{% if error_warning %}
  <div class="alert alert-warning alert-dismissible">{{ error_warning }}</div>
{% endif %}
<p><img src="https://cdn.klarna.com/public/images/{{ iso_code_2 }}/badges/v1/account/{{ iso_code_2 }}_account_badge_std_blue.png?width=150&eid={{ merchant }}"/></p>
<form id="payment" class="form-horizontal">
  <fieldset>
    <legend>{{ text_payment_option }}</legend>
    {% for payment_option in payment_options %}
      <div class="radio">
        <label> {% if not code %}
          {% set code = payment_option.code %}
          <input type="radio" name="code" value="{{ payment_option.code }}" checked="checked"/>
          {% else %}
          <input type="radio" name="code" value="{{ payment_option.code }}"/>
          {% endif %}
          {% if iso_code_3 == 'NLD' %} <img src="catalog/view/theme/default/image/klarna_nld_banner.png"/> {% endif %}
          {{ payment_option.title }}
        </label>
      </div>
    {% endfor %}
  </fieldset>
  <br/>
  <fieldset>
    <legend>{{ text_additional }}</legend>
    {% if not company %}
      {% if iso_code_3 == 'DEU' or iso_code_3 == 'NLD' %}
      <div class="form-group required">
        <label class="col-sm-2 control-label" for="input-dob">{{ entry_dob }}</label>
        <div class="col-sm-3">
          <select name="pno_day" id="input-dob" class="form-control">
            <option value="">{{ text_day }}</option>
            {% for day in days %}
              <option value="{{ day.value }}">{{ day.text }}</option>
            {% endfor %}
          </select>
        </div>
        <div class="col-sm-3">
          <select name="pno_month" class="form-control">
            <option value="">{{ text_month }}</option>
            {% for month in months %}
              <option value="{{ month.value }}">{{ month.text }}</option>
            {% endfor %}
          </select>
        </div>
        <div class="col-sm-3">
          <select name="pno_year" class="form-control">
            <option value="">{{ text_year }}</option>
            {% for year in years %}
              <option value="{{ year.value }}">{{ year.text }}</option>
            {% endfor %}
          </select>
        </div>
      </div>
      {% else %}
        <div class="form-group required">
          <label class="col-sm-2 control-label" for="input-pno">{{ entry_pno }}</label>
          <div class="col-sm-10">
            <input type="text" name="pno" value="" id="input-pno" class="form-control"/>
          </div>
        </div>
      {% endif %}
    {% else %}
      <div class="form-group required">
        <label class="col-sm-2 control-label" for="input-company">{{ entry_company }}</label>
        <div class="col-sm-10">
          <input type="text" name="pno" value="" id="input-company" class="form-control"/>
        </div>
      </div>
    {% endif %}
    {% if iso_code_3 == 'DEU' or iso_code_3 == 'NLD' %}
      <div class="form-group required">
        <label class="col-sm-2 control-label">{{ entry_gender }}</label>
        <div class="col-sm-10">
          <label class="radio-inline">
            <input type="radio" name="gender" value="1"/>
            {{ text_male }}</label>
          <label class="radio-inline">
            <input type="radio" name="gender" value="0"/>
            {{ text_female }}</label>
        </div>
      </div>
      <div class="form-group required">
        <label class="col-sm-2 control-label" for="input-street">{{ entry_street }}</label>
        <div class="col-sm-10">
          <input type="text" name="street" value="{{ street }}" id="input-street" class="form-control"/>
        </div>
      </div>
      <div class="form-group required">
        <label class="col-sm-2 control-label" for="input-house-no">{{ entry_house_no }}</label>
        <div class="col-sm-10">
          <input type="text" name="house_no" value="{{ street_number }}" id="input-house-no" class="form-control"/>
        </div>
      </div>
    {% endif %}
    {% if iso_code_3 == 'NLD' %}
      <div class="form-group">
        <label class="col-sm-2 control-label" for="input-house-ext">{{ entry_house_ext }}</label>
        <div class="col-sm-10">
          <input type="text" name="house_ext" value="{{ street_extension }}" id="input-house-ext" class="form-control"/>
        </div>
      </div>
    {% endif %}
    <div class="form-group required">
      <label class="col-sm-2 control-label" for="input-phone-no">{{ entry_phone_no }}</label>
      <div class="col-sm-10">
        <input type="text" name="phone_no" value="{{ phone_number }}" id="input-phone-no" class="form-control"/>
      </div>
    </div>
    {% if iso_code_3 == 'DEU' %}
      <div class="radio">
        <input type="checkbox" name="deu_terms" value="1"/>
        {{ text_terms_description }}
      </div>
    {% endif %}
  </fieldset>
</form>
<div class="buttons">
  <div class="pull-right">
    <input type="button" value="{{ button_confirm }}" id="button-confirm" data-loading-text="{{ text_loading }}" class="btn btn-primary"/>
  </div>
</div>
<script type="text/javascript"><!--
    $('#button-confirm').on('click', function() {
        $.ajax({
            url: 'index.php?route=extension/payment/klarna_account/send',
            type: 'post',
            data: $('#payment input[type=\'text\'], #payment input[type=\'checkbox\']:checked, #payment input[type=\'radio\']:checked, #payment select'),
            dataType: 'json',
            cache: false,
            beforeSend: function() {
                $('#button-confirm').button('loading');
            },
            complete: function() {
                $('#button-confirm').button('reset');
            },
            success: function (json) {
                $('.alert-dismissible').remove();
          
                if (json['error']) {
                    $('#payment').before('<div class="alert alert-danger alert-dismissible">' + json['error'] + '</div>');
                }
          
                if (json['redirect']) {
                    location = json['redirect'];
                }
            }
        });
    });
//--></script>