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  1. <!doctype html>
  2. <html >
  3. <head>
  4. <title>Kostenerstattungsforumlar</title>
  5. <meta charset="utf-8">
  6. <meta name="viewport" content="width=device-width, initial-scale=1">
  7. <!-- Kube CSS -->
  8. <link rel="stylesheet" href="css/kube.min.css">
  9. <link rel="stylesheet" href="addons/kube-addons.min.css" />
  10. <link rel="stylesheet" href="master.css" />
  11. </head>
  12. <body>
  13. <div class="page is-container">
  14. <div class="main-sidebar">
  15. <img alt="wikimedia logo" src="Wikimedia_Deutschland-Logo.svg"/>
  16. </div>
  17. <div class="main-content">
  18. <h1>Antrag auf Kostenerstattung</h1>
  19. <p>Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines
  20. Projektes entstanden sind?<BR>
  21. Bitte fülle dieses Formular aus.
  22. Pflichtfelder sind mit einem * gekennzeichnet.
  23. </p>
  24. <form data-kube="kaform" name="theform" id="theform" action="submit.php" method="POST">
  25. <div class="is-row">
  26. <div class="is-col is-70">
  27. <fieldset>
  28. <legend>1. Erfasse deine Stammdaten</legend>
  29. <div class="is-row">
  30. <div class="is-col">
  31. <input required type="input"
  32. size="32" id="projectid" name="project"
  33. placeholder="Projekt/Zweck der Reise*" />
  34. </div>
  35. </div>
  36. <!-- <div class="is-row">
  37. <div class="is-col">
  38. <input required type="input"
  39. size="32" id="nickname" name="nickname"
  40. placeholder="Nickname*" />
  41. </div>
  42. <div class="is-col">
  43. <input required type="input"
  44. size="32" id="projectid" name="project"
  45. placeholder="Projekt-ID*" />
  46. </div>
  47. </div>
  48. --> <br>
  49. <div class="is-row">
  50. <div class="is-col">
  51. <input required type="input" size="32"
  52. ` id="realname" name="realname" placeholder="Dein Realname (Vorname Nachname)*" />
  53. </div>
  54. <div class="is-col">
  55. <input required type="input" size="32"
  56. ` id="wmdecontact" name="wmdecontact" placeholder="Deine Ansprechperson bei Wikimedia*" />
  57. </div>
  58. </div>
  59. <br>
  60. <div class="is-row">
  61. <div class="is-col">
  62. <input type="tel" size="32"
  63. id="phone" name="phone"
  64. placeholder="Deine Telefonnummer" />
  65. </div>
  66. <div class="is-col">
  67. </div>
  68. </div>
  69. <br>
  70. <div class="is-row">
  71. <div class="is-col">
  72. <input required type="email" size="32" id="email"
  73. name="email" placeholder="Deine E-Mail-Adresse*" />
  74. </div>
  75. <div class="is-col">
  76. </div>
  77. </div>
  78. <br>
  79. <div class="is-row">
  80. <div class="is-col">
  81. <nav class="tabs" data-kube="tabs" data-equal="false">
  82. <a href="#bank-eu" class="is-active">Banküberweisung</a>
  83. <a href="#bank-noneu">Banküberweisung (Non-EU)</a>
  84. <!-- <a href="#bank-paypal">PayPal</a>
  85. <a href="#bank-bar">Barauszahlung</a>
  86. --> </nav>
  87. <section id="bank-eu">
  88. <div class="is-row">
  89. <div class="is-col">
  90. <input type="input" size="32" name="Owner" placeholder="Kontoinhabende Person" />
  91. </div>
  92. <div class="is-col">
  93. </div>
  94. </div>
  95. <br>
  96. <div class="is-row">
  97. <div class="is-col">
  98. <input type="input" size="32" id="iban" name="iban" placeholder="IBAN*" />
  99. </div>
  100. <div class="is-col">
  101. <input type="input" size="32" id="bic" name="bic" placeholder="BIC (wenn ausländische Bank)" />
  102. </div>
  103. </div>
  104. <br>
  105. <!-- <input type="input" size="32" id="purpose" name="purpose" placeholder="Verwendungszweck" /> -->
  106. <textarea id="comments" name="comments"
  107. style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
  108. z.B. intermediäre Bank,
  109. Grund für abweichende Kontoinhbende Person"></textarea>
  110. </section>
  111. <section id="bank-noneu">
  112. <div class="is-row">
  113. <div class="is-col">
  114. <input type="input" size="32" name="Owner" placeholder="Kontoinhabende Person" />
  115. </div>
  116. <div class="is-col">
  117. </div>
  118. </div>
  119. <br>
  120. <div class="is-row">
  121. <div class="is-col">
  122. <input type="input" size="32" id="n_iban" name="n_iban" placeholder="Kontonummer*" />
  123. </div>
  124. <div class="is-col">
  125. <input type="input" size="32" id="n_bic" name="n_bic" placeholder="BIC/SWIFT*" />
  126. </div>
  127. </div>
  128. <br>
  129. <input class="EU nonEU" type="input" size="32" id="n_bank" name="n_bankname" placeholder="Name der Bank*" />
