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{{ header }}{{ column_left }}
<div id="content">
  <div class="page-header">
    <div class="container-fluid">
      <div class="pull-right">
        <button type="submit" form="form-payment" data-toggle="tooltip" title="{{ button_save }}" class="btn btn-primary"><i class="fa fa-save"></i></button>
        <a href="{{ cancel }}" data-toggle="tooltip" title="{{ button_cancel }}" class="btn btn-default"><i class="fa fa-reply"></i></a></div>
      <h1>{{ heading_title }}</h1>
      <ul class="breadcrumb">
        {% for breadcrumb in breadcrumbs %}
        <li><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
        {% endfor %}
      </ul>
    </div>
  </div>
  <div class="container-fluid"> {% if error_warning %}
    <div class="alert alert-danger alert-dismissible"><i class="fa fa-exclamation-circle"></i> {{ error_warning }}
      <button type="button" class="close" data-dismiss="alert">×</button>
    </div>
    {% endif %}
    <div class="panel panel-default">
      <div class="panel-heading">
        <h3 class="panel-title"><i class="fa fa-pencil"></i> {{ text_edit }}</h3>
      </div>
      <div class="panel-body">
        <form action="{{ action }}" method="post" enctype="multipart/form-data" id="form-payment" class="form-horizontal">
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-email">{{ entry_email }}</label>
            <div class="col-sm-10">
              <input type="text" name="payment_nochex_email" value="{{ payment_nochex_email }}" placeholder="{{ entry_email }}" id="input-email" class="form-control" />
              {% if error_email %}
              <div class="text-danger">{{ error_email }}</div>
              {% endif %} </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-account">{{ entry_account }}</label>
            <div class="col-sm-10">
              <select name="payment_nochex_account" id="input-account" class="form-control">
                
                {% if payment_nochex_account == 'seller' %}
                
                <option value="seller" selected="selected">{{ text_seller }}</option>
                
                {% else %}
                
                <option value="seller">{{ text_seller }}</option>
                
                {% endif %}
                {% if payment_nochex_account == 'merchant' %}
                
                <option value="merchant" selected="selected">{{ text_merchant }}</option>
                
                {% else %}
                
                <option value="merchant">{{ text_merchant }}</option>
                
                {% endif %}
              
              </select>
            </div>
          </div>
          <div class="form-group required">
            <label class="col-sm-2 control-label" for="input-merchant">{{ entry_merchant }}</label>
            <div class="col-sm-10">
              <input type="text" name="payment_nochex_merchant" value="{{ payment_nochex_merchant }}" placeholder="{{ entry_merchant }}" id="input-merchant" class="form-control" />
              {% if error_merchant %}
              <div class="text-danger">{{ error_merchant }}</div>
              {% endif %} </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label">{{ entry_template }}</label>
            <div class="col-sm-10">
              <label class="radio-inline"> {% if payment_nochex_template %}
                <input type="radio" name="payment_nochex_template" value="1" checked="checked" />
                {{ text_yes }}
                {% else %}
                <input type="radio" name="payment_nochex_template" value="1" />
                {{ text_yes }}
                {% endif %} </label>
              <label class="radio-inline"> {% if not payment_nochex_template %}
                <input type="radio" name="payment_nochex_template" value="0" checked="checked" />
                {{ text_no }}
                {% else %}
                <input type="radio" name="payment_nochex_template" value="0" />
                {{ text_no }}
                {% endif %} </label>
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label">{{ entry_test }}</label>
            <div class="col-sm-10">
              <label class="radio-inline"> {% if payment_nochex_test %}
                <input type="radio" name="payment_nochex_test" value="1" checked="checked" />
                {{ text_yes }}
                {% else %}
                <input type="radio" name="payment_nochex_test" value="1" />
                {{ text_yes }}
                {% endif %} </label>
              <label class="radio-inline"> {% if not payment_nochex_test %}
                <input type="radio" name="payment_nochex_test" value="0" checked="checked" />
                {{ text_no }}
                {% else %}
                <input type="radio" name="payment_nochex_test" value="0" />
                {{ text_no }}
                {% endif %} </label>
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-total"><span data-toggle="tooltip" title="{{ help_total }}">{{ entry_total }}</span></label>
            <div class="col-sm-10">
              <input type="text" name="payment_nochex_total" value="{{ payment_nochex_total }}" placeholder="{{ entry_total }}" id="input-total" class="form-control" />
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-order-status">{{ entry_order_status }}</label>
            <div class="col-sm-10">
              <select name="payment_nochex_order_status_id" id="input-order-status" class="form-control">
                
                {% for order_status in order_statuses %}
                {% if order_status.order_status_id == payment_nochex_order_status_id %}
                
                <option value="{{ order_status.order_status_id }}" selected="selected">{{ order_status.name }}</option>
                
                {% else %}
                
                <option value="{{ order_status.order_status_id }}">{{ order_status.name }}</option>
                
                {% endif %}
                {% endfor %}
              
              </select>
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-geo-zone">{{ entry_geo_zone }}</label>
            <div class="col-sm-10">
              <select name="payment_nochex_geo_zone_id" id="input-geo-zone" class="form-control">
                <option value="0">{{ text_all_zones }}</option>
                
                {% for geo_zone in geo_zones %}
                {% if geo_zone.geo_zone_id == payment_nochex_geo_zone_id %}
                
                <option value="{{ geo_zone.geo_zone_id }}" selected="selected">{{ geo_zone.name }}</option>
                
                {% else %}
                
                <option value="{{ geo_zone.geo_zone_id }}">{{ geo_zone.name }}</option>
                
                {% endif %}
                {% endfor %}
              
              </select>
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-status">{{ entry_status }}</label>
            <div class="col-sm-10">
              <select name="payment_nochex_status" id="input-status" class="form-control">
                
                {% if payment_nochex_status %}
                
                <option value="1" selected="selected">{{ text_enabled }}</option>
                <option value="0">{{ text_disabled }}</option>
                
                {% else %}
                
                <option value="1">{{ text_enabled }}</option>
                <option value="0" selected="selected">{{ text_disabled }}</option>
                
                {% endif %}
              
              </select>
            </div>
          </div>
          <div class="form-group">
            <label class="col-sm-2 control-label" for="input-sort-order">{{ entry_sort_order }}</label>
            <div class="col-sm-10">
              <input type="text" name="payment_nochex_sort_order" value="{{ payment_nochex_sort_order }}" placeholder="{{ entry_sort_order }}" id="input-sort-order" class="form-control" />
            </div>
          </div>
        </form>
      </div>
    </div>
  </div>
</div>
{{ footer }}