alpcentaur
/
wmdeit_kaform

<!doctype html><?php
	$lang=$_GET['lang'];	if ( in_array ($lang, array('en_US'))){
		$loc = "$lang".".utf8";		$loc1 = $lang;	}	else		$loc = "de_DE";


	$domain = "messages";
	setlocale(LC_MESSAGES, $loc); 	setlocale(LC_ALL, $loc); 
	$results = putenv("LC_ALL=$loc");	$results = putenv("LC_MESSAGES=$loc");	$results = bindtextdomain($domain,"./locale");?>
<html ><head>	<title>Kostenerstattungsformular</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>		<?php echo _( "Antrag auf Kostenerstattung")?>
		</h1>		<p>		<?php echo _("Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines Projektes entstanden sind?")?><BR>
		<?php echo _("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="<?php echo _("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="<?php echo _("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 				$ct = @file_get_contents( "./locale/$loc1/h1.php"); 			if ($ct==false)				$ct = file_get_contents( "h1.php"); 			echo $ct;
		?>
		</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"">						<?=_("Hiermit bestätige ich die Vollständig- und Richtigkeit meiner Angaben:")?>*
				</div>				<div class="is-col">					<input id="agree" type="checkbox" />				</div>				</div>				</fieldset>		<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 class="is-col">		<?php 			$ct = @file_get_contents( "./locale/$loc1/h2.php"); 			if ($ct==false)				$ct = file_get_contents( "h2.php"); 			echo $ct;
		?>
		</div>					</div>
		</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="iban.js/iban.js"></script>	<script src="js/kaform.js"></script>
      </div>    </div>      </body></html>