{% load staticfiles %}
<div class="row">
    <div class="col-md-12">
        <h2>Request New Account</h2>

        <p>Use the following form to request an account on the system.</p>

        {% if data.action_result %}
        <div class="alert alert-danger">
            {{ data.action_result }}
        </div>
        {% endif %}

        <form novalidate action="{% url 'core_website_app_account_request' %}" method="post" class="form-horizontal">
            {% csrf_token %}

            {% for field in data.request_form %}
            <div class="form-group">
                <label for="{{ field.id_for_label }}" class="col-sm-2 control-label">{{ field.label }}</label>
                <div class="col-sm-10">
                    {{ field }}
                    <span style="color:red">{{ field.errors }}</span>
                </div>
            </div>
            {% endfor %}
            <div class="form-group">
                <div class="col-sm-12">
                    <button type="submit" class="btn btn-lg btn-default pull-right">
                        <i class="fa fa-send-o"></i> Send Request
                    </button>
                </div>
            </div>
        </form>
    </div>
</div>