  130. <br>
  131. <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>
  132. <br>
  133. <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)
  134. "></textarea>
  135. <br>
  136. <!-- <input type="input" size="32" id="n_purpose" name="n_purpose" placeholder="Verwendungszweck" /> -->
  137. <textarea id="n_comments" name="n_comments"
  138. style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
  139. z.B. intermediäre Bank,
  140. Grund für abweichende Kontoinhabende Person"></textarea>
  141. </section>
  142. <!-- <section id="bank-paypal">
  143. <input name="paypal" type="input" size="32"
  144. id="paypal" placeholder="Dein PayPal Account (paypal@example.com)" />
  145. </section> -->
  146. <!-- <section id="bank-bar">
  147. </section> -->
  148. </div> <!-- i-col -->
  149. </div> <!-- is-row -->
  150. </fieldset>
  151. </div>
  152. <div class="is-col ">
  153. <?php include "h1.php"; ?>
  154. </div>
  155. </div> <!-- is row -->
  156. <br>
  157. <div class="is-row">
  158. <div class="is-col is-70">
  159. <fieldset id="fieldset2">
  160. <legend>2. Erfasse deine Ausgaben</legend>
  161. <div class="is-row">
  162. <div class="is-col is-70">
  163. <div class="is-row">
  164. <div class="is-col is-60">
  165. <input id="a_date" type="date" name="a_date" placeholder="Datum*"/>
  166. <!-- <input id="a_type" type="text" name="type" placeholder="Auslagenart*"/> -->
  167. </div>
  168. <div class="is-col is-40">
  169. </div>
  170. </div>
  171. <br>
  172. <input id="a_description" type="text" name="description" placeholder="Beschreibung*"/>
  173. <br>
  174. <div class="is-row">
  175. <div class="is-col">
  176. <input id="a_amount" type="text" name="amount" placeholder="Betrag*"/>
  177. </div>
  178. <div class="is-col">
  179. <select disabled id="a_currency" name="currency" >
  180. <option value="EUR">EUR</option>
  181. <option value="USD">USD</option>
  182. <option value="CHF">CHF</option>
  183. <option value="BTC">BTC</option>
  184. </select>
  185. <!-- <input id="a_currency" type="text" name="curreny" placeholder="Waehrung*"/> -->
  186. </div>
  187. <div class="is-col">
  188. <button type="button" onclick="addTableRow();"
  189. class="button is-green">Ausgabe hinzuf&uuml;gen</button>
  190. </div>
  191. </div>
  192. </div>
  193. <div class="is-col is-30">
  194. <div id="uploadfield" class="form-item">
  195. </div>
  196. </div>
  197. </div>
  198. <br>
  199. <table id="tabtab" class="is-bordered is-striped">
  200. <thead>
  201. <tr>
  202. <!-- <th>Auslagenart</th>-->
  203. <th>Datum</th>
  204. <th>Beschreibung</th>
  205. <th>Betrag</th>
  206. <th>W&auml;hrung</th>
  207. <th>L&ouml;schen</th>
  208. </tr>
  209. </thead>
  210. <tbody id="tabbody">
  211. </tbody>
  212. </table>
  213. </fieldset>
  214. <br>
  215. <fieldset>
  216. <legend>3. Vorschuss und Sonstiges</legend>
  217. <div class="is-row">
  218. <div class="is-col valign="center"">
  219. Ich habe bereits einen Vorschuss erhalten in
  220. H&ouml;he von:
  221. </div>
  222. <div class="is-col">
  223. <input input name="advance" id="advance" type="text" placeholder="0,00 EUR"/>
  224. </div>
  225. </div>
  226. <br>
  227. <div class="is-row">
  228. <div class="is-col valign="center"">
  229. Ich versichere, dass ich alle Angaben
  230. nach bestem Wissen und Gewissen gemacht habe:
  231. </div>
  232. <div class="is-col">
  233. <input id="agree" type="checkbox" />
  234. </div>
  235. </div>
  236. </fieldset>
  237. </div>
  238. <div class="is-col">
  239. <?php include "h2.php"; ?>
  240. </div>
  241. </div>
  242. <button onclick="downloadDocument(true);"
  243. class="button is-green">Antrag elektronisch direkt an WMDE schicken</button>
  244. <button type="button" onclick="downloadDocument(false);"
  245. class="button is-orange">Antrag herunterladen und später einreichen</button>
  246. </div>
  247. </div>
  248. <input type="hidden" id="banktype" name="banktype"/>
  249. <input type="hidden" id="sendmail" name="sendmail"/>
  250. <!-- <input type="submit" style="display:none" name="submitButton" /> -->
  251. </form>
  252. <!-- Kube JS (optional if you are using Kube CSS only) -->
  253. <script src="js/kube.min.js"></script>
  254. <script src="addons/upload/kube.upload.min.js"></script>
  255. <script src="addons/kube-addons.min.js"></script>
  256. <script src="kaform.js"></script>
  257. <script src="iban.js/iban.js"></script>
  258. </div>
  259. </div>
  260. </body>
  261. </html>