newdesigngestionnaire/Vue/Ajaxtbmodifierintermediaires/index.php

<form id="formData" class="container-fluid p-0">
    <input type="hidden" id="id" name="id" value="<?= $intermediaire['id'] ?>">

    <div class="card border-0 shadow-sm border-start border-4 border-primary" style="border-radius: var(--radius-md);">
        <div class="card-header bg-white py-3 border-bottom">
            <h6 class="mb-0 fw-bold text-uppercase text-warning small">
                <i class="fas fa-edit me-2"></i><?= _("Modification des données de l'intermédiaire") ?>
            </h6>
        </div>
        
        <div class="card-body bg-light-50 p-4">
            <div class="row g-3 mb-4">
                <div class="col-md-2">
                    <label class="form-label small fw-bold text-muted"><?= _("Code") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-light border-2 border-end-0"><i class="fas fa-barcode text-muted"></i></span>
                        <input type="text" class="form-control border-2 border-start-0 majuscule fw-bold text-center" 
                               id="codeApporteur" name="codeApporteur" value="<?= $this->nettoyer($intermediaire['codeApporteur']); ?>" readonly>
                    </div>
                </div>

                <div class="col-md-2">
                    <label class="form-label small fw-bold text-muted required"><?= _("Type") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-user-tie text-muted"></i></span>
                        <select name="codeTypeApporteur" id="codeTypeApporteur" class="form-control selectpicker border-2 border-start-0" required>
                            <?= liste_options($typeinter, $this->nettoyer($intermediaire['codeTypeApporteur']), true) ?>
                        </select>
                    </div>
                </div>

                <div class="col-md-4">
                    <label class="form-label small fw-bold text-muted required"><?= _("Raison Sociale") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-building text-muted"></i></span>
                        <input type="text" class="form-control border-2 border-start-0 majuscule" 
                               id="libelle" name="libelle" required value="<?= $this->nettoyer($intermediaire['libelle']); ?>">
                    </div>
                </div>

                <div class="col-md-4">
                    <label class="form-label small fw-bold text-muted"><?= _("Responsable") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-user text-muted"></i></span>
                        <input type="text" class="form-control border-2 border-start-0 majuscule" 
                               id="nomResponsable" name="nomResponsable" value="<?= $this->nettoyer($intermediaire['nomResponsable']); ?>">
                    </div>
                </div>
            </div>

            <div class="row g-3 mb-4">
                <div class="col-md-3">
                    <label class="form-label small fw-bold text-muted required"><?= _("Téléphone") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-phone text-muted"></i></span>
                        <input type="tel" class="form-control border-2 border-start-0" 
                               id="telephone" name="telephone" value="<?= $this->nettoyer($intermediaire['telephone']); ?>" required>
                    </div>
                </div>

                <div class="col-md-3">
                    <label class="form-label small fw-bold text-muted required"><?= _("E-mail") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-envelope text-muted"></i></span>
                        <input type="email" class="form-control border-2 border-start-0" 
                               id="email" name="email" value="<?= $this->nettoyer($intermediaire['email']); ?>" required>
                    </div>
                </div>

                <div class="col-md-3">
                    <label class="form-label small fw-bold text-muted"><?= _("Bureau") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-map-marked-alt text-muted"></i></span>
                        <select name="codeBureau" id="codeBureau" class="form-control selectpicker border-2 border-start-0">
                            <?= liste_options($bureau, $this->nettoyer($intermediaire['codeBureau']), true) ?>
                        </select>
                    </div>
                </div>

                <div class="col-md-3">
                    <label class="form-label small fw-bold text-muted"><?= _("Déduire Commission") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-percent text-muted"></i></span>
                        <select name="deduireComm" id="deduireComm" class="form-control selectpicker border-2 border-start-0">
                            <?= liste_options($ouinonplafondmodifiable, $this->nettoyer($intermediaire['deduireComm']), true) ?>
                        </select>
                    </div>
                </div>
            </div>

            <div class="row g-3">
                <div class="col-md-3">
                    <label class="form-label small fw-bold text-muted"><?= _("N° Mobile Paiement") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-mobile-alt text-muted"></i></span>
                        <input type="number" class="form-control border-2 border-start-0" 
                               id="mobilePaiement" name="mobilePaiement" value="<?= $this->nettoyer($intermediaire['mobilePaiement']); ?>" title="<?= _("L'indicatif est obligatoire")?>">
                    </div>
                </div>

                <div class="col-md-4">
                    <label class="form-label small fw-bold text-muted"><?= _("Adresse Géographique") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-map-marker-alt text-muted"></i></span>
                        <input type="text" class="form-control border-2 border-start-0 majuscule" 
                               id="adresseGeo" name="adresseGeo" value="<?= $this->nettoyer($intermediaire['adresseGeo']); ?>">
                    </div>
                </div>

                <div class="col-md-5">
                    <label class="form-label small fw-bold text-muted"><?= _("Adresse Postale") ?></label>
                    <div class="input-group shadow-xs">
                        <span class="input-group-text bg-white border-2 border-end-0"><i class="fas fa-mailbox text-muted"></i></span>
                        <input type="text" class="form-control border-2 border-start-0 majuscule" 
                               id="adressePost" name="adressePost" value="<?= $this->nettoyer($intermediaire['adressePost']); ?>">
                    </div>
                </div>
            </div>
        </div>
    </div>
</form>