alpcentaur
/
wmdeit_kaform

<!doctype html><?php	$lang=$_GET['lang'];	if ( !in_array ($lang, array('en'))){		$lang="";	}?>
<html ><head>	<title>Kostenerstattungsforumlar</title>	<meta charset="utf-8">		<meta name="viewport" content="width=device-width, initial-scale=1">
	<!-- Kube CSS -->	<link rel="stylesheet" href="css/kube.min.css">	<link rel="stylesheet" href="addons/kube-addons.min.css" />
	<link rel="stylesheet" href="master.css" />
</head><body>	<div class="page is-container">	<div class="main-sidebar">		<img alt="wikimedia logo" src="Wikimedia_Deutschland-Logo.svg"/>	</div>      	<div class="main-content">   		<?php echo _( "
		<h1>Antrag auf Kostenerstattung</h1>		<p>Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines		Projektes entstanden sind?<BR>		Bitte fülle dieses Formular aus.		Pflichtfelder sind mit einem * gekennzeichnet.		</p>") ?>

		<form data-kube="kaform" name="theform" id="theform" action="submit.php" method="POST">
		<div class="is-row">		<div class="is-col is-70">			<fieldset>			<legend><?php echo _("1. Erfasse deine Stammdaten</legend>")?>
				<div class="is-row">					<div class="is-col"> 						<input required type="input"						   size="32" id="projectid" name="project"						   placeholder="Projekt/Zweck der Reise*" />					</div>				</div>				<br>				<div class="is-row">					<div class="is-col"> 						<input required type="input" size="32"				`		id="realname"	name="realname" placeholder="Dein Realname (Vorname Nachname)*" />					</div>					<div class="is-col"> 						<input type="input" size="32"				`		id="wmdecontact"	name="wmdecontact" placeholder="Deine Ansprechperson bei Wikimedia" />					</div>				</div>				<br>

				<div class="is-row">					<div class="is-col"> 							<input type="tel" size="32" 							id="phone" name="phone"							placeholder="Deine Telefonnummer" />					</div>					<div class="is-col"> 					</div>				</div>				<br>

				<div class="is-row">					<div class="is-col"> 						<input required type="email" size="32" id="email"							name="email" placeholder="Deine E-Mail-Adresse*" />					</div>					<div class="is-col"> 					</div>				</div>				<br>
				<div class="is-row">					<div class="is-col"> 
					<nav class="tabs" data-kube="tabs" data-equal="false">					<a href="#bank-eu" class="is-active">Banküberweisung</a>					<a href="#bank-noneu">Banküberweisung (Non-EU)</a><!--					<a href="#bank-paypal">PayPal</a>					<a href="#bank-bar">Barauszahlung</a>-->					</nav>
					<section id="bank-eu">						<div class="is-row">						<div class="is-col">						<input type="input" size="32" name="Owner" placeholder="Kontoinhabende Person" />						</div>						<div class="is-col">						</div>						</div>						<br>
						<div class="is-row">						<div class="is-col">			<input type="input" size="32" id="iban" name="iban" placeholder="IBAN*" />

						</div>						<div class="is-col">			<input type="input" size="32" id="bic" name="bic" placeholder="BIC (wenn ausländische Bank)" />						</div>						</div>						<br><!--			<input type="input" size="32" id="purpose" name="purpose" placeholder="Verwendungszweck" /> -->			<textarea  id="comments" name="comments"					style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
z.B. intermediäre Bank,Grund für abweichende Kontoinhbende Person"></textarea>


					</section>

					<section id="bank-noneu">						<div class="is-row">						<div class="is-col">						<input type="input" size="32" name="Owner" placeholder="Kontoinhabende Person" />						</div>						<div class="is-col">						</div>						</div>						<br>
						<div class="is-row">						<div class="is-col">			<input type="input" size="32" id="n_iban" name="n_iban" placeholder="Kontonummer*" />

