<patTemplate:tmpl name="pageoutput" unusedvars="strip">
<script language="JavaScript" type="text/javascript">
<!--
jomresJquery(function(){
	jomresJquery("#guest_country").change(function(){
		var selectedValue = jomresJquery(this).find(":selected").val();
		clause = "&task=get_region_dropdown_for_country_code&country="+selectedValue;
		jomresJquery.get(live_site_ajax + clause, function (data) {
			populateDiv("guest_region_div",data);
			});
		});
	});
//-->
</script>

<h2 class="page-header">{PAGETITLE}</h2>

<form action="{JOMRES_SITEPAGE_URL_NOSEF}" method="post" name="adminForm" class="form-horizontal" role="form">
	<div class="form-group">
		<label class="col-md-2 control-label" for="firstname">{HFIRSTNAME}</label>
		<div class="col-md-10">
			<input id="firstname" name="firstname" type="text" value="{FIRSTNAME}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_FIRSTNAME}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="surname">{HSURNAME}</label>
		<div class="col-md-10">
			<input id="surname" name="surname" type="text" value="{SURNAME}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_SURNAME}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="house">{HHOUSE}</label>
		<div class="col-md-10">
			<input id="house" name="house" type="text" value="{HOUSE}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_HOUSENUMBER}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="street">{HSTREET}</label>
		<div class="col-md-10">
			<input id="street" name="street" type="text" value="{STREET}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_STREET}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="town">{HTOWN}</label>
		<div class="col-md-10">
			<input id="town" name="town" type="text" value="{TOWN}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_TOWN}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="postcode">{HPOSTCODE}</label>
		<div class="col-md-10">
			<input id="postcode" name="postcode" type="text" value="{POSTCODE}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_POSTCODE}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="region">{HREGION}</label>
		<div class="col-md-10">
			<div id="guest_region_div">{REGION}</div>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="guest_country">{HCOUNTRY}</label>
		<div class="col-md-10">
			{COUNTRY}
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="landline">{HLANDLINE}</label>
		<div class="col-md-10">
			<input id="landline" name="landline" type="tel" value="{LANDLINE}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_LANDLINE}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="mobile">{HMOBILE}</label>
		<div class="col-md-10">
			<input id="mobile" name="mobile" type="tel" value="{MOBILE}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_MOBILE}"/>
		</div>
	</div>
	<div class="form-group">
		<label class="col-md-2 control-label" for="email">{HEMAIL}</label>
		<div class="col-md-10">
			<input id="email" name="email" type="text" value="{EMAIL}" class="required form-control" placeholder="{COMMON_PLACEHOLDER_EMAIL}"/>
		</div>
	</div>
	
	<div class="form-group">
		<label class="col-md-2 control-label" for="vat_number">{_JOMRES_COM_YOURBUSINESS_VATNO}</label>
		<div class="col-md-10">
			<input id="vat_number" name="vat_number" type="text" value="{VAT_NUMBER}" class="form-control" placeholder="{_JOMRES_COM_YOURBUSINESS_VATNO}"/>
			<patTemplate:tmpl name="validation" type="simpleCondition" requiredVars="validation_class">
			<span class="help-block">
				<div class="alert {VALIDATION_CLASS}">
					{VAT_NUMBER_VALIDATION_STATUS}
				</div>
			</span>
			</patTemplate:tmpl>
		</div>
	</div>
	
	<div class="form-group">
		<label class="col-md-2 control-label" for="discount">{HDISCOUNT}</label>
		<div class="col-md-10">
			{DISCOUNT}
			<span class="help-block">(%)</span>
		</div>
	</div>
    
    
	<div class="form-group">
		<label class="col-md-2 control-label" for="blacklisted">{_JOMRES_GUEST_BLACKLISTED}</label>
		<div class="col-md-10">
			{BLACKLISTED}
            <span class="help-block">{_JOMRES_GUEST_BLACKLISTED_DESC}</span>
		</div>
	</div>
    
	<div class="form-actions">
		<div class="col-md-10 col-md-offset-2">
			{JOMRESTOOLBAR}
		</div>
	</div>
	<input type="hidden" name="id" value="{GUESTUID}"/>
	<input type="hidden" name="task" value="save_guest"/>
	<input type="hidden" name="no_html" value="1"/>
	{CSRF_TOKEN}
</form>
</patTemplate:tmpl>