[% sidebar_html | safe %]

<div id="report-a-problem-main">
    <h1>[% loc('Reporting a problem') %]</h1>

    [% INCLUDE 'errors.html' %]
        <div id="problem_form">

            [% INCLUDE 'report/new/form_after_heading.html' %]


            [% IF field_errors.bodies %]
                <p class='form-error'>[% field_errors.bodies %]</p>
            [% END %]

            [% PROCESS "report/new/category_wrapper.html" %]

            [% PROCESS 'report/form/photo_upload.html' %]
            [% PROCESS 'report/new/after_photo.html' %]

            <label for="form_detail">[% loc('Details') %]</label>
            [% IF field_errors.detail %]
                <p class='form-error'>[% field_errors.detail %]</p>
            [% END %]
            <textarea class="form-control" rows="7" cols="26" name="detail" id="form_detail" required>[% report.detail | html %]</textarea>

                <label for="form_username_register">[% loc('Your email') %]</label>
                [% IF field_errors.username_register %]
                    <p class='form-error'>[% field_errors.username_register %]</p>
                [% END %]
                <input class="form-control" type="email" value="[% email | html %]" name="username_register" id="form_username_register" required>

                <label for="form_name">[% loc('Name') %] [% loc('(optional)') %]</label>
                [% IF field_errors.name %]
                    <p class='form-error'>[% field_errors.name %]</p>
                [% END %]
                <input class="form-control js-form-name" type="text" value="[% report.name | html %]" name="name" id="form_name" autocomplete="name">

                <label for="form_phone">[% loc('Phone number') %]</label>
                [% IF field_errors.phone %]
                    <p class='form-error'>[% field_errors.phone %]</p>
                [% END %]
                <input class="form-control" type="text" value="[% phone | html %]" name="phone" id="form_phone" required>

                <div class="form-txt-submit-box">
                    [%# class of submit_sign_in so name can be optional, name of submit_register so it doesn't try and sign us in %]
                    <p>
                    <input class="desk-only btn btn--primary js-submit_sign_in" type="submit" name="submit_register" value="[% loc('Submit') %]">
                    <input class="mob-only btn btn--primary js-submit_sign_in" type="submit" name="submit_register_mobile" value="[% loc('Submit') %]">
                    </p>
                </div>

        </div>

    [% IF partial_token %]
        <input type="hidden" name="partial" value="[% partial_token.token %]">
    [% END %]

    <input type="hidden" name="submit_problem" value="1">
</div>