alpcentaur
/
wmdeit_kaform

<!doctype html><html ><head>	<title>Kostenerstattungsforumlar</title>	<meta charset="utf-8">		<meta name="viewport" content="width=device-width, initial-scale=1">
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</head><body>	<div class="page is-container">	<div class="main-sidebar">Wikimedia Logo</div>      	<div class="main-content">    		<h1>Auslagenersatz</h1>		<p>Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines		Projektes entstanden sind?<BR>		Bitte fülle dieses Formular aus ...		</p>
		<form name="theform" id="theform" action="submit.php" method="POST">
		<div class="is-row">		<div class="is-col is-70">			<fieldset>				<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="projekt" name="project"						   placeholder="Projekt-ID*" />					</div>				</div>				<br>				<div class="is-row">					<div class="is-col"> 						<input required type="input" size="32"				`			name="realname" placeholder="Realname*" />					</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="E-Mail-Adresse*" />					</div>					<div class="is-col"> 					</div>				</div>				<br>
				<div class="is-row">					<div class="is-col"> 
			<input class="screen" type="radio"  id="eu"				   name="bank" value="EU" checked>			<label class="screen radio" for="eu">EU-Banküberweisung</label>			<br>			<input class="screen" type="radio"				   id="noneu" name="bank" value="Non-EU">			    <label class="screen radio" for="noneu">				      Non-EU-Banküberweisung</label>			<br>			<input class="screen" type="radio" id="paypal"				   name="bank" value="PayPal">			<label class="screen radio" for="paypal">PayPal</label>			<br>			<input class="screen" type="radio" id="bar"				name="bank" value="Bar">			<label class="screen radio" for="bar" lang="de">	      			Bargeld</label>			<br><br>				
			<label class="EU nonEU" for="owner" >Kontoinhaber</label>	    		<input class="EU nonEU" type="input" size="32" id="ownerDe" name="Owner" placeholder="wenn abweichend vom Realnamen" />
			<label class="EU nonEU" for="iban" >IBAN</label>			<input class="EU nonEU" type="input" size="32" id="iban" name="IBAN" placeholder="DE0123…" />
			<label class="EU nonEU" for="bic">BIC / SWIFT</label>			<input class="EU nonEU" type="input" size="32" id="bic" name="BIC" placeholder="LBMU…" />

			<label class="EU nonEU" for="bank" >Name der Bank</label>			<input class="EU nonEU" type="input" size="32" id="bank" name="Bankname" placeholder="Banky McBankface" />


			<label class="nonEU" for="bankaddress" >Bankanschrift</label>			<textarea  class="nonEU" name="bankaddress" id="bankaddress" style="resize:both;" cols="32" rows="4" placeholder="Straße und HausnummerPostleitzahl und OrtLand"></textarea>
			<label class="nonEU"  for="address" >Deine Anschrift</label>			<textarea name="address" lang="de" class="nonEU" id="address" style="resize:both;" cols="32" rows="4" placeholder="Straße und HausnummerPostleitzahl und OrtLand"></textarea>			<label class="EU nonEU" for="comments" lang="de">Weitere Anmerkungen</label>			<textarea  class="EU nonEU" id="comments" name="comments"					style="resize:both;" cols="32" rows="4" placeholder="z.B. intermdiäre Bank,Grund für abweichende Kontoinhaberin"></textarea>

			<label class="paypal" for="accountnumber">			  PayPal account</label>			<input class="paypal" type="input" size="32"			       id="paypal" placeholder="paypal@example.com" />
			</div> <!-- i-col -->				</div> <!-- is-row -->
			</fieldset>		</div>		<div class="is-col ">			Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext		</div>		</div> <!-- is row -->		Hallo
		</div>	</div>	  		<fieldset>			<legend>Deine Ansprechperson bei Wikimedia</legend>			<input required type="input" size="32" id="wmdecontact"			name="wmdecontact" placeholder="John Doe" />		</fieldset>
		<fieldset>			<legend>Deine Kontaktdaten</legend>			<label for="realname" >Dein Realname</label>			<input required type="input" size="32"				name="realname" placeholder="Corinna Commonsuser" />				<label for="email">E-Mail-Adresse</label>			<input required type="email" size="32" id="email"				name="email" placeholder="name@example.org" />	    			<label for="phone" >Telefonnummer</label>				<input required type="tel" size="32" "phone" name="phone"				placeholder="0123-456789" />		</fieldset>

