{% extends "base.html" %}

{% block title %}Submit reimbursement request{% endblock %}
{% block content %}

<h2>UA Reimbursement Request Form</h2>

<form method="post">
<table>
<tr>
    <td></td>
    <th>You are requesting a reimbursement from:</th>
</tr>
<tr>
    <th>Term</th>
    <td>{{term}}</td>
</tr>
<tr>
    <th>Committee</th>
    <td>{{comm}}</td>
</tr>

<tr>
    <td></td>
    <th>Request details:</th>
</tr>
{{ form.as_table }}
<tr><td></td><td><input type='submit' value='Request Reimbursement' /></td></tr>
</table>
</form>

{% endblock %}