{include "header.inc.html"}
{include "user/header.inc.html"}
<div class="layout-user">
	<div class="layout-side">{include "user/side.inc.html"}</div>
	<div class="layout-main">
		<div class="mypp_container">
			<div class="mypp_box">
				<div class="hd"><h2>申请提现</h2></div>
				<div class="user-main">
<div id="payform">
<form class="form userform" action="" method="post" id="J_pay"><input type="hidden" name="act" value="withdraw" /><input type="hidden" name="inajax" value="1" />
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>我的账户：</div><div class="fm-field">{$smarty.cookies.account}</div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>余额：</div><div class="fm-field"><span class="amount-number">{$userInfo.amount|string_format:'%.2f'}</span> 元</div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>银行名称：</div><div class="fm-field"><input type="text" class="fm-text w200" name="bank" value="" autocomplete="off" /></div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>银行卡账号：</div><div class="fm-field"><input type="text" class="fm-text w200" name="account" value="" autocomplete="off" /></div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>户名：</div><div class="fm-field"><input type="text" class="fm-text w200" name="name" value="" autocomplete="off" /></div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>联系手机：</div><div class="fm-field"><input type="text" class="fm-text w200" name="mobile" value="" autocomplete="off" /></div></div>
<div class="fm-item"><div class="fm-title"><span class="tred">*</span>提现金额：</div><div class="fm-field"><input type="text" class="fm-text w80" name="amount" value="" autocomplete="off" /> 元</div></div>

<div class="fm-item"><div class="fm-title"></div><div class="fm-field"><button class="btn btn-fmsubmit btn-submit" style="" type="submit">确认充值</button></div></div>
</form>
<script type="text/javascript" src="{$baseUrl}static/js/qlib.js"></script>
<script type="text/javascript" src="{$baseUrl}static/js/jquery.form.js"></script>

<script type="text/javascript">
$("#J_pay").ajaxForm({ dataType:'json',success:function(json){ var icon='error';if(json.success){ icon='success'; } qlib.tips({ icon:icon,msg:json.message }); }});
</script>
</div>

				</div>
			</div>
		</div>
	</div>
	<div class="clear"></div>
</div>
{include "footer.inc.html"}