<!-- Kontaktní údaje
		============================================= -->
<section id="content">
				 <div class="content-wrap nopadding">

<div class="section parallax parallax-bg mt-4 mb-3 light"
style="margin: 0px !important;background: #F9F9F9 url('') no-repeat bottom center / cover; z-index: 10;"
data-rellax-speed="15"
data-bottom-top="background-position:-130px -64px;"
data-top-bottom="background-position: -130px 0px;">

<div class="container">
	<div class="heading-block center mt-0 divcenter nobottomborder clearfix" style="max-width: 750px;">
		<h2 class="_black" style="text-align: center;">Kontaktní údaje</h2>
				<p class="_black t600">Vyplňte prosím kontaktní údaje nezbytné pro doručení zboží</p>
		</div>

		<form  style="border-radius:6px; background:none; ">

<!-- fa-low-vision -->
	          		  <div class="form-group form_left_2">
				        			<label for="modalMail_username_field">Vaše jméno</label>
				              <input type="text" class="form-control input-lg" placeholder="Vaše jméno"  name="cash_name" id="cash_name" style="padding-left:40px;">
				        			<i class="fa fa-user" style="position:relative; z-index:1; top:-34px; left:10px; margin-right:15px; font-size:24px;"></i>
				       		</div>

									<div class="form-group form_right_2">
				        			<label for="modalMail_username_field">Vaše příjmení</label>
				              <input type="text" class="form-control input-lg" placeholder="Vaše příjmení"  name="cash_surname" id="cash_surname" style="padding-left:40px;">
				        			<i class="fa fa-user-o" style="position:relative; z-index:1; top:-34px; left:10px; margin-right:15px; font-size:24px;"></i>
				       		</div>

						      <div class="form-group form_left_3">
						      		<label for="modalMail_mail_field">Ulice</label>
						          <input type="text" class="form-control input-lg" placeholder="Ulice"  name="cash_street" id="cash_street" style="padding-left:40px;">
						      		<i class="fa fa-map-signs" style="position:relative; z-index:1; top:-33px; left:10px; margin-right:15px; font-size:24px;"></i>
						      </div>

									<div class="form-group form_middle_3">
						      		<label for="modalMail_mail_field">Číslo popisné</label>
						          <input type="text" class="form-control input-lg" placeholder="Číslo popisné"  name="cash_cp" id="cash_cp" style="padding-left:40px;">
						      		<i class="fa fa-bell-o" style="position:relative; z-index:1; top:-33px; left:10px; margin-right:15px; font-size:24px;"></i>
						      </div>

									<div class="form-group form_right_3">
											<label for="modalMail_mail_field">PSČ</label>
											<input type="text" class="form-control input-lg" placeholder="PSČ"  name="cash_psc" id="cash_psc" style="padding-left:40px;">
											<i class="fa fa-building-o" style="position:relative; z-index:1; top:-33px; left:10px; margin-right:15px; font-size:24px;"></i>
									</div>

                  <div class="form-group form_left_2">
                    <label for="modalMail_mail_field">Město</label>
                    <input type="text" class="form-control input-lg" placeholder="Město"  name="cash_city" id="cash_city" style="padding-left:40px;">
                    <i class="fa fa-building-o" style="position:relative; z-index:1; top:-33px; left:10px; margin-right:15px; font-size:24px;"></i>
                  </div>

									<div class="form-group form_right_2">
				      				<label for="modalMail_subject_field">Země</label>
				             	<input type="text" class="form-control input-lg" placeholder="Země" value="Česká Republika"  disabled="disabled" name="cash_country" id="cash_country" style="padding-left:40px;">
				      				<i class="fa fa-globe" style="position:relative; z-index:1; top:-33px; left:10px; margin-right:15px; font-size:24px;"></i>
				      		</div>

									<div style="border-top: 1px solid #000; width: 100%; clear: both; margin-top:46px; margin-bottom: 64px;"></div>

									<div class="form-group form_left_2">
										 <label for="modalMail_username_field">Email</label>
										 <input type="text" class="form-control input-lg" placeholder="Email"  name="cash_mail" id="cash_mail" style="padding-left:40px;">
										 <i class="fa fa-envelope-open-o" style="position:relative; z-index:1; top:-34px; left:10px; margin-right:15px; font-size:24px;"></i>
								 </div>

								 <div class="form-group form_right_2">
										 <label for="modalMail_username_field">Telefon</label>
										 <input type="text" class="form-control input-lg" placeholder="Telefon"  name="cash_phone" id="cash_phone" style="padding-left:40px;">
										 <i class="fa fa-phone" style="position:relative; z-index:1; top:-31px; left:10px; margin-right:15px; font-size:24px;"></i>
								 </div>

								 <div style="border-top: 1px solid #000; width: 100%; clear: both; margin-top:46px; margin-bottom: 64px;"></div>

	     						<div class="form-group">
	         	      		<label for="modalMail_message_field">Zpráva</label>
	             				<textarea class="form-control input-lg" placeholder="Zpráva"  name="modalMail_message" id="modalMail_message_field" style="height:277px;">
	             				</textarea>
	      					</div>

			 	<!--					<div class="form-group" style="float:right; position: relative; top: -20px;">
	      						<label for="modalMail_sendCopy" style="float:right; display:inline;">Odeslat kopii na můj e-mail</label>
	              		<input type="checkbox" checked="checked" name="modalMail_sendCopy" id="modalMail_sendCopy" style="position:relative; top:3px; left: -6px;">
	      				</div>
				-->

	         </form>

			 </div>
<div class="container">
 <span style="color: #000 !important;background-color: #eee !important; float: left;" class="button button-3d button-small m-0" onclick="window.location.href = $('#domain').val();">Pokračovat v nákupu</span>
 <span style="color: #fff !important; float: right;" class="button button-3d button-small m-0" onclick="update_user_data();">Dále</span>
</div>

</div>



			 </div>
</section><!-- #content end -->
