<?php
$index = $_GET['index'];
$error_messages = __('front_sys', true);
?>
<div class="container-fluid pjTsContainer">
	<?php include PJ_VIEWS_PATH . 'pjLoad/elements/header.php'; ?>
	<div class="panel panel-default pjTsBody">
		<header class="panel-heading text-center">
			<p class="panel-title"><?php __('front_menu_create_account'); ?></p><!-- /.panel-title -->
		</header><!-- /.panel-heading text-center -->

		<div class="panel-body">
			<form id="pjTsRegisterForm_<?php echo $index;?>" action="<?php echo PJ_INSTALL_URL; ?>index.php?controller=pjLoad&amp;action=pjActionRegister<?php echo isset($_GET['iframe']) ? '&amp;iframe' : NULL; ?>" method="post" class="form-horizontal pjTsForm pjTsFormProfile" data-toggle="validator" role="form">
				<input type="hidden" name="register" value="1" />
				
				<div class="row">
					<div class="pjTsRegisterFormInner">
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_contact_name'); ?></label>
						
							<div class="col-sm-6">
								<input type="text" name="name" class="form-control required" data-msg-required="<?php echo $error_messages['contact_name'];?>"/>
								<div class="help-block with-errors"><ul class="list-unstyled"></ul></div>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_contact_email'); ?></label>
						
							<div class="col-sm-6">
								<input type="email" name="email" class="form-control required email" data-msg-required="<?php echo $error_messages['contact_email'];?>" data-msg-email="<?php echo $error_messages['contact_email_inv'];?>" data-msg-remote="<?php echo $error_messages['duplicated_email'];?>"/>
						
								<div class="help-block with-errors"><ul class="list-unstyled"></ul></div>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_password'); ?></label>
						
							<div class="col-sm-6">
								<input type="password" name="password" class="form-control required" data-msg-required="<?php echo $error_messages['log_pass'];?>"/>
								<div class="help-block with-errors"><ul class="list-unstyled"></ul></div>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_website'); ?></label>
						
							<div class="col-sm-6">
								<input type="text" name="website" class="form-control" />
								<div class="help-block with-errors"><ul class="list-unstyled"></ul></div>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_country'); ?></label>
						
							<div class="col-sm-8">
								<select name="country_id" class="form-control">
									<option value="">-- <?php __('lblChoose'); ?>--</option>
									<?php
									foreach ($tpl['country_arr'] as $k => $v)
									{
										?><option value="<?php echo $v['id']; ?>"><?php echo $v['name']; ?></option><?php
									}
									?>
								</select>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_state'); ?></label>
						
							<div class="col-sm-6">
								<input type="text" name="state" class="form-control" />
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_city'); ?></label>
						
							<div class="col-sm-6">
								<input type="text" name="city" class="form-control" />
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_address'); ?></label>
						
							<div class="col-sm-8">
								<input type="text" name="address" class="form-control" />
							</div><!-- /.col-sm-8 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_phone'); ?></label>
						
							<div class="col-sm-4">
								<input type="text" name="phone" class="form-control" />
							</div><!-- /.col-sm-4 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_cell_phone'); ?></label>
						
							<div class="col-sm-4">
								<input type="text" name="cell_phone" class="form-control" />
							</div><!-- /.col-sm-4 -->
						</div><!-- /.form-group -->
						
						<div class="form-group">
							<label for="" class="col-sm-3 control-label"><?php __('front_label_fax'); ?></label>
						
							<div class="col-sm-4">
								<input type="text" name="fax" class="form-control" />
							</div><!-- /.col-sm-4 -->
						</div><!-- /.form-group -->
						<div class="form-group pjTsCaptcha">
							<label for="" class="col-sm-3 control-label"><?php __('front_verification');?></label>
						
							<div class="col-sm-4">
								<input type="text" name="verification" maxlength="6" autocomplete="off" class="form-control required" data-msg-required="<?php echo $error_messages['add_verification'];?>" data-msg-remote="<?php echo $error_messages['add_verification_inv'];?>"/>
								<img id="pjTsCaptchaImage_<?php echo $index;?>" src="<?php echo PJ_INSTALL_URL; ?>index.php?controller=pjFront&amp;action=pjActionCaptcha&amp;rand=<?php echo rand(1, 999999); ?><?php echo isset($_GET['session_id']) ? '&session_id=' . $_GET['session_id'] : NULL;?>" alt="" />
								<div class="help-block with-errors"><ul class="list-unstyled"></ul></div>
							</div><!-- /.col-sm-6 -->
						</div><!-- /.form-group pjTsCaptcha -->
						<div class="form-group">
							<div class="col-sm-9 col-sm-offset-3">
								<button type="submit" class="btn btn-default pjTsBtn pjTsBtnPrimary"><?php __('front_btn_save'); ?></button>
								<a href="#" class="btn btn-link pjTsBtn pjTsBtnLink pjTsMenuItem" data-hash="Login"><?php __('btnLogin'); ?></a>
							</div><!-- /.col-sm-9 col-sm-offset-3 -->
						</div><!-- /.form-group -->
					</div>
					<div class="form-group" style="display: none;">
						<div class="col-sm-12 text-center">
							<p id="pjTsMessage_<?php echo $index;?>"></p>
						</div><!-- /.col-sm-6 col-sm-offset-3 -->
						<div id="pjTsLoginLink_<?php echo $index;?>" class="col-sm-12 text-center" style="display: none;">
							<a href="#" class="btn btn-link pjTsBtn pjTsBtnLink pjTsMenuItem" data-hash="Login"><b><?php __('btnLogin'); ?></b></a>
						</div>
					</div><!-- /.form-group -->
				</div><!-- /.row -->
			</form><!-- /.form-horizontal pjTsForm pjTsFormProfile -->
		</div><!-- /.panel-body -->
	</div><!-- /.panel panel-default pjTsBody -->
</div><!-- /.container-fluid pjTsContainer -->					