prestation/Vue/Ajaxtbajoutercontactsassureur/index.php
2025-12-01 18:54:33 +00:00

41 lines
1.8 KiB
PHP

<form id="formData">
<legend id="titre_formData">Ajouter des données</legend>
<table class="table table-responsive table-condensed">
<tbody>
<tr>
<td width="10%" align="center" class="required">Nom</td>
<td width="40%" ><INPUT class="form-control majuscule" TYPE="text" id="nom" NAME="nom" required AUTOCOMPLETE="OFF" autofocus ></td>
<td width="10%" align="center" class="required">Prénoms</td>
<td width="40%" ><INPUT class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" required AUTOCOMPLETE="OFF" ></td>
</tr>
<tr>
<td width="10%" align="center">Téléphone</td>
<td width="40%" ><INPUT class="form-control" TYPE="tel" id="telephone" NAME="telephone"></td>
<td width="10%" align="center">Email</td>
<td width="40%" ><INPUT class="form-control" TYPE="email" id="email" NAME="email"></td>
</tr>
<tr>
<td width="10%" align="center">Fonction</td>
<td width="40%" ><INPUT class="form-control majuscule" TYPE="text" id="fonction" NAME="fonction"></td>
<td width="1%" align="center">Fonction Eng</td>
<td width="40%" ><INPUT class="form-control majuscule" TYPE="text" id="fonctionEng" NAME="fonctionEng"></td>
</tr>
<tr>
<td width="10%" align="center">Genre</td>
<td width="40%">
<select name="sexe" id="sexe" class="form-control">
<option value="F">Femme</option>
<option value="M" selected>Homme</option>
</select>
</td>
<td width="10%" align="center">Ordre</td>
<td width="40%" ><INPUT class="form-control" TYPE="number" id="ordre" NAME="ordre"></td>
</tr>
</tbody>
</table>
</form>