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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>Auslagenersatz</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. </p>
  23. <form data-kube="kaform" name="theform" id="theform" action="submit.php" method="POST">
  24. <div class="is-row">
  25. <div class="is-col is-70">
  26. <fieldset>
  27. <legend>1. Erfasse deine Stammdaten</legend>
  28. <div class="is-row">
  29. <div class="is-col">
  30. <input required type="input"
  31. size="32" id="projectid" name="project"
  32. placeholder="Projekt/Zweck der Reise*" />
  33. </div>
  34. </div>
  35. <!-- <div class="is-row">
  36. <div class="is-col">
  37. <input required type="input"
  38. size="32" id="nickname" name="nickname"
  39. placeholder="Nickname*" />
  40. </div>
  41. <div class="is-col">
  42. <input required type="input"
  43. size="32" id="projectid" name="project"
  44. placeholder="Projekt-ID*" />
  45. </div>
  46. </div>
  47. --> <br>
  48. <div class="is-row">
  49. <div class="is-col">
  50. <input required type="input" size="32"
  51. ` id="realname" name="realname" placeholder="Dein Realname (Vorname Nachname)*" />
  52. </div>
  53. <div class="is-col">
  54. <input required type="input" size="32"
  55. ` id="wmdecontact" name="wmdecontact" placeholder="Deine Ansprechperson bei Wikimedia*" />
  56. </div>
  57. </div>
  58. <br>
  59. <div class="is-row">
  60. <div class="is-col">
  61. <input required type="tel" size="32"
  62. id="phone" name="phone"
  63. placeholder="Deine Telefonnummer" />
  64. </div>
  65. <div class="is-col">
  66. </div>
  67. </div>
  68. <br>
  69. <div class="is-row">
  70. <div class="is-col">
  71. <input required type="email" size="32" id="email"
  72. name="email" placeholder="Deine E-Mail-Adresse*" />
  73. </div>
  74. <div class="is-col">
  75. </div>
  76. </div>
  77. <br>
  78. <div class="is-row">
  79. <div class="is-col">
  80. <nav class="tabs" data-kube="tabs" data-equal="false">
  81. <a href="#bank-eu" class="is-active">Banküberweisung</a>
  82. <a href="#bank-noneu">Banküberweisung(Non-EU)</a>
  83. <a href="#bank-paypal">PayPal</a>
  84. <a href="#bank-bar">Barauszahlung</a>
  85. </nav>
  86. <section id="bank-eu">
  87. <div class="is-row">
  88. <div class="is-col">
  89. <input type="input" size="32" name="Owner" placeholder="Kontoinhaberin" />
  90. </div>
  91. <div class="is-col">
  92. </div>
  93. </div>
  94. <br>
  95. <div class="is-row">
  96. <div class="is-col">
  97. <input type="input" size="32" id="iban" name="iban" placeholder="IBAN*" />
  98. </div>
  99. <div class="is-col">
  100. <input type="input" size="32" id="bic" name="bic" placeholder="BIC*" />
  101. </div>
  102. </div>
  103. <br>
  104. <!-- <input type="input" size="32" id="purpose" name="purpose" placeholder="Verwendungszweck" /> -->
  105. <textarea id="comments" name="comments"
  106. style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
  107. z.B. intermdiäre Bank,
  108. Grund für abweichende Kontoinhaberin"></textarea>
  109. </section>
  110. <section id="bank-noneu">
  111. <div class="is-row">
  112. <div class="is-col">
  113. <input type="input" size="32" name="Owner" placeholder="Kontoinhaberin" />
  114. </div>
  115. <div class="is-col">
  116. </div>
  117. </div>
  118. <br>
  119. <div class="is-row">
  120. <div class="is-col">
  121. <input type="input" size="32" id="n_iban" name="n_iban" placeholder="Kontonummer*" />
  122. </div>
  123. <div class="is-col">
  124. <input type="input" size="32" id="n_bic" name="n_bic" placeholder="BIC/SWIFT*" />
  125. </div>
  126. </div>
  127. <br>
  128. <input class="EU nonEU" type="input" size="32" id="n_bank" name="n_bankname" placeholder="Name der Bank*" />
