{% extends 'mtp_common/feedback/submit_feedback.html' %}
{% load i18n %}

{% block get_help_heading %}
  <header>
    <h1 class="govuk-heading-xl">
      <span class="govuk-caption-xl">
        {% trans 'Help with' %}
      </span>
      {% trans 'Making a payment' %}
    </h1>
  </header>
{% endblock %}

{% block get_help_leading %}{% endblock %}

{% block get_help_form %}

  {% block contact_us_lede %}
    <p class="govuk-body-l">
      {% trans 'Contact us about a payment you are finding it difficult to make.' %}
      {% trans 'Give exact details so we can get back to you as soon as possible.' %}
    </p>
  {% endblock %}

  <form action="." method="post" id="mtp-feedback-form">
    {% include 'govuk-frontend/components/error-summary.html' with form=form only %}

    <fieldset class="govuk-fieldset">
      <legend class="govuk-visually-hidden">{% trans 'Your message' %}</legend>

      <div class="govuk-!-display-none">
        {% include 'mtp_common/forms/field.html' with field=form.subject only %}
      </div>

      {% block extra_ticket_fields %}
        {% include 'mtp_common/forms/field.html' with field=form.prisoner_number input_classes='govuk-input--width-10 mtp-input--prisoner-number' only %}
        {% include 'mtp_common/forms/date-field.html' with field=form.prisoner_dob year_field_completion=True only %}

        {% include 'mtp_common/forms/field.html' with field=form.contact_name input_classes='govuk-input--width-20' autocomplete='name' only %}
        {% include 'mtp_common/forms/field.html' with field=form.contact_email input_classes='govuk-input--width-20' autocomplete='email' value=request.GET.email|default:'' only %}
      {% endblock %}

      {% include 'mtp_common/forms/textarea.html' with field=form.ticket_content value=request.GET.message|default:None rows=6 only %}

      <div class="govuk-form-group">
        {% csrf_token %}
        {{ form.referer }}
        <button type="submit" class="govuk-button" data-module="govuk-button" data-prevent-double-click="true" name="submit-feedback">{% trans 'Send' %}</button>
      </div>
    </fieldset>
  </form>

{% endblock %}