<?php
/**
 * Magento
 *
 * NOTICE OF LICENSE
 *
 * This source file is subject to the Academic Free License (AFL 3.0)
 * that is bundled with this package in the file LICENSE_AFL.txt.
 * It is also available through the world-wide-web at this URL:
 * http://opensource.org/licenses/afl-3.0.php
 * If you did not receive a copy of the license and are unable to
 * obtain it through the world-wide-web, please send an email
 * to license@magentocommerce.com so we can send you a copy immediately.
 *
 * DISCLAIMER
 *
 * Do not edit or add to this file if you wish to upgrade Magento to newer
 * versions in the future. If you wish to customize Magento for your
 * needs please refer to http://www.magentocommerce.com for more information.
 *
 * @category    design
 * @package     default_iphone
 * @copyright   Copyright (c) 2010 Magento Inc. (http://www.magentocommerce.com)
 * @license     http://opensource.org/licenses/afl-3.0.php  Academic Free License (AFL 3.0)
 */
?>
<script type="text/javascript">countryRegions = <?php echo $this->helper('directory')->getRegionJson() ?></script>

<div class="page-head">
    <h3><?php if($data->getAddressId()): ?><?php echo $this->__('Edit Address Entry') ?><?php else: ?><?php echo $this->__('New Address Entry') ?><?php endif ?></h3>
<?php echo $this->getMessagesBlock()->getGroupedHtml() ?>
<form action="<?php echo $action ?>" method="post" id="form-validate">
    <fieldset class="group-select">
<input type="hidden" name="address_id" value="<?php echo $data->getAddressId() ?>" />
<input type="hidden" name="customer_id" id="address_id" value="<?php echo $data->getCustomerId() ?>" />
        <h3 class="legend"><?php echo $this->__('Personal Information') ?></h3>
        <ul>
            <li>
                <div class="input-box">
                    <label for="firstname"><?php echo $this->__('First Name') ?> <span class="required">*</span></label><br />
                    <input type="text" name="firstname" id="firstname" title="<?php echo $this->__('First Name') ?>" value="<?php echo $this->htmlEscape($data->getFirstname()) ?>" class="required-entry input-text" />
                </div>
                <div class="input-box">
                    <label for="lastname"><?php echo $this->__('Last Name') ?> <span class="required">*</span></label><br />
                    <input type="text" name="lastname" id="lastname" title="<?php echo $this->__('Last Name') ?>" value="<?php echo $this->htmlEscape($data->getLastname()) ?>" class="required-entry input-text" />
                </div>
            </li>
            <li>
                <div class="input-box">
                    <label for="company"><?php echo $this->__('Company') ?></label><br />
                    <input type="text" name="company" id="company" title="<?php echo $this->__('Company') ?>" value="<?php echo $this->htmlEscape($data->getCompany()) ?>" class="input-text" />
                </div>
            </li>
        </ul>
    </fieldset>
    <fieldset class="group-select">
        <h3 class="legend"><?php echo $this->__('Address') ?></h3>
        <ul>
            <li>
                <label for="street_1"><?php echo $this->__('Street Address') ?> <span class="required">*</span></label><br />
                <input type="text" name="street[1]" value="<?php echo $this->htmlEscape($data->getStreet(1)) ?>" title="<?php echo $this->__('Street Address') ?>" id="street_1" class="required-entry input-text" />
            </li>
            <li>
                <input type="text" name="street[2]" value="<?php echo $this->htmlEscape($data->getStreet(2)) ?>" title="<?php echo $this->__('Street Address 2') ?>" id="street_2" class="input-text" />
            </li>
            <li>
                <div class="input-box">
                    <label for="city"><?php echo $this->__('City') ?> <span class="required">*</span></label><br />
                    <input type="text" name="city" value="<?php echo $this->htmlEscape($data->getCity()) ?>" title="<?php echo $this->__('City') ?>" class="required-entry input-text" id="city" />
                </div>
                <div class="input-box">
                    <label for="region_id"><?php echo $this->__('State/Province') ?> <span class="required">*</span></label><br />
                    <select id="region_id" name="region_id" title="<?php echo $this->__('State/Province') ?>" class="validate-select" style="display:none">
                        <option value=""><?php echo $this->__('Please select region, state or province') ?></option>
                    </select>
                    <script type="text/javascript">
                        $('region_id').setAttribute('defaultValue',  "<?php echo $this->getAddress()->getRegionId() ?>");
                    </script>
                    <input type="text" id="region" name="region" value="<?php echo $this->htmlEscape($this->getAddress()->getRegion()) ?>"  title="<?php echo $this->__('State/Province') ?>" class="required-entry  input-text" style="display:none" />
                </div>
            </li>
            <li>
                <div class="input-box">
                    <label for="zip"><?php echo $this->__('Zip/Postal Code') ?> <span class="required">*</span></label><br />
                    <input type="text" name="postcode" value="<?php echo $this->htmlEscape($data->getPostcode()) ?>" title="<?php echo $this->__('Zip/Postal Code') ?>" id="zip" class="validate-zip-international required-entry input-text" />
                </div>
                <div class="input-box">
                    <label for="country"><?php echo $this->__('Country') ?> <span class="required">*</span></label><br />
                    <select name="country_id" id="country" title="<?php echo $this->__('Country') ?>" class="validate-select">
                        <?php echo $countries->toHtmlOptions($data->getCountryId()) ?>
                    </select>
                </div>
            </li>
            <li>
                <div class="input-box">
                    <label for="telephone"><?php echo $this->__('Telephone') ?> <span class="required">*</span></label><br />
                    <input type="text" name="telephone" value="<?php echo $this->htmlEscape($data->getTelephone()) ?>" title="<?php echo $this->__('Telephone') ?>" class="input-text" id="telephone" /></div>
                <div class="input-box">
                    <label for="fax"><?php echo $this->__('Fax') ?></label><br />
                    <input type="text" name="fax" value="<?php echo $this->htmlEscape($data->getFax()) ?>" title="<?php echo $this->__('Fax') ?>" class="input-text" id="fax" />
                </div>
            </li>
            <?php foreach ($primaryTypes as $code=>$type): ?>
                <li>
                <?php if ($address->isPrimary($type['address_type_id'])): ?>
                    <?php echo $this->__("This is My Default %s Address", ucfirst($type['name'])) ?>
                <?php else: ?>
                    <input type="checkbox" id="primary_<?php echo $code ?>" name="primary_types[]" value="<?php echo $type['address_type_id'] ?>" />&nbsp;
                    <label for="primary_<?php echo $code ?>"><?php echo $this->__("Use as My Default %s Address", ucfirst($type['name'])) ?></label>
                <?php endif ?>
                </li>
            <?php endforeach ?>
        </ul>
    </fieldset>
    <div class="button-set">
        <p class="required"><?php echo $this->__('* Required Fields') ?></p>
        <a href="<?php echo $this->getUrl('customer/address/') ?>" class="left">&laquo; <?php echo $this->__('Back') ?></a>
        <button class="form-button" type="submit"><span><?php echo $this->__('Save Address') ?></span></button>
    </div>
</form>
<script type="text/javascript">
    var dataForm = new VarienForm('form-validate', true);
    //dataForm.setElementsRelation('country', 'state', '<?php echo $this->getUrl('directory/json/childRegion') ?>');

    new RegionUpdater('country', 'region', 'region_id', countryRegions, undefined, 'zip');
</script>