{template modoer_header}
<div id="body">
<div class="myhead"></div>
<div class="mymiddle">
    <div class="myleft">
        <!--{template 'menu','member','member'}-->
    </div>
    <div class="myright">
        <div class="myright_top"></div>
        <div class="myright_middle">
            <h3>兑换礼品</h3>
            <div class="mainrail">
                <form method="post" name="myform" action="{url exchange/member/ac/$ac/rand/$_G[random]}">
                <input type="hidden" name="giftid" value="$giftid" />
                <table width="100%" cellspacing="0" cellpadding="0" class="maintable">
                    <tr>
                        <td align="right" width="80">奖品名称：</td>
                        <td width="*"><a href="{url exchange/gift/id/$gift[giftid]}" target="_blank">$gift[name]</a></td>
                        <td width="220" rowspan="6"><img src="{URLROOT}/$gift[thumb]" /></td>
                    </tr>
                    <tr>
                        <td align="right">我的金币：</td>
                        <td><span class="font_2">$user->coin</span></td>
                    </tr>
                    <tr>
                        <td align="right"><span class="font_1">*</span>兑换数量：</td>
                        <td><input type="text" name="number" class="t_input" size="10" value="1"  /></td>
                    </tr>
                    <tr>
                        <td align="right"><span class="font_1">*</span>联系人：</td>
                        <td><input type="text" name="linkman" class="t_input" size="30" /></td>
                    </tr>
                    <tr>
                        <td align="right"><span class="font_1">*</span>联系电话：</td>
                        <td><input type="text" name="contact" class="t_input" size="30" /></td>
                    </tr>
                    <tr>
                        <td align="right"><span class="font_1">*</span>邮编：</td>
                        <td><input type="text" name="postcode" class="t_input" size="10" /></td>
                    </tr>
                    <tr>
                        <td align="right"><span class="font_1">*</span>联系地址：</td>
                        <td><input type="text" name="address" class="t_input" size="40"  /></td>
                    </tr>
                    <tr>
                        <td align="right" valign="top">备注说明：</td>
                        <td colspan="2"><textarea name="des" style="width:98%;height:100px;"></textarea></td>
                    </tr>
                </table>
                <div class="text_center">
                    <input type="hidden" name="forward" value="{print get_forward()}" />
                    <input type="hidden" name="dosubmit" value="yes" />
                    <button type="submit" name="dosubmit" value="yes">提交兑换</button>
                </div>
                </form>
            </div>
        </div>
    </div>
    <div class="clear"></div>
</div>
<div class="mybottom"></div>
</div>
<!--{eval footer();}-->