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<! doctype html >
< html >
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< head >
< title > Kostenerstattungsforumlar </ title >
< meta charset = " utf-8 " >
< meta name = " viewport " content = " width=device-width, initial-scale=1 " >
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<!-- Kube CSS -->
< link rel = " stylesheet " href = " css/kube.min.css " >
< link rel = " stylesheet " href = " addons/kube-addons.min.css " />
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< link rel = " stylesheet " href = " master.css " />
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</ head >
< body >
< div class = " page is-container " >
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< div class = " main-sidebar " >
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< img alt = " wikimedia logo " src = " Wikimedia_Deutschland-Logo.svg " />
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</ div >
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< div class = " main-content " >
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< h1 > Antrag auf Kostenerstattung </ h1 >
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< p > Du möchtest dir Kosten erstatten lassen , welche im Rahmen deines
Projektes entstanden sind ? < BR >
Bitte fülle dieses Formular aus ...
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</ p >
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< form data - kube = " kaform " name = " theform " id = " theform " action = " submit.php " method = " POST " >
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< div class = " is-row " >
< div class = " is-col is-70 " >
< fieldset >
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< legend > 1. Erfasse deine Stammdaten </ legend >
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< div class = " is-row " >
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< 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 " >
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< 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 "
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size = " 32 " id = " projectid " name = " project "
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placeholder = " Projekt-ID* " />
</ div >
</ div >
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--> < br >
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< div class = " is-row " >
< div class = " is-col " >
< input required type = " input " size = " 32 "
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` id = " realname " name = " realname " placeholder = " Dein Realname (Vorname Nachname)* " />
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</ div >
< div class = " is-col " >
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< input required type = " input " size = " 32 "
` id = " wmdecontact " name = " wmdecontact " placeholder = " Deine Ansprechperson bei Wikimedia* " />
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</ div >
</ div >
< br >
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< div class = " is-row " >
< div class = " is-col " >
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< input type = " tel " size = " 32 "
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id = " phone " name = " phone "
placeholder = " Deine Telefonnummer " />
</ div >
< div class = " is-col " >
</ div >
</ div >
< br >
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< div class = " is-row " >
< div class = " is-col " >
< input required type = " email " size = " 32 " id = " email "
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name = " email " placeholder = " Deine E-Mail-Adresse* " />
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</ div >
< div class = " is-col " >
</ div >
</ div >
< br >
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< div class = " is-row " >
< div class = " is-col " >
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< nav class = " tabs " data - kube = " tabs " data - equal = " false " >
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< a href = " #bank-eu " class = " is-active " > Banküberweisung </ a >
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< a href = " #bank-noneu " > Banküberweisung ( Non - EU ) </ a >
<!-- < a href = " #bank-paypal " > PayPal </ a >
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< a href = " #bank-bar " > Barauszahlung </ a >
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--> </ nav >
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< section id = " bank-eu " >
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< div class = " is-row " >
< div class = " is-col " >
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< input type = " input " size = " 32 " name = " Owner " placeholder = " Kontoinhabende Person " />
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</ div >
< div class = " is-col " >
</ div >
</ div >
< br >
< div class = " is-row " >
< div class = " is-col " >
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< input type = " input " size = " 32 " id = " iban " name = " iban " placeholder = " IBAN* " />
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</ div >
< div class = " is-col " >
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< input type = " input " size = " 32 " id = " bic " name = " bic " placeholder = " BIC* " />
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</ div >
</ div >
< br >
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<!-- < 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
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z . B . intermediäre Bank ,
Grund für abweichende Kontoinhbende Person " ></textarea>
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</ section >
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< section id = " bank-noneu " >
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< div class = " is-row " >
< div class = " is-col " >
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< input type = " input " size = " 32 " name = " Owner " placeholder = " Kontoinhabende Person " />
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</ div >
< div class = " is-col " >
</ div >
</ div >
< br >
< div class = " is-row " >
< div class = " is-col " >
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< input type = " input " size = " 32 " id = " n_iban " name = " n_iban " placeholder = " Kontonummer* " />
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</ div >
< div class = " is-col " >
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< input type = " input " size = " 32 " id = " n_bic " name = " n_bic " placeholder = " BIC/SWIFT* " />
