103 lines
6.3 KiB
PHP
Executable File
103 lines
6.3 KiB
PHP
Executable File
<form id="formData" class="container-fluid p-0">
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<div class="card border-0 shadow-sm border-start border-4 border-primary" style="border-radius: var(--radius-md);">
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<div class="card-header bg-white py-3 border-bottom">
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<h6 class="mb-0 fw-bold text-uppercase text-success small">
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<i class="fas fa-plus-circle me-2"></i><?= _("Ajouter un nouvel intermédiaire / courtier") ?>
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</h6>
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</div>
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<div class="card-body bg-light-50 p-4">
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<div class="row g-3 mb-4">
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted required"><?= _("Type Intermédiaire") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-user-tie text-muted"></i></span>
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<select name="codeTypeApporteur" id="codeTypeApporteur" class="form-control selectpicker border-2 border-start-0" required>
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<?= liste_options($typeinter, '', true) ?>
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</select>
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</div>
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</div>
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<div class="col-md-5">
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<label class="form-label small fw-bold text-muted required"><?= _("Raison Sociale") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-building text-muted"></i></span>
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<input type="text" class="form-control border-2 border-start-0 majuscule" id="libelle" name="libelle" required autocomplete="off">
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</div>
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</div>
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<div class="col-md-4">
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<label class="form-label small fw-bold text-muted"><?= _("Responsable") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-user text-muted"></i></span>
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<input type="text" class="form-control border-2 border-start-0 majuscule" id="nomResponsable" name="nomResponsable" autocomplete="off">
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</div>
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</div>
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</div>
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<div class="row g-3 mb-4">
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted required"><?= _("Téléphone") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-phone text-muted"></i></span>
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<input type="tel" class="form-control border-2 border-start-0" id="telephone" name="telephone" required>
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</div>
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</div>
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted required"><?= _("E-mail") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-envelope text-muted"></i></span>
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<input type="email" class="form-control border-2 border-start-0" id="email" name="email" required>
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</div>
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</div>
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted"><?= _("Bureau") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-map-marked-alt text-muted"></i></span>
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<select name="codeBureau" id="codeBureau" class="form-control selectpicker border-2 border-start-0">
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<?= liste_options($bureau, '', true) ?>
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</select>
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</div>
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</div>
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted"><?= _("Déduire Commmission") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-percent text-muted"></i></span>
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<select name="deduireComm" id="deduireComm" class="form-control selectpicker border-2 border-start-0">
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<?= liste_options($ouinonoptionnelle, '1', true) ?>
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</select>
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</div>
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</div>
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</div>
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<div class="row g-3">
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<div class="col-md-3">
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<label class="form-label small fw-bold text-muted required"><?= _("N° Mobile Paiement") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-mobile-alt text-muted"></i></span>
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<input type="number" class="form-control border-2 border-start-0" id="mobilePaiement" name="mobilePaiement" value="0" title="<?= _("L'indicatif est obligatoire")?> required">
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</div>
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</div>
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<div class="col-md-4">
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<label class="form-label small fw-bold text-muted"><?= _("Adresse Géographique") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-map-marker-alt text-muted"></i></span>
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<input type="text" class="form-control border-2 border-start-0 majuscule" id="adresseGeo" name="adresseGeo">
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</div>
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</div>
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<div class="col-md-5">
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<label class="form-label small fw-bold text-muted"><?= _("Adresse Postale") ?></label>
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<div class="input-group shadow-xs">
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<span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-mailbox text-muted"></i></span>
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<input type="text" class="form-control border-2 border-start-0 majuscule" id="adressePost" name="adressePost">
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</div>
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</div>
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</div>
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</div>
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</div>
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</form>
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