187 lines
7.3 KiB
PHP
Executable File
187 lines
7.3 KiB
PHP
Executable File
<?php $this->titre = "INTER SANTE - Nouveau Souscripteur"; ?>
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<form method="post" action="Creerclient/ajouter">
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<fieldset>
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<legend> <?= _("Nouveau Souscripteur") ?> </legend>
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<table class="table table-responsive table-condensed">
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<tbody>
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<tr>
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<td width="10%" class="required">Type</td>
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<td width="38%">
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<select class="form-select" id="typeClient" NAME="typeClient" onChange="JAVASCRIPT:controletytpeclient();" required AUTOCOMPLETE="OFF" autofocus>
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<?php liste_options($typeclient,""); ?>
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</SELECT>
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</td>
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<td width="15%" align="center" class="required"> <?= _("Titre") ?> </td>
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<td>
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<select class="form-select" id="codeTitre" NAME="codeTitre" required >
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<?php liste_options($titre,""); ?>
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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 class="required"> <?= _("Nom") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="nom" NAME="nom" required style="text-transform: uppercase;"></td>
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<td align="center"> <?= _("Prénoms") ?> </td>
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<td><INPUT class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" ></td>
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</tr>
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<tr>
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<td> <?= _("Indicatif") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="prefixePaiementMobile" NAME="prefixePaiementMobile" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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<td align="center"> <?= _("Mobile Paiement") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="mobilePaiement" NAME="mobilePaiement" value=""></td>
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</tr>
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<tr>
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<td ><?= _("Tarif Actes") ?></td>
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<td >
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<select name="codeTarifActe" id="codeTarifActe" class="form-control selectpicker" data-live-search="true">
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<?= liste_options($tarifActe,"",false) ?>
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</select>
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</td>
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<td align="center" > <?= _("Pays") ?> </td>
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<td>
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<SELECT onChange="ajaxListerVille();" class="form-select" id="codePays" NAME="codePays">
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<?php liste_options($pays,$_SESSION['codePaysSociete']); ?>
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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 > <?= (isset($_SESSION['affichagedynamique']['District / Région'])) ? _($_SESSION['affichagedynamique']['District / Région']) : _("District / Région") ?> </td>
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<td>
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<div id="listeville">
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<SELECT onChange="ajaxListerLocalite();" class="form-select" id="codeVille" NAME="codeVille">
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<?php liste_options($ville,""); ?>
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</SELECT>
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</div>
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</td>
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<td align="center" > <?= (isset($_SESSION['affichagedynamique']['Commune'])) ? _($_SESSION['affichagedynamique']['Commune']) : _("Commune") ?> </td>
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<td>
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<div id="listelocalite" >
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<select class="form-select" id="codeLocalite" NAME="codeLocalite">
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<?php liste_options($listelocalite,""); ?>
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</SELECT>
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</div>
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</td>
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</tr>
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<tr>
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<td> <?= _("Tél Bureau") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephoneBureau" NAME="telephoneBureau" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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<td align="center"> <?= _("Tél Domicile") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonedomicile" NAME="telephonedomicile" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Tél Portable") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonePortable" NAME="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>" placeholder="Tél portable obligatoire" required AUTOCOMPLETE="OFF" minlength="5" ></td>
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<td align="center">Fax</td>
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<td><INPUT class="form-control" TYPE="tel" id="fax" NAME="fax" ></td>
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</tr>
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<tr>
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<td class="required">E-mail</td>
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<td><INPUT class="form-control" TYPE="email" id="email" NAME="email" placeholder="E-mail obligatoire" required AUTOCOMPLETE="OFF"></td>
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<td align="center" > <?= _("Secteur Activité") ?> </td>
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<td>
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<select class="form-control selectpicker" data-live-search="true" id="codeSecteur" NAME="codeSecteur">
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<?php liste_options($secteuractivite,""); ?>
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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 > <?= _("Mandataire") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="nomMandataire" NAME="nomMandataire" style="text-transform: uppercase;" placeholder="Nom & Prénoms" AUTOCOMPLETE="OFF"></td>
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<td align="center" > <?= _("Mobile Mandataire") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonePortablemandataire" NAME="telephonePortablemandataire" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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</tr>
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<tr>
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<td> <?= _("Fixe Mandataire") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephoneFixemandataire" NAME="telephoneFixemandataire" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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<td align="center" > <?= _("E-mail Mandataire") ?> </td>
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<td><INPUT class="form-control" TYPE="email" id="emailMandataire" NAME="emailMandataire"></td>
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</tr>
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<tr>
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<td> <?= _("Registre Comm") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="registreCommerce" NAME="registreCommerce" placeholder="Registre de Commerce" ></td>
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<td align="center" class="required"> <?= _("Langue") ?> </td>
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<td>
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<select class="form-select" id="codeLangueUser" NAME="codeLangueUser" required AUTOCOMPLETE="OFF" >
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<?php liste_options($langue, $_SESSION['codeLangueSociete'] ); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td > <?= _("Seuil RD (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="seuilRdClient" NAME="seuilRdClient" step="1" TYPE="number" value="0" min="0" max="100"></td>
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<td align='center'> <?= _("Type Remboursement") ?> </td>
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<td >
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<SELECT style="font-size:10pt;" class="form-control selectpicker" data-live-search="true" id="codeTypeRemboursement" NAME="codeTypeRemboursement">
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<?php liste_options($typeremboursement,"RDTP",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 > <?= _("Mode Paiement") ?> </td>
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<td>
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<select class="form-select" id="codeModePaiement" NAME="codeModePaiement" style='font-size:10pt;' >
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<?php liste_options($modepaiement,""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("RIB") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="text" id="rib" NAME="rib" style='font-size:10pt;' >
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</td>
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</tr>
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<tr>
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<td> <?= _("Adresse Géo.") ?> </td>
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<td ><INPUT class="form-control majuscule" TYPE="text" id="adresseGeo" NAME="adresseGeo" ></td>
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<td> <?= _("Adresse Postale") ?> </td>
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<td><INPUT class="form-control majuscule" TYPE="text" id="boitepostale" NAME="boitepostale"></td>
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</tr>
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<tr>
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<td colspan="4" style="height:15px; background-color:white;"></td>
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</tr>
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<tr>
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<td colspan="4"><input class = "form-control btn btn-primary" type="submit" value="<?= _("Enregistrer") ?>" /></td>
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</tr>
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</tbody>
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</table>
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</fieldset>
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<fieldset id="zonemandat" style="display:none">
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</fieldset>
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<fieldset id="zoneparticulier" style="display:none">
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</fieldset>
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</form>
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