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</ div >
</ div >
< br >
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< input class = " EU nonEU " type = " input " size = " 32 " id = " n_bank " name = " n_bankname " placeholder = " Name der Bank* " />
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< br >
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< 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 >
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< br >
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< 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)
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" ></textarea>
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< br >
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<!-- < 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
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z . B . intermediäre Bank ,
Grund für abweichende Kontoinhabende Person " ></textarea>
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</ section >
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<!-- < section id = " bank-paypal " >
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< input name = " paypal " type = " input " size = " 32 "
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id = " paypal " placeholder = " Dein PayPal Account (paypal@example.com) " />
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</ section > -->
<!-- < section id = " bank-bar " >
</ section > -->
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</ div > <!-- i - col -->
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</ div > <!-- is - row -->
</ fieldset >
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</ div >
< div class = " is-col " >
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< ? php include " h1.php " ; ?>
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</ div >
</ div > <!-- is row -->
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< br >
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< div class = " is-row " >
< div class = " is-col is-70 " >
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< fieldset id = " fieldset2 " >
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< legend > 2. Erfasse deine Ausgaben </ legend >
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< div class = " is-row " >
< div class = " is-col is-70 " >
< div class = " is-row " >
< div class = " is-col is-60 " >
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< input id = " a_date " type = " date " name = " a_date " placeholder = " Datum* " />
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<!-- < input id = " a_type " type = " text " name = " type " placeholder = " Auslagenart* " /> -->
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</ div >
< div class = " is-col is-40 " >
</ div >
</ div >
< br >
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< input id = " a_description " type = " text " name = " description " placeholder = " Beschreibung* " />
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< br >
< div class = " is-row " >
< div class = " is-col " >
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< input id = " a_amount " type = " text " name = " amount " placeholder = " Betrag* " />
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</ div >
< div class = " is-col " >
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< select disabled id = " a_currency " name = " currency " >
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< 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* " /> -->
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</ div >
< div class = " is-col " >
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< button type = " button " onclick = " addTableRow(); "
class = " button is-green " > Ausgabe hinzuf & uuml ; gen </ button >
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</ div >
</ div >
</ div >
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< div class = " is-col is-30 " >
< div id = " uploadfield " class = " form-item " >
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</ div >
</ div >
</ div >
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< br >
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< table id = " tabtab " class = " is-bordered is-striped " >
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< thead >
< tr >
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<!-- < th > Auslagenart </ th >-->
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< th > Datum </ th >
< th > Beschreibung </ th >
< th > Betrag </ th >
< th > W & auml ; hrung </ th >
< th > L & ouml ; schen </ th >
</ tr >
</ thead >
< tbody id = " tabbody " >
</ tbody >
</ table >
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</ 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 " >
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< input input name = " advance " id = " advance " type = " text " placeholder = " 0,00 EUR " />
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</ 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 >
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</ fieldset >
</ div >
< div class = " is-col " >
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< ? php include " h2.php " ; ?>
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</ div >
</ div >
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< button onclick = " downloadDocument(true); "
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class = " button is-green " > Antrag elektronisch versenden </ button >
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< button type = " button " onclick = " downloadDocument(false); "
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class = " button is-orange " > Herunterladen </ button >
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</ div >
</ div >
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< input type = " hidden " id = " banktype " name = " banktype " />
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< input type = " hidden " id = " sendmail " name = " sendmail " />
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<!-- < input type = " submit " style = " display:none " name = " submitButton " /> -->
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</ form >
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<!-- 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 >
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< script src = " iban.js/iban.js " ></ script >
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</ div >
</ div >
</ body >
</ html >
