82 lines
4.6 KiB
PHP
82 lines
4.6 KiB
PHP
<?php $this->titre = "INTER-SANTE - Modification Garant Gestion Confiée"; ?>
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<input class="sr-only" type="text" id="idGc" name="idGc" value="<?= $this->nettoyer($gc['id']) ?>" >
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<legend> <?= _("Modification Fiche Garant") ?> </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="12%" >Code</td>
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<td width="10%"><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="codeGcAssureur" NAME="codeGcAssureur" value="<?=$this->nettoyer($gc['codeGcAssureur'])?>" readonly></td>
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<td width="10%" align="center" class="required"> <?= _("Nom") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="libelle" NAME="libelle" value="<?=$this->nettoyer($gc['libelle'])?>" required AUTOCOMPLETE="OFF" ></td>
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<td width="12%" align="center" class="required">Type</td>
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<td width="20%">
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<select name="typeGarant" id="typeGarant" class="form-control" required AUTOCOMPLETE="OFF" >
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<?= liste_options($gctypegarant,$this->nettoyer($gc['typeGarant']),true) ?>
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</select>
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</td>
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</tr>
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<tr>
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<td > <?= _("Taux Commission (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxFraisReel" NAME="gcTauxFraisReel" TYPE="number" value="<?= $this->nettoyer($gc['gcTauxFraisReel']) ?>" step="0.01"></td>
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<td align="center">Téléphone</td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="tel" id="telephoneGarant" NAME="telephoneGarant" value="<?=$this->nettoyer($gc['telephoneGarant'])?>" ></td>
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<td align="center"> <?= _("Frais Nouvelle Carte") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteAfn" NAME="fraisCarteAfn" value="<?=$this->nettoyer($gc['fraisCarteAfn'])?>" ></td>
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</tr>
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<tr>
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<td > <?= _("Taux Redressement (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRedressement" NAME="gcTauxRedressement" TYPE="number" value="<?= $this->nettoyer($gc['gcTauxRedressement']) ?>" step="0.01" ></td>
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<td align="center">Représentant</td>
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<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="representant" NAME="representant" value="<?=$this->nettoyer($gc['representant'])?>"></td>
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<td align="center"> <?= _("Frais Renouvellement Carte") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteRen" NAME="fraisCarteRen" value="<?=$this->nettoyer($gc['fraisCarteRen'])?>" ></td>
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</tr>
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<tr>
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<td > <?= _("Taux Provision (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxProvision" NAME="gcTauxProvision" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxProvision']) ?>" onkeyup="controle_numerique(this);"></td>
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<td align="center"> <?= _("Forfait Provision") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="gcForfaitProvision" NAME="gcForfaitProvision" value="<?= format_N($this->nettoyer($gc['gcForfaitProvision'])) ?> " onkeyup="controle_numerique(this);" onblur="formatMonetaire(this);"></td>
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<td align="center"> <?= _("Frais RE-IMPRESSION") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteImp" NAME="fraisCarteImp" value="<?=$this->nettoyer($gc['fraisCarteImp'])?>" ></td>
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</tr>
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<tr>
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<td > <?= _("Taux Tva (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxTva" NAME="gcTauxTva" TYPE="number" value="<?= $this->nettoyer($gc['gcTauxTva']) ?>" step="0.01" ></td>
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<td align="center">E-mail</td>
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<td colspan="3"><INPUT style='font-size:10pt;' class="form-control" TYPE="email" id="emailGcAssureur" NAME="emailGcAssureur" value="<?=$this->nettoyer($gc['email'])?>" ></td>
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</tr>
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<tr>
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<td colspan="2"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:enregistrer_modif_gc_assureur();" style='font-size:10pt;' > </td>
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<td > </td>
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<td > <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:retour_gc_assureur();" style='font-size:9pt;' > </td>
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<td > </td>
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<td> <input id="btn_desactive" name="btn_desactive" class = "form-control btn btn-danger" type="button" value="<?= _("Désactiver") ?>" onClick="javascript:desactive_gc_assureur(<?= $this->nettoyer($gc['id']) ?>);" style='font-size:10pt;' ></td>
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</tr>
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</tbody>
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</table>
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<div id="div_test_gc">
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</div>
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