	  		<fieldset id="bankdetails">			<legend>Auszahlungsweg</legend>
			<input class="screen" type="radio"  id="eu"				   name="bank" value="EU" checked>			<label class="screen radio" for="eu">EU-Banküberweisung</label>			<br>			<input class="screen" type="radio"				   id="noneu" name="bank" value="Non-EU">			    <label class="screen radio" for="noneu">				      Non-EU-Banküberweisung</label>			<br>			<input class="screen" type="radio" id="paypal"				   name="bank" value="PayPal">			<label class="screen radio" for="paypal">PayPal</label>			<br>			<input class="screen" type="radio" id="bar"				name="bank" value="Bar">			<label class="screen radio" for="bar" lang="de">	      			Bargeld</label>			<br><br>				
			<label class="EU nonEU" for="owner" >Kontoinhaber</label>	    		<input class="EU nonEU" type="input" size="32" id="ownerDe" name="Owner" placeholder="wenn abweichend vom Realnamen" />
			<label class="EU nonEU" for="iban" >IBAN</label>			<input class="EU nonEU" type="input" size="32" id="iban" name="IBAN" placeholder="DE0123…" />
			<label class="EU nonEU" for="bic">BIC / SWIFT</label>			<input class="EU nonEU" type="input" size="32" id="bic" name="BIC" placeholder="LBMU…" />

			<label class="EU nonEU" for="bank" >Name der Bank</label>			<input class="EU nonEU" type="input" size="32" id="bank" name="Bankname" placeholder="Banky McBankface" />


			<label class="nonEU" for="bankaddress" >Bankanschrift</label>			<textarea  class="nonEU" name="bankaddress" id="bankaddress" style="resize:both;" cols="32" rows="4" placeholder="Straße und HausnummerPostleitzahl und OrtLand"></textarea>
			<label class="nonEU"  for="address" >Deine Anschrift</label>			<textarea name="address" lang="de" class="nonEU" id="address" style="resize:both;" cols="32" rows="4" placeholder="Straße und HausnummerPostleitzahl und OrtLand"></textarea>			<label class="EU nonEU" for="comments" lang="de">Weitere Anmerkungen</label>			<textarea  class="EU nonEU" id="comments" name="comments"					style="resize:both;" cols="32" rows="4" placeholder="z.B. intermdiäre Bank,Grund für abweichende Kontoinhaberin"></textarea>

			<label class="paypal" for="accountnumber">			  PayPal account</label>			<input class="paypal" type="input" size="32"			       id="paypal" placeholder="paypal@example.com" />	  </fieldset>	  	  	  <label>Dein Projekt / Zweck der Reise</label>	  <input type="text" name="projekt"/>	  <br> 	  <h2>Bitte trage deine einzelnen Kostenpositionen ein.</h2>	  <p>	    Bitte trage nur eine Ausgabe pro Zeile ein, lege den	    Originalbeleg dem Antrag bei und kennzeichne den Beleg	    mit der entsprechenden Zeilennummer. Aus der Beschreibung	    soll zu ersehen sein, ob es sich um Transport, Dienstleistung,	    Materialien, Verpflegung oder ähnliches handelt.	  </p>	  	  	  <table id="tabtab" class="is-bordered">	    <thead>	      <tr>		<th>Pos.</th>		<th>Beschreibung</th>		<th>Belegdatum</th>		<th>Betrag</th>		<th>Beleg</th>	      </tr>	    </thead>	    <tbody id="tabbody">	    </tbody>	    	  </table>		<input type="submit" style="display:none" name="submitButton" />   	</form>		<button onclick="addTableRow();"		class="button">Position hinzuf&uuml;gen</button>	<button onclick="document.theform.submitButton.click();"		class="button">Absenden</button>				<!-- 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>      </div>    </div>      </body></html>