40 lines
2.3 KiB
PHP
40 lines
2.3 KiB
PHP
<form id="formData">
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<legend id="titre_formData">Modification des données</legend>
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<INPUT class="sr-only" TYPE="text" id = "id" name = "id" value="<?=$contactsassureur['id']?>">
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<table class="table table-responsive table-condensed">
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<tbody>
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<tr>
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<td width="5%" align="center" class="required">Nom</td>
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<td width="20%" ><INPUT class="form-control majuscule" TYPE="text" id="nom" NAME="nom" required AUTOCOMPLETE="OFF" autofocus value="<?=$contactsassureur['nom']?>"></td>
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<td width="5%" align="center" class="required">Prénoms</td>
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<td width="20%" ><INPUT class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" required AUTOCOMPLETE="OFF" value="<?=$contactsassureur['prenoms']?>"></td>
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</tr>
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<tr>
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<td width="5%" align="center">Téléphone</td>
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<td width="20%" ><INPUT class="form-control" TYPE="tel" id="telephone" NAME="telephone" value="<?=$contactsassureur['telephone']?>"></td>
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<td width="5%" align="center">Email</td>
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<td width="20%" ><INPUT class="form-control" TYPE="email" id="email" NAME="email" value="<?=$contactsassureur['email']?>"></td>
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</tr>
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<tr>
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<td width="5%" align="center">Fonction</td>
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<td width="20%" ><INPUT class="form-control majuscule" TYPE="text" id="fonction" NAME="fonction" value="<?=$contactsassureur['fonction']?>"></td>
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<td width="5%" align="center">Fonction Eng</td>
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<td width="20%" ><INPUT class="form-control majuscule" TYPE="text" id="fonctionEng" NAME="fonctionEng" value="<?=$contactsassureur['fonctionEng']?>"></td>
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<tr>
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<tr>
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<td width="5%" align="center">Genre</td>
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<td width="20%">
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<select name="sexe" id="sexe" class="form-control" value="<?=$contactsassureur['sexe']?>">
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<option value="F">Femme</option>
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<option value="M" selected>Homme</option>
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</select>
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</td>
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<td width="5%" align="center">Ordre</td>
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<td width="20%" ><INPUT class="form-control" TYPE="number" id="ordre" NAME="ordre" value="<?=$contactsassureur['ordre']?>"></td>
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</tr>
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</tbody>
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</table>
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</form> |