{assign var="user" value=$engine->components["users"]->db->get_user($engine->user_id)}	
{if !$posted}
<div class="row-fluid">
        <div class="span12">
            <div class="head">
                <div class="isw-brush"></div>
                <h1>Takarítás kérése</h1>
                <div class="clear"></div>
            </div>
            <div class="block-fluid">                        
                <form id="validation" method="post" action="" enctype="multipart/form-data">

                <div class="row-form">
                    <div class="span3">Bejelentő neve*:</div>
                    <div class="span4"><input class="myself validate[required]" type="text" name="name" value="" rel="{$user.first_name} {$user.last_name}" /></div>
                    <div class="span3"><button class="btn btn-mini btn-warning" type="button" id="myself">Saját magam</button></div>
                    <div class="clear"></div>
                </div>
                <div class="row-form">
                    <div class="span3">Cégnév:</div>
                    <div class="span4"><input class="myself" type="text" name="company_name" value="" rel="{$user.company_name}" /></div>
                    <div class="clear"></div>
                </div>
 
                <div class="row-form">
                    <div class="span3">Bejelentő telefonszáma:</div>
                    <div class="span4">
                    	<input type="text" class="myself" name="phone" id="mask_phone" value="{if !$values.phone}+36-00-000-00-00{/if}" rel="{$user.phone}" />
                    	<span>Például: +36-01-123-45-67</span>
                    </div>
                    <div class="clear"></div>
                </div> 
 
                <div class="row-form">
                    <div class="span3">Bejelentő e-mail címe: </div>
                    <div class="span4"><input class="myself" type="text" name="email" value="" rel="{$user.email}" /></div>
                    <div class="clear"></div>
                </div> 


                <div class="row-form">
                    <div class="span3">Takarítás megnevezése*: </div>
                     <div class="span9">
                     	<input type="text" class="validate[required]" name="bug_name" value=""/>
                     </div>
                   <div class="clear"></div>
                </div> 

                <div class="row-form">
                    <div class="span3">Takarítás leírása: </div>
                    <div class="span9"><textarea type="text" name="bug_text" value=""/>Nincs</textarea></div>
                    <div class="clear"></div>
                </div> 

                <div class="row-form">
                    <div class="span3">Takarítás helye*: </div>
                     <div class="span4"><input class="validate[required]" type="text" name="bug_place" value=""/></div>
                   <div class="clear"></div>
                </div>

                <div class="row-form">
                    <div class="span3">Megjegyzés: </div>
                    <div class="span9"><textarea type="text" name="comment" value=""/>Nincs</textarea></div>
                    <div class="clear"></div>
                </div> 

				{simple_fileupload_new}
 
                <div class="row-form center">               
               		<div class="clear"></div>
               		<input type="submit" class="btn-large btn"  value="Küldés">
               	</div>
               	
               	</form>
               	
            </div>
       </div>
</div>
{else}
<div class="alert alert-success">                
	<h4>Sikeres rögzités!</h4>
     A takarítás kérelme rögzitésre került!
     <span id="forward" rel="/"></span>
</div>
{/if}