<div id="main_borders">
 <div id="main_inner_borders">
 <h2><strong><?=$title?></strong></h2>
<div style="height:15px;"></div>
        <? if ($this-> session-> flashdata('message')): ?>
    <div class='warning'>
      <?=$this-> session-> flashdata('message');?>
    </div>
    <? endif; ?>
   <div class="subcolumns">
   <div class="c25l">
    <center>
            <img class="left" src="<?=base_url()?>images/bottle_mediterra.png" style="max-width:120px; max-height:200px;" />
    </center>
    </div>
   <div class="c75l">
       <div class="subcolumns">
   <div class="c50l">
  <h3 style="text-transform:uppercase;">Mediterra 3 φιαλες Chardonnay λευκο &amp; 3 φιαλες Merlot ερυθρο</h3>
  </div>
   <div class="c50r">
   <div align="right">
   <strong><?=$this->lang->line('price_txt')?></strong>23,20&nbsp;&euro;&nbsp;
   </div>
   </div>
   </div>
    </div>
    </div>
    <hr / color="#E1D39C">
    <br />
<div id="orderForm">
<? $attributes = array('class' => 'yform','AUTOCOMPLETE'=>'off'); ?> 
<?=form_open('page/create_offer_user', $attributes); ?>
   <? //$countries = $this->MFuncs->getCountries();?>
   <? //foreach ($countries as $countries => $country){
	//$options_country[0] = 'Select Country';
	//$options_country[$country['id']]=$country['name'] ;
	//} ?>

           <fieldset>
            <legend><?=$this->lang->line('buy_offer_form_qty_title')?></legend>
            <? $options = array('1' => '1', '2' => '2', '3' => '3', '4' => '4'); ?>
			<div class="type-select"><? echo "<label for='qty'>".$this->lang->line('cart_qty')." *"."</label>";
	echo form_dropdown('qty',$options, 1) .""; ?>
			</div>      
          </fieldset>
         <fieldset>
            <legend><?=$this->lang->line('buy_offer_form_title')?></legend>
            <div class="type-text"> <?=form_label(lang('fname')." *", 'fname')?> <? $data = array('name'=>'fname','id'=>'fname','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('lname')." *", 'lname')?> <? $data = array('name'=>'lname','id'=>'lname','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('address')." *", 'address')?> <? $data = array('name'=>'address','id'=>'address','size'=>25)?> <?=form_input($data); ?> </div>
<?php /*?>			<div class="type-select"><? echo "<label for='country'>".$this->lang->line('country')." *"."</label>";
	echo form_dropdown('country',$options_country, 0) .""; ?>
			</div>      
<?php */?>            <div class="type-text"> <?=form_label(lang('city')." *", 'city')?> <? $data = array('name'=>'city','id'=>'city','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('postal')." *", 'postal')?> <? $data = array('name'=>'postal','id'=>'postal','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('floor'), 'floor')?> <? $data = array('name'=>'floor','id'=>'floor','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('name_bell'), 'name_bell')?> <? $data = array('name'=>'name_bell','id'=>'name_bell','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('tel')." *", 'tel')?> <? $data = array('name'=>'tel','id'=>'tel','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('mob')." *", 'mob')?> <? $data = array('name'=>'mob','id'=>'mob','size'=>25)?> <?=form_input($data); ?> </div>
            <div class="type-text"> <?=form_label(lang('email')." *", 'email')?> <? $data = array('name'=>'email','id'=>'email','size'=>25)?> <?=form_input($data); ?> </div>
          </fieldset>
          
           <div class="buttons"><button type="submit" class="positive"> <?=$this->lang->line('continue')?> </button></div>
          <?=form_close();?></div>
          
  </div>
</div>