22 lines
923 B
PHP
22 lines
923 B
PHP
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<legend> <?= _("Modification facturation") ?> </legend>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="6%" > <?= _("Assureur") ?> </td>
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<td width="25%" > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="souscripteur" NAME="souscripteur" value="<?=$this->nettoyer($reglement['gcassureur'])?>" readonly> </td>
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<td width="10%" align='center'> Observations </td>
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<td><INPUT style='font-size:10pt;' id="observations" name="observations" class="form-control" TYPE="text" value="<?=$this->nettoyer($reglement['observations'])?>" ></td>
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<td> </td>
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<td width="20%" > <button style='font-size:10pt;' type="button" class="form-control btn btn-primary" onclick="javascript:modifier_facturation_gc();"> <?= _("Enregistrer") ?> </button> </td>
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</tr>
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</tbody>
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</table>
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<div id="div_test">
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</div>
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