  129. <br>
  130. <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>
  131. <br>
  132. <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)
  133. "></textarea>
  134. <br>
  135. <!-- <input type="input" size="32" id="n_purpose" name="n_purpose" placeholder="Verwendungszweck" /> -->
  136. <textarea id="n_comments" name="n_comments"
  137. style="resize:both;" cols="32" rows="4" placeholder="Weitere Anmerkungen
  138. z.B. intermdiäre Bank,
  139. Grund für abweichende Kontoinhaberin"></textarea>
  140. </section>
  141. <section id="bank-paypal">
  142. <input name="paypal" type="input" size="32"
  143. id="paypal" placeholder="Dein PayPal Account (paypal@example.com)" />
  144. </section>
  145. <section id="bank-bar">
  146. </section>
  147. </div> <!-- i-col -->
  148. </div> <!-- is-row -->
  149. </fieldset>
  150. </div>
  151. <div class="is-col ">
  152. <?php include "h1.php"; ?>
  153. </div>
  154. </div> <!-- is row -->
  155. <br>
  156. <div class="is-row">
  157. <div class="is-col is-70">
  158. <fieldset id="fieldset2">
  159. <legend>2. Erfasse deine Ausgaben</legend>
  160. <div class="is-row">
  161. <div class="is-col is-70">
  162. <div class="is-row">
  163. <div class="is-col is-60">
  164. <input id="a_date" type="date" name="type" placeholder="Datum*"/>
  165. <!-- <input id="a_type" type="text" name="type" placeholder="Auslagenart*"/> -->
  166. </div>
  167. <div class="is-col is-40">
  168. </div>
  169. </div>
  170. <br>
  171. <input id="a_description" type="text" name="description" placeholder="Beschreibung*"/>
  172. <br>
  173. <div class="is-row">
  174. <div class="is-col">
  175. <input id="a_amount" type="text" name="amount" placeholder="Betrag*"/>
  176. </div>
  177. <div class="is-col">
  178. <select id="a_currency" name="currency" >
  179. <option value="EUR">EUR</option>
  180. <option value="USD">USD</option>
  181. <option value="CHF">CHF</option>
  182. <option value="BTC">BTC</option>
  183. </select>
  184. <!-- <input id="a_currency" type="text" name="curreny" placeholder="Waehrung*"/> -->
  185. </div>
  186. <div class="is-col">
  187. <button type="button" onclick="addTableRow();"
  188. class="button is-green">Ausgabe hinzuf&uuml;gen</button>
  189. </div>
  190. </div>
  191. </div>
  192. <div class="is-col is-30">
  193. <div id="uploadfield" class="form-item">
  194. </div>
  195. </div>
  196. </div>
  197. <br>
  198. <table id="tabtab" class="is-bordered is-striped">
  199. <thead>
  200. <tr>
  201. <!-- <th>Auslagenart</th>-->
  202. <th>Datum</th>
  203. <th>Beschreibung</th>
  204. <th>Betrag</th>
  205. <th>W&auml;hrung</th>
  206. <th>L&ouml;schen</th>
  207. </tr>
  208. </thead>
  209. <tbody id="tabbody">
  210. </tbody>
  211. </table>
  212. </fieldset>
  213. </div>
  214. <div class="is-col">
  215. hilfe 2
  216. </div>
  217. </div>
  218. <button onclick="addTableRow();"
  219. class="button is-green">Antrag elektronisch versenden</button>
  220. <button type="button" onclick="downloadDocument();"
  221. class="button is-orange">Herunterladen</button>
  222. </div>
  223. </div>
  224. <input type="hidden" id="banktype" name="banktype"/>
  225. <!-- <input type="submit" style="display:none" name="submitButton" /> -->
  226. </form>
  227. <!-- Kube JS (optional if you are using Kube CSS only) -->
  228. <script src="js/kube.min.js"></script>
  229. <script src="addons/upload/kube.upload.min.js"></script>
  230. <script src="addons/kube-addons.min.js"></script>
  231. <script src="kaform.js"></script>
  232. <script src="iban.js/iban.js"></script>
  233. </div>
  234. </div>
  235. </body>
  236. </html>