17 lines
855 B
PHP
Executable File
17 lines
855 B
PHP
Executable File
<form id="formData">
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<legend id="titre_formData">Ajouter des données</legend>
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<table class="table table-responsive table-condensed">
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<tbody>
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<tr>
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<td width="5%" align="center" class="required">Code</td>
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<td width="5%" ><INPUT class="form-control majuscule" TYPE="text" id="codeTypeRemboursement" NAME="codeTypeRemboursement" required AUTOCOMPLETE="OFF" autofocus ></td>
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<td width="5%" align="center" class="required">Libellé Fr</td>
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<td width="28%" ><INPUT class="form-control majuscule" TYPE="text" id="libelle" NAME="libelle" required AUTOCOMPLETE="OFF" ></td>
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<td width="5%" align="center">Libellé Eng</td>
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<td width="27%"><INPUT class="form-control majuscule" TYPE="text" id="libelleEng" NAME="libelleEng"></td>
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</tr>
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</tbody>
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</table>
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</form> |