<?php echo $header; ?>
<div id="content">
  <div class="breadcrumb">
    <?php foreach ($breadcrumbs as $breadcrumb) { ?>
    <?php echo $breadcrumb['separator']; ?><a href="<?php echo $breadcrumb['href']; ?>"><?php echo $breadcrumb['text']; ?></a>
    <?php } ?>
  </div>
  <?php if ($error_warning) { ?>
  <div class="warning"><?php echo $error_warning; ?></div>
  <?php } ?>
  <div class="box">
    <div class="heading">
      <h1><img src="view/image/payment.png" alt="" /> <?php echo $heading_title; ?></h1>
      <div class="buttons"><a onclick="$('#form').submit();" class="button"><span><?php echo $button_save; ?></span></a><a onclick="location = '<?php echo $cancel; ?>';" class="button"><span><?php echo $button_cancel; ?></span></a></div>
    </div>
    <div class="content">
      <form action="<?php echo $action; ?>" method="post" enctype="multipart/form-data" id="form">
        <table class="form">
          <tr>
        <td width="25%"><?php echo $entry_status; ?></td>
        <td><select name="boleto_itau_status">
          <?php if ($boleto_itau_status) { ?>
          <option value="1" selected="selected"><?php echo $text_enabled; ?></option>
          <option value="0"><?php echo $text_disabled; ?></option>
          <?php } else { ?>
          <option value="1"><?php echo $text_enabled; ?></option>
          <option value="0" selected="selected"><?php echo $text_disabled; ?></option>
          <?php } ?>
        </select></td>
      </tr>
      <tr>
        <td><?php echo $entry_geo_zone; ?></td>
        <td><select name="boleto_itau_geo_zone_id">
          <option value="0"><?php echo $text_all_zones; ?></option>
          <?php foreach ($geo_zones as $geo_zone) { ?>
          <?php if ($geo_zone['geo_zone_id'] == $boleto_itau_geo_zone_id) { ?>
          <option value="<?php echo $geo_zone['geo_zone_id']; ?>" selected="selected"><?php echo $geo_zone['name']; ?></option>
          <?php } else { ?>
          <option value="<?php echo $geo_zone['geo_zone_id']; ?>"><?php echo $geo_zone['name']; ?></option>
          <?php } ?>
          <?php } ?>
        </select></td>
      </tr>
      <tr>
        <td><?php echo $entry_order_status; ?></td>
        <td><select name="boleto_itau_order_status_id">
          <?php foreach ($order_statuses as $order_status) { ?>
          <?php if ($order_status['order_status_id'] == $boleto_itau_order_status_id) { ?>
          <option value="<?php echo $order_status['order_status_id']; ?>" selected="selected"><?php echo $order_status['name']; ?></option>
          <?php } else { ?>
          <option value="<?php echo $order_status['order_status_id']; ?>"><?php echo $order_status['name']; ?></option>
          <?php } ?>
          <?php } ?>
        </select></td>
      </tr>
      <tr>
        <td><?php echo $entry_identificacao; ?></td>
        <td><input maxlength="50" style="width:350px" type="text" name="boleto_itau_identificacao" value="<?php echo $boleto_itau_identificacao; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_cpf_cnpj; ?></td>
        <td><input maxlength="18" style="width:120px"  name="boleto_itau_cpf_cnpj" type="text" id="boleto_itau_cpf_cnpj" value="<?php echo $boleto_itau_cpf_cnpj; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_endereco; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_endereco" type="text" id="boleto_itau_endereco" value="<?php echo $boleto_itau_endereco; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_cidade_uf; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_cidade_uf" type="text" id="boleto_itau_cidade_uf" value="<?php echo $boleto_itau_cidade_uf; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_cedente; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_cedente" type="text" id="boleto_itau_cedente" value="<?php echo $boleto_itau_cedente; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_agencia; ?></td>
        <td><input maxlength="4" style="width:40px" name="boleto_itau_agencia" type="text" id="boleto_itau_agencia" value="<?php echo $boleto_itau_agencia; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_conta; ?></td>
        <td><input maxlength="5" style="width:50px" name="boleto_itau_conta" type="text" id="boleto_itau_conta" value="<?php echo $boleto_itau_conta; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_conta_dv; ?></td>
        <td><input maxlength="1" style="width:10px" maxlength="1" style="width:10px" name="boleto_itau_conta_dv" type="text" id="boleto_itau_conta_dv" value="<?php echo $boleto_itau_conta_dv; ?>"  /></td>
      </tr>
      <tr>
        <td><?php echo $entry_carteira; ?></td>
        <td><input maxlength="3" style="width:30px" name="boleto_itau_carteira" type="text" id="boleto_itau_carteira" value="<?php echo $boleto_itau_carteira; ?>" maxlength="3" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_dia_prazo_pg; ?></td>
        <td><input maxlength="2" style="width:15px"  name="boleto_itau_dia_prazo_pg" type="text" id="boleto_itau_dia_prazo_pg" value="<?php echo $boleto_itau_dia_prazo_pg; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_taxa_boleto; ?></td>
        <td><input maxlength="5" style="width:40px" name="boleto_itau_taxa_boleto" type="text" id="boleto_itau_taxa_boleto" value="<?php echo $boleto_itau_taxa_boleto; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_demonstrativo1; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_demonstrativo1" type="text" id="boleto_itau_demonstrativo1" value="<?php echo $boleto_itau_demonstrativo1; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_demonstrativo2; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_demonstrativo2" type="text" id="boleto_itau_demonstrativo2" value="<?php echo $boleto_itau_demonstrativo2; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_demonstrativo3; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_demonstrativo3" type="text" id="boleto_itau_demonstrativo3" value="<?php echo $boleto_itau_demonstrativo3; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_instrucoes1; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_instrucoes1" type="text" id="boleto_itau_instrucoes1" value="<?php echo $boleto_itau_instrucoes1; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_instrucoes2; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_instrucoes2" type="text" id="boleto_itau_instrucoes2" value="<?php echo $boleto_itau_instrucoes2; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_instrucoes3; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_instrucoes3" type="text" id="boleto_itau_instrucoes3" value="<?php echo $boleto_itau_instrucoes3; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_instrucoes4; ?></td>
        <td><input maxlength="50" style="width:350px" name="boleto_itau_instrucoes4" type="text" id="boleto_itau_instrucoes4" value="<?php echo $boleto_itau_instrucoes4; ?>" /></td>
      </tr>
      <tr>
        <td><?php echo $entry_sort_order; ?></td>
        <td><input maxlength="2" style="width:15px" type="text" name="boleto_itau_sort_order" value="<?php echo $boleto_itau_sort_order; ?>" size="1" /></td>
      </tr>
	  
      <tr>
        <td><?php echo $entry_prefixo; ?></td>
        <td><input maxlength="1" style="width:15px" type="text" name="boleto_itau_prefixo" value="<?php echo $boleto_itau_prefixo; ?>" size="1" /></td>
      </tr>	  
	  
      <tr>
        <td><?php echo $text_suporte; ?></td>
        <td><?php echo $help_suporte; ?></td>
      </tr>
    </table>
 
</form>
</div>
</div>
<script type="text/javascript"><!--
$.tabs('.tabs a'); 
//--></script>
<?php echo $footer; ?>
