{% include 'header.twig' %}

    <div class="wrapper-content__header">
          </div>
    <div class="wrapper-content__body">
      <!-- Main variables *content* -->
      <div id="block_16">
    <div class="ticket-form">
        <div class="bg"></div>
        <div class="divider-top"></div>
        <div class="divider-bottom"></div>
        <div class="container-fluid">
            <div class="row ticket-form__alignment">
                <div class="col-lg-12">
                   <div class="component_card">
                      <div class="card">
    <div class="col-md-12">
            {% if error %}
      <div class="alert alert-dismissible alert-danger">
          <button type="button" class="close" data-dismiss="alert">&times;</button>
        {{ errorText }}
      </div>
    {% endif %}  

    {% if data["childpanel"]["success"] == 1 %}
      <div class="alert alert-dismissible alert-success">
          <strong> Order Id: </strong> {{ data['childpanel']['id'] }} <br>
          <strong> Service: </strong> {{ data['childpanel']['service'] }} <br>
          <strong> Domain: </strong> {{ data['childpanel']['link'] }} <br>
          <strong> Quantity: </strong> {{ data['childpanel']['quantity'] }} <br>
          <strong> Charge: </strong> {{ data['childpanel']['price'] }} <br>
      </div>
    {% endif %}
		<div class="well ">
    <form name="contact-form" action="child-panels" method="post">
    <div class="form-group">
    <label for="Domain">Domain</label>
    <input type="text" class="form-control" name="domain" placeholder="Domain" required>
    </div>
		 <div class="alert alert-info " id="orderNote">
            <p class="help-block" style="margin-bottom: 5px">Please visit your registrar's dashboard to change nameservers to:</p><ul style="color: #737373; padding-left: 20px"><li>{{ site['ns1'] }}</li><li>{{ site['ns2'] }}</li></ul>        </div>
    
		
		<div class="form-group">
        
<label class="Domain" for="currency">Currency</label>
			
		<select class="form-control" name="currency" required>
<option value="USD">United States Dollars (USD)</option>
<option value="INR">Indian Rupee (INR)</option>
</select>
    </div>
	
    <div class="form-group">
    <label for="exampleInputEmail1">Username</label>
    <input type="text" class="form-control" name="username" placeholder="Username" required>
    </div>
		
		  <div class="form-group">
        
<label class="control-label" for="orderpanelform-password">Password</label><input type="password" class="form-control" name="password" placeholder="Password" required>
    </div>
    		  <div class="form-group">
        
<label class="control-label" for="orderpanelform-password">Confirm Password</label><input type="password" class="form-control" name="password_confirm" placeholder="Password" required>
    </div>
		

    <div class="form-group">
              <label for="charge" class="control-label">{{ lang["neworder.charge"] }}</label>
              <input type="text" class="form-control" value="{{ site['childpanel_price'] }} {% if settings['site_currency'] == "TRY" %}{{ "&#8378;" }}
                {% elseif settings['site_currency'] == "USD" %}{{ "&#36;" }}
                {% else %}{{ "₹" }}
                {% endif %}" readonly>
            </div>
    <button type="submit" class="btn btn-block btn-big-primary" name="submit" value="Submit" id="submit_form">Submit Order</button>
    
    </form>
    <div class="response_msg"></div>
    </div></div></div></div>
    <script src="http://ajax.googleapis.com/ajax/libs/jquery/1.11.2/jquery.min.js"></script>
   </div>
    <br><br></div></div></div></div>
{% include 'footer.twig' %}
