dr
This commit is contained in:
parent
c68cca1049
commit
3abf4c5006
|
|
@ -19,7 +19,7 @@
|
|||
<div class="card-body">
|
||||
<div class="row g-3">
|
||||
<div class="col-md-6 col-lg-3">
|
||||
<label class="form-label small fw-bold text-dark mb-1"><?= _("Numéro Bénéficiaire") ?></label>
|
||||
<label class="form-label small fw-bold text-muted mb-1"><?= _("Numéro Bénéficiaire") ?></label>
|
||||
<div class="input-group input-group-merge">
|
||||
<span class="input-group-text bg-light border-end-0 text-muted"><i class="fas fa-id-card small"></i></span>
|
||||
<input class="form-control border-start-0 ps-0" type="text" id="numeroBeneficiaire" name="numeroBeneficiaire" autofocus autocomplete="off" placeholder="Ex: 100234...">
|
||||
|
|
@ -35,17 +35,17 @@
|
|||
</div>
|
||||
|
||||
<div class="col-md-6 col-lg-3">
|
||||
<label class="form-label small fw-bold text-dark mb-1"><?= _("Nom") ?></label>
|
||||
<label class="form-label small fw-bold text-muted mb-1"><?= _("Nom") ?></label>
|
||||
<input class="form-control" type="text" id="nomBeneficiaire" name="nomBeneficiaire" placeholder="Ex: DOE" style="text-transform: uppercase;">
|
||||
</div>
|
||||
|
||||
<div class="col-md-6 col-lg-3">
|
||||
<label class="form-label small fw-bold text-dark mb-1"><?= _("Prénoms") ?></label>
|
||||
<label class="form-label small fw-bold text-muted mb-1"><?= _("Prénoms") ?></label>
|
||||
<input class="form-control" type="text" id="prenomsBeneficiaire" name="prenomsBeneficiaire">
|
||||
</div>
|
||||
|
||||
<div class="col-md-6 col-lg-3">
|
||||
<label class="form-label small fw-bold text-dark mb-1"><?= _("Téléphone") ?></label>
|
||||
<label class="form-label small fw-bold text-muted mb-1"><?= _("Téléphone") ?></label>
|
||||
<div class="input-group">
|
||||
<span class="input-group-text bg-light border-end-0 text-muted"><i class="fas fa-phone-alt small"></i></span>
|
||||
<input class="form-control border-start-0 ps-0" type="tel" id="telephonePortable" name="telephonePortable">
|
||||
|
|
@ -53,7 +53,7 @@
|
|||
</div>
|
||||
|
||||
<div class="col-md-6 col-lg-3">
|
||||
<label class="form-label small fw-bold text-dark mb-1">E-mail</label>
|
||||
<label class="form-label small fw-bold text-muted mb-1">E-mail</label>
|
||||
<div class="input-group">
|
||||
<span class="input-group-text bg-light border-end-0 text-muted"><i class="fas fa-at small"></i></span>
|
||||
<input class="form-control border-start-0 ps-0" type="email" id="email" name="email">
|
||||
|
|
|
|||
Loading…
Reference in New Issue
Block a user