						</div>						<div class="is-col">			<input type="input" size="32" id="n_bic" name="n_bic" placeholder="BIC/SWIFT*" />						</div>						</div>						<br>			<input class="EU nonEU" type="input" size="32" id="n_bank" name="n_bankname" placeholder="Name der Bank*" />						<br>
			<textarea  class="nonEU" name="n_bankaddress" id="n_bankaddress" style="resize:both;" cols="32" rows="4" placeholder="Adresse der Bank (Stra&szlig;e und Hausnummer/Postleitzahl/Land)"></textarea>			<br>			<textarea name="n_address" lang="de" class="nonEU" id="n_address" style="resize:both;" cols="32" rows="4" placeholder="Deine Anschrift (Srta&szlig;e und Hausnummer/Postleitzahl/Land)
"></textarea>
			<br>


<!--			<input type="input" size="32" id="n_purpose" name="n_purpose" placeholder="Verwendungszweck" /> -->			<textarea  id="n_comments" name="n_comments"					style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
z.B. intermediäre Bank,Grund für abweichende kontoinhabende Person"></textarea>


					</section><!--					<section id="bank-paypal">						<input name="paypal" type="input" size="32"						       id="paypal" placeholder="Dein PayPal Account (paypal@example.com)" />	
					</section> --><!--					<section id="bank-bar">					</section> -->


					</div> <!-- i-col -->				</div> <!-- is-row -->
			</fieldset>
		</div>		<div class="is-col ">			<?php include "h1.php"; ?>
		</div>		</div> <!-- is row -->
		<br>
		<div class="is-row">		<div class="is-col is-70">			<fieldset id="fieldset2">				<legend>2. Erfasse deine Ausgaben</legend>				<div class="is-col is-70">				Währung:				</div>				<div class="is-col is-20">					<select onchange="renumberTableRows()" id="currency"  >						<option value="EUR">EUR</option>						<option value="USD">USD</option>						<option value="CHF">CHF</option>						<option value="XBT">XBT</option>					</select>`				</div>
				<table id="tabtab" class="is-bordered is-striped">				<thead>				<tr>					<th>Pos.</th>					<th>Datum</th>					<th>Beschreibung</th>					<th>Betrag</th>					<th>Währung</th>					<th>Belege</th>					<th>L&ouml;schen</th>				</tr>				</thead>				<tbody id="tabbody">				</tbody>				</table>				<div class="is-col">					<button id="add_issue" type="button" onclick="addRow();" 					class="button is-green">Ausgabe hinzuf&uuml;gen</button>				</div>
			</fieldset>			<br>			<fieldset>				<legend>3. Vorschuss und Sonstiges</legend>				<div class="is-row">				<div class="is-col valign="center"">						Ich habe bereits einen Vorschuss erhalten in 						H&ouml;he von:				</div>				<div class="is-col">					<input input name="advance" id="advance" type="text" placeholder="0,00 EUR"/>				</div>				</div>					<br>
				<div class="is-row">				<div class="is-col valign="center"">						Ich versichere, dass ich alle Angaben 						nach bestem Wissen und Gewissen gemacht habe:				</div>				<div class="is-col">					<input id="agree" type="checkbox" />				</div>				</div>	


			</fieldset>		</div>		<div class="is-col">			<?php include "h2.php"; ?>
		</div>					</div>		<button type="button" onclick="downloadDocument(true);"			class="button is-green">Antrag elektronisch direkt an WMDE schicken</button>
		<button type="button" onclick="downloadDocument(false);"			class="button is-orange">Antrag herunterladen und später einreichen</button>			</div>	</div>	<input type="hidden" id="banktype" name="banktype"/>  	<input type="hidden" id="sendmail" name="sendmail"/>    	<!--		<input type="submit" style="display:none" name="submitButton" />  -->	</form>	
			<!-- Kube JS (optional if you are using Kube CSS only) -->	<script src="js/kube.min.js"></script>	<script src="addons/upload/kube.upload.min.js"></script>	<script src="addons/kube-addons.min.js"></script>	<script src="kaform.js"></script>	<script src="iban.js/iban.js"></script>
      </div>    </div>      </body></html>