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- <!doctype html>
- <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">
-
- <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>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>
- <!-- <div class="is-row">
- <div class="is-col">
- <input required type="input"
- size="32" id="nickname" name="nickname"
- placeholder="Nickname*" />
- </div>
- <div class="is-col">
- <input required type="input"
- size="32" id="projectid" name="project"
- placeholder="Projekt-ID*" />
- </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 (Straße 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 (Srtaße 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-row">
- <div class="is-col is-70">
- <div class="is-row">
- <div class="is-col is-60">
- <input id="a_date" type="date" name="a_date" placeholder="Datum*"/>
-
- <!-- <input id="a_type" type="text" name="type" placeholder="Auslagenart*"/> -->
- </div>
- <div class="is-col is-40">
- </div>
- </div>
- <br>
- <input id="a_description" type="text" name="description" placeholder="Beschreibung*"/>
- <br>
-
- <div class="is-row">
- <div class="is-col">
- <input id="a_amount" type="text" name="amount" placeholder="Betrag*"/>
- </div>
- <div class="is-col">
- <select disabled id="a_currency" name="currency" >
- <option value="EUR">EUR</option>
- <option value="USD">USD</option>
- <option value="CHF">CHF</option>
- <option value="BTC">BTC</option>
- </select>
- <!-- <input id="a_currency" type="text" name="curreny" placeholder="Waehrung*"/> -->
- </div>
- <div class="is-col">
- <button type="button" onclick="addTableRow();"
- class="button is-green">Ausgabe hinzufügen</button>
- </div>
- </div>
-
- </div>
- <div class="is-col is-30">
- <div id="uploadfield" class="form-item">
- </div>
- </div>
- </div>
- <br>
- <table id="tabtab" class="is-bordered is-striped">
- <thead>
- <tr>
- <!-- <th>Auslagenart</th>-->
- <th>Pos.</th>
- <th>Datum</th>
- <th>Beschreibung</th>
- <th>Betrag</th>
- <th>Belege</th>
- <th>Löschen</th>
- </tr>
- </thead>
- <tbody id="tabbody">
- </tbody>
-
- </table>
- </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
- Höhe 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>
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