{embed="common/pagetop" page_title="{page_title}"}

{embed="common/header" body_class="checkout" body_id="{body_id}"}

	{exp:store:checkout next="/" return="/" payment_method="manual" require="name|address1|address3|postcode" error_handling="inline" error_delimiters='<span class="errors">|</span>'}
		<h3>Checkout</h3>
		<hr />
		<h4>Totals: {order_qty} items - {order_total}</h4>
		<table id="shipping_info">
			<tr>
    			<td class="label"><label for="">* Your Name</label></td>
    			<td><input type="text" name="shipping_name" value="{shipping_name}" /></td>
    			<td>{error:shipping_name}</td>
    		</tr>
    		<tr>
		    	<td class="label"><label for="">* Email Address</label></td>
		    	<td><input type="text" name="order_email" value="{order_email}" /></td>
		    	<td>{error:order_email}</td>
    		</tr>
    		<tr>
		    	<td class="label"><label for="">* Phone</label></td>
		    	<td><input type="text" name="shipping_phone" value="{shipping_phone}" /></td>
		    	<td>{error:shipping_phone}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">Alt Phone</label></td><td><input type="text" name="order_custom2" value="{order_custom2}" /></td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">* Fulfillment</label></td>
		    	<td>
		    		<input type="radio" class="radio" name="order_custom1" value="Delivery - {lv_10_deliver_before}"> Delivery - {lv_10_deliver_before}<br>
				<input type="radio" class="radio" ame="order_custom1" value="Delivery - {lv_10_deliver_day_of}"> Delivery - {lv_10_deliver_day_of}<br />
				<input type="radio" class="radio" name="order_custom1" value="Pick Up - {lv_10_pickup_before}" checked>Pick Up - {lv_10_pickup_before}<br>
				<input type="radio" class="radio" name="order_custom1" value="Pick Up - {lv_10_pickup_day_of_beacon}"> Pick Up - {lv_10_pickup_day_of_beacon}<br>
				<input type="radio" class="radio" name="order_custom1" value="Pick Up - {lv_10_pickup_day_of}"> Pick Up - {lv_10_pickup_day_of}<br>
				<input type="radio" class="radio" name="order_custom1" value="Pick Up - {lv_10_pickup_before_beacon}"> Pick Up - {lv_10_pickup_before_beacon}<br>
				<input type="radio" class="radio" name="order_custom1" value="Delivery - {lv_10_deliver_Val_day}"> Delivery - {lv_10_delivery_Val_day}<br>

		    	</td>

		    </tr>
		    <tr><td></td><td><hr /></td></tr>
    		<tr>
		    	<td class="label"><label for="">Additional Info</label></td>
		    	<td>{lv_additional_info}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">Company</label></td><td><input type="text" name="order_custom3" value="{order_custom3}" /></td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">* Address</label></td>
		    	<td><input type="text" name="shipping_address1" value="{shipping_address1}" /></td>
		    	<td>{error:shipping_address1}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">Address 2</label></td><td><input type="text" name="shipping_address2" value="{shipping_address2}" /></td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">* City</label></td>
		    	<td><input type="text" name="shipping_address3" value="{shipping_address3}" /></td>
		    	<td>{if error:shipping_address3}<span class="errors">The Shipping City field is required.</span>{/if}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">* State</label></td>
		    	<td><input type="text" name="shipping_region" value="{shipping_region}" /></td>
		    	<td>{error:shipping_region}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">* Zipcode</label></td>
		    	<td><input type="text" name="shipping_postcode" value="{shipping_postcode}" /></td>
		    	<td>{error:shipping_postcode}</td>
		    </tr>
    		<tr>
		    	<td class="label"><label for="">Additional Instructions</label></td><td><textarea type="text" name="order_custom4" value="{order_custom4}"></textarea></td>
		    </tr>
    	</table>
    	<input type="hidden" name="payment_method" value="manual">
    	<input type="hidden" name="shipping_method" value="included">
    	<input type="hidden" name="billing_same_as_shipping" value="1"/>

    	<p id="place_order"><input type="submit" name="submit" value="Place Order"/></p>
	{/exp:store:checkout}

{embed="common/footer"}