smarty.const.TRADER_ZIPCODE} {$smarty.const.TRADER_LOCATION}
{$smarty.const.STORE_COUNTRY_NAME}

{if $smarty.const.TRADER_FAX != ''} {$txt.fax}: {$smarty.const.TRADER_FAX}
{/if} {if $smarty.const.STORE_OWNER_EMAIL_ADDRESS != ''} {$txt.mail}: {$smarty.const.STORE_OWNER_EMAIL_ADDRESS} {/if}

{$txt.withdrawal}


{$txt.withdrawal_textarea_hint|escape:'html'}
{if $content_data.errors.withdrawal_content}{$txt.input_error}{/if}

{$txt.order}
{$txt.get_on}
{if $content_data.errors.delivery_date || $content_data.errors.order_date}{$txt.input_error}{/if}

{$txt.first_last_name}

{$txt.male}
{$txt.female}
customer.gender =='m' || $smarty.post.withdrawal_data.customer_gender == $txt.male} checked="checked"{/if} style="visibility: hidden;" /> customer.gender =='f' || $smarty.post.withdrawal_data.customer_gender == $txt.female} checked="checked"{/if} style="visibility: hidden;" />
{if $content_data.errors.customer_gender}{$txt.input_error}{/if}
customer.firstname|escape:'html'}{$content_data.order->customer.firstname|escape:'html'}{else}{$txt.firstname}{/if}" class="value_save" /> {if $content_data.errors.customer_firstname}{$txt.input_error}{/if}
customer.lastname|escape:'html'}{$content_data.order->customer.lastname|escape:'html'}{else}{$txt.lastname}{/if}" class="value_save" /> {if $content_data.errors.customer_lastname}{$txt.input_error}{/if}

{$txt.address}

customer.street_address|escape:'html'}{$content_data.order->customer.street_address|escape:'html'}{else}{$txt.street_and_number}{/if}" class="value_save" /> {if $content_data.errors.customer_street_address}{$txt.input_error}{/if}
customer.postcode|escape:'html'}{$content_data.order->customer.postcode|escape:'html'}{else}{$txt.zipcode}{/if}" class="value_save" />
customer.city|escape:'html'}{$content_data.order->customer.city|escape:'html'}{else}{$txt.city}{/if}" class="value_save" />
{if $content_data.errors.customer_postcode or $content_data.errors.customer_city} {$txt.input_error} {/if}
customer.country|escape:'html'}{$content_data.order->customer.country|escape:'html'}{else}{$txt.country}: {$txt.country_placeholder}{/if}" class="value_save" /> {if $content_data.errors.customer_country}{$txt.input_error}{/if}

{$txt.ask_for_email}

customer.email_address|escape:'html'}{$content_data.order->customer.email_address|escape:'html'}{else}{$txt.your_email}*{/if}" class="value_save" /> {if $content_data.errors.customer_email}{$txt.input_error}{/if}

{$txt.withdrawal_date}

{if $content_data.errors.withdrawal_date}{$txt.input_error}{/if}
{if $content_data.show_privacy}

{$txt.title_privacy}

{if $content_data.show_privacy_checkbox} {else} {$content_data.privacy_link} {/if} {if $content_data.errors.privacy_accepted} {$txt.privacy_error} {/if}
{/if} {$txt.sendwithdrawalbutton}
{$txt.mandatory_fields}
{/if}