Linux SRV-16 6.18.44-paas #1 SMP PREEMPT_DYNAMIC Thu Aug 13 10:08:12 UTC 2026 x86_64
/srv/data/trash/vhost_www.sanimoderne.fr_1511970463/htdocs/old/pages/
//srv/data/trash/vhost_www.sanimoderne.fr_1511970463/htdocs/old/pages/devis.php
 <?php
	//start_block('title','keywords','description')
	start_block('','','');
?>
<?php include "functions/devis.php" ?>
<div id="devis">
	<h1 id="formD">Devis</h1>

	<?php if ($form_has_errors): ?>
		<div class='alert alert-danger alert-dismissable'>
		  <button type='button' class='close' data-dismiss='alert' aria-hidden='true'>&times;</button>
		  <strong>Erreur!</strong> Nous n'avons pas reçu votre demande, merci de vérifier que les champs obligatoires du formulaire sont correctement remplis.
		</div>
	<?php endif ?>

	<div class="row">
		<div class="col-sm-12">
			<?=form_open($routes['devis'],array('enctype'=>'multipart/form-data'))?>
				<div class="row">
					<div class="col-sm-5">
						<fieldset>
							<legend>Coordonnées</legend>
							
							<div class="row">
								
								<div class="col-sm-12">
									<div class="form-group has-feedback <?=$data['lastname']['status']?>">
										<?=form_label($data['lastname']['label'],'lastname')?>
										<?=form_text('lastname',$data['lastname']['value'],array('class'=>'form-control','placeholder'=>'NOM'))?>
										<?=form_feedback($form_is_submitted,$data['lastname']['status'])?>
									</div>
								</div>
							</div>
							
							<?php /* PSEUDO utilisé pour bloquer les robots, ne pas afficher. Si le robot rempli ce champs, il est redirigé sur la page success sans envoyer le mail */ ?>
							<div class="form-group has-feedback pseudoForm">
								<?=form_label($data['pseudo']['label'],'pseudo')?>
								<?=form_text('pseudo',$data['pseudo']['value'],array('class'=>'form-control','placeholder'=>'Pseudonyme'))?>
								<?=form_feedback($form_is_submitted,$data['pseudo']['status'])?>
							</div>
							<div class="form-group has-feedback <?=$data['address']['status']?>">
								<?=form_label($data['address']['label'],'address')?>
								<?=form_text('address',$data['address']['value'],array('class'=>'form-control','placeholder'=>'Adresse'))?>
								<?=form_feedback($form_is_submitted,$data['address']['status'])?>
							</div>
							<div class="row">
								<div class="col-sm-5">
									<div class="form-group has-feedback <?=$data['zipcode']['status']?>">
										<?=form_label($data['zipcode']['label'],'zipcode')?>
										<?=form_text('zipcode',$data['zipcode']['value'],array('class'=>'form-control','placeholder'=>'75001'))?>
										<?=form_feedback($form_is_submitted,$data['zipcode']['status'])?>
									</div>
								</div>
								<div class="form-group has-feedback <?=$data['address2']['status']?>">
								<?=form_label($data['address2']['label'],'address2')?>
								<?=form_text('address2',$data['address2']['value'],array('class'=>'form-control','placeholder'=>'Adresse'))?>
								<?=form_feedback($form_is_submitted,$data['address2']['status'])?>
							</div>
								<div class="col-sm-7">
									<div class="form-group has-feedback <?=$data['city']['status']?>">
										<?=form_label($data['city']['label'],'city')?>
										<?=form_text('city',$data['city']['value'],array('class'=>'form-control','placeholder'=>'Ville'))?>
										<?=form_feedback($form_is_submitted,$data['city']['status'])?>
									</div>
								</div>
							</div>
							<div class="form-group has-feedback <?=$data['email']['status']?>">
								<?=form_label($data['email']['label'],'email')?>
								<?=form_text('email',$data['email']['value'],array('class'=>'form-control','placeholder'=>'text@exemple.fr'))?>
								<?=form_feedback($form_is_submitted,$data['email']['status'])?>
							</div>
							<div class="form-group has-feedback <?=$data['phone']['status']?>">
								<?=form_label($data['phone']['label'],'phone')?>
								<?=form_text('phone',$data['phone']['value'],array('class'=>'form-control','placeholder'=>'06 00 00 00 00'))?>
								<?=form_feedback($form_is_submitted,$data['phone']['status'])?>
							</div>
						</fieldset>
						
					</div>
					<div class="col-sm-6 col-sm-offset-1">
						<fieldset>
							<legend>Demande</legend>
							<div class="form-group has-feedback <?=$data['select1']['status']?>">
								<?=form_label($data['select1']['label'],'select1')?>
								<?=form_select('select1',$data['select1']['value'],array("opt1","opt2","opt3"),array('class'=>'form-control'))?>
							</div>

							<div class="form-group has-feedback <?=$data['select2']['status']?>">
								<?=form_label($data['select2']['label'],'select2')?>
								<?=form_select('select2',$data['select2']['value'],array("opt1","opt2","opt3"),array('class'=>'form-control'))?>
							</div>

							<div class="form-group has-feedback <?=($form_is_submitted)?'has-success':''?>">
								<label>Prestations</label>
								<div class="checkbox" style="margin-top: 0;">
									<?=form_checkbox('checkbox1',$data['checkbox1']['value'],$data['checkbox1']['label'])?>
								</div>
								<div class="checkbox" style="margin-top: 0;">
									<?=form_checkbox('checkbox2',$data['checkbox2']['value'],$data['checkbox2']['label'])?>
								</div>
								
								<?=form_feedback($form_is_submitted,'has-success')?>
							</div>
							<div class="form-group has-feedback <?=$data['radio1']['status']?>">
								<?=form_label($data['radio1']['label']['title'],'radio1')?>
								<div class="radio" style="margin-top: 0;">
									<?=form_radio('radio1',$data['radio1']['value'],'option1',$data['radio1']['label']['options']['option1'],$form_is_submitted)?>
								</div>
								<div class="radio">
									<?=form_radio('radio1',$data['radio1']['value'],'option2',$data['radio1']['label']['options']['option2'])?>
								</div>
								<?=form_feedback($form_is_submitted,$data['radio1']['status'])?>
							</div>
							
							<div class="form-group <?=$data['amount1']['status']?>">
								<?=form_label($data['amount1']['label'],'amount1')?>
								<div class="input-group">
									<?=form_text('amount1',$data['amount1']['value'],array('class'=>'form-control','placeholder'=>'29,90'))?>
									<span class="input-group-addon"><span class="fa fa-eur fa-fw"></span></span>
								</div>
							</div>
							<div class="form-group has-feedback <?=$data['date1']['status']?>">
								<?=form_label($data['date1']['label'],'date1')?>
								<div class="input-group bootstrap-datepicker">
									<?=form_text('date1',$data['date1']['value'],array('class'=>'form-control','placeholder'=>date("d/m/Y")))?>
									<span class="input-group-addon"><span class="fa fa-calendar fa-fw"></span></span>
								</div>
							</div>
							
						</fieldset>
					</div>
				</div>
				<div class="form-group has-feedback <?=$data['message']['status']?>">
					<?=form_label($data['message']['label'],'message')?>
					<?=form_textarea('message',$data['message']['value'],array('class'=>'form-control','rows'=>'6'))?>
				</div>
				<br>
				<div class="text-center">
					<button type="reset" class="btn btn-default">Annuler</button>
					<button type="submit" name="devis" class="btn btn-success">Envoyer</button>
				</div>
			<?=form_close()?>
		</div>
	</div>
</div>
<?php end_block(); ?>