56 lines
2.9 KiB
PHP
Executable File
56 lines
2.9 KiB
PHP
Executable File
<?php
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$this->titre = "INTER-SANTE - ". _("Modification Assureur");
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?>
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<input class="sr-only" type="text" id="idGc" name="idGc" value="<?= $this->nettoyer($gc['id']) ?>" >
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<legend> <?= _("Modification Fiche Assureur") ?></legend>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" >Code</td>
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<td width="10%"><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="codeGcAssureur" NAME="codeGcAssureur" value="<?=$this->nettoyer($gc['codeGcAssureur'])?>" readonly></td>
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<td width="10%" align="center"><?= _("Nom") ?></td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="libelle" NAME="libelle" value="<?=$this->nettoyer($gc['libelle'])?>" ></td>
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<td width="10%" align="center">E-mail</td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="emailGcAssureur" NAME="emailGcAssureur" value="<?=$this->nettoyer($gc['email'])?>" ></td>
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</tr>
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<tr>
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<td><?= _("Tx Comm (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxFraisReel" NAME="gcTauxFraisReel" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxFraisReel']) ?>" ></td>
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<td align="center"><?= _("Tx Redr (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRedressement" NAME="gcTauxRedressement" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxRedressement']) ?>" ></td>
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<td align="center"> <?= _("Tx Tva (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxTva" NAME="gcTauxTva" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxTva']) ?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Nouv Carte") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteAfn" NAME="fraisCarteAfn" value="<?=$this->nettoyer($gc['fraisCarteAfn'])?>" ></td>
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<td align="center"> <?= _("Carte REN") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteRen" NAME="fraisCarteRen" value="<?=$this->nettoyer($gc['fraisCarteRen'])?>" ></td>
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<td align="center"> <?= _("Carte RE-IMPR") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteImp" NAME="fraisCarteImp" value="<?=$this->nettoyer($gc['fraisCarteImp'])?>" ></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="3"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _(Enregistrer) ?>" onClick="javascript:enregistrer_modif_gc_assureur();" style='font-size:10pt;' > </td>
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<td> </td>
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<td colspan="1"> <input class = "form-control btn btn-warning" type="button" value="<?= _(Annuler) ?>" onClick="javascript:retour_gc_assureur();" style='font-size:9pt;' > </td>
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</tr>
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</tbody>
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</table>
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<div id="div_test_gc">
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</div>
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