{load_language_text section="withdrawal"} {if $error != ''}
{$error}
{/if} {if $success == '1'}
{$txt.text_success}

{$BUTTON_CONTINUE} {else}

{$txt.heading_withdrawal}

{$txt.text_withdrawal}
{$FORM_ACTION} {$CUSTOMER_ID} {*if $ANTISPAMCODEACTIVE == 'true'} {#text_antispam#}{$ANTISPAMCODEQUESTION}
{#text_antispam_input#} {$INPUT_ANTISPAMCODE} {$ANTISPAMCODEID}
{/if*}
{$txt.title_namefield}
{$txt.text_gender}
{$CUSTOMER_GENDER}
{$txt.text_firstname}
{$INPUT_FIRSTNAME}
{$txt.text_lastname}
{$INPUT_LASTNAME}
{$txt.text_email}
{$INPUT_EMAIL}
{$txt.title_adress}
{$txt.text_street}
{$CUSTOMER_STREET_ADDRESS}
{$txt.text_plz}
{$INPUT_POSTCODE}
{$txt.text_city}
{$INPUT_CITY}
{if $SELECT_COUNTRY_ENABLE == 'true'}
{$txt.text_country}
{$INPUT_COUNTRY}
{/if}
{$txt.title_message}
{$txt.text_message}
{$INPUT_TEXT}*
{$txt.text_warning}
{$txt.title_dates}
{if $ORDER_ID_ENABLE == 'true'}
{$txt.text_order_id}
{$ORDER_ID}
{$txt.hinweis_order_id}
{else} {$ORDER_ID} {/if}
{$txt.text_orderdate}
{$ORDER_DATE}
{$txt.text_date}
{$txt.text_deliverydate}
{$INPUT_DELIVERYDATE}
{$txt.text_date}
{$txt.text_withdrawaldate}
{$INPUT_WITHDRAWALDATE}
{$txt.text_date}
{$BUTTON_SUBMIT} {$FORM_END}
{/if}