71 lines
2.8 KiB
PHP
Executable File
71 lines
2.8 KiB
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"><?= _("Nom et Prénoms") ?></td>
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<td width="20%"><INPUT class="form-control majuscule" TYPE="text" id="libelle" NAME="libelle" required AUTOCOMPLETE="OFF" ></td>
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<td width="8%" align="center" class="required">Type</td>
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<td >
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<select name="codeTypeApporteur" id="codeTypeApporteur" class="form-select">
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<?= liste_options($typeapp,'',false) ?>
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</select>
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</td>
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<td width="5%" align="center"><?= _("Type Système") ?></td>
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<td colspan="5%">
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<select name="typeSysteme" id="typeSysteme" class="form-select">
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<?= liste_options($ouinonoptionnelle,'0',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 width="5%" align="center"><?= _("Téléphone") ?></td>
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<td width="20%"><INPUT class="form-control" TYPE="tel" id="telephone" NAME="telephone"></td>
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<td width="5%" align="center">E-mail</td>
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<td colspan="3"><INPUT class="form-control" TYPE="email" id="email" NAME="email"></td>
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</tr>
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<tr>
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<td width="5%" align="center"><?= _("Responsable") ?></td>
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<td width="20%"><INPUT class="form-control majuscule" TYPE="text" id="nomResponsable" NAME="nomResponsable"></td>
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<td width="5%" align="center"><?= _("Mobile Payer") ?></td>
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<td width="20%"><INPUT class="form-control" TYPE="number" id="mobilePaiement" NAME="mobilePaiement" value="0" title="<?= _("L'indicatif est obligatoire")?>"></td>
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<td width="5%" align="center"><?= _("Déduire Commission") ?></td>
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<td colspan="5%">
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<select name="deduireComm" id="deduireComm" class="form-select">
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<?= liste_options($ouinonoptionnelle,'1',true) ?>
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</select>
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</td>
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</tr>
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<tr>
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<td width="5%" align="center" class="required"><?= _("Bureau") ?></td>
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<td width="50%">
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<select name="codeBureau" id="codeBureau" class="form-select" required AUTOCOMPLETE="OFF">
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<?= liste_options($bureau,'',false) ?>
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</select>
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</td>
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<td width="5%" align="center"><?= _("Adr. Postale") ?></td>
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<td colspan="5%">
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<INPUT class="form-control majuscule" TYPE="text" id="adressePost" NAME="adressePost">
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</td>
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</tr>
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<tr>
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<td width="5%" align="center"><?= _("Adr. Géo.") ?></td>
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<td colspan="5"><INPUT class="form-control majuscule" TYPE="text" id="adresseGeo" NAME="adresseGeo" value=" "></td>
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</tr>
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</tbody>
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</table>
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</form>
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