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.glodie-evenements.com_1516803304/htdocs/modules/
/srv/data/trash/vhost_www.glodie-evenements.com_1516803304/htdocs/modules/pre-devis2.php
 <?php include "functions/devis-ligne2.php"; ?>
   <div class="ligne-devis col-sm-10 col-sm-offset-1 ">
      <!--   <h2>Ne perdez plus de temps, réservez votre chauffeur ! </h2> -->
<?=form_open($slug."#contact1") ?>
 <div class="row pad1" >
    <div class="col-sm-4 ">
      <div class="form-group has-feedback <?=$data['lastname']['status']?>">
        
        <input type="text" class="form-control " id="lastname" name="lastname" value="<?=$data['lastname']['value']?>" placeholder="Nom">
        <?php if($form_is_submitted)echo"<span class='fa ".(($data['lastname']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
       <!--    <label for="lastname">Nom</label> -->
      </div>
    </div>
    <div class="col-sm-4 ">
      <div class="form-group has-feedback <?=$data['email']['status']?>">
        
        <input type="text" class="form-control " id="email" name="email" value="<?=$data['email']['value']?>" placeholder="E-mail">
        <?php if($form_is_submitted)echo"<span class='fa ".(($data['email']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
       <!--    <label for="email">E-mail</label> -->
      </div>
    </div>
    <div class="col-sm-4">
      <div class="form-group has-feedback <?=$data['phone']['status']?>">
        
        <input type="text" class="form-control " id="phone" name="phone" value="<?=$data['phone']['value']?>" placeholder="Téléphone">
        <?php if($form_is_submitted)echo"<span class='fa ".(($data['phone']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
        <!-- <label for="phone">Téléphone</label> -->
      </div>
    </div>
    <div class="col-sm-12">
    <div class="form-group has-feedback <?=$data['message']['status']?>" >
          
          <?=form_textarea('message',str_ireplace("<br>", "\r\n", $data['message']['value']),array('class'=>'form-control','rows'=>'6','placeholder'=>'Message'))?>
        <!--   <?=form_label($data['message']['label'],'message')?> -->
          <?=form_feedback($form_is_submitted,$data['message']['status'])?>
        </div>
    </div>

 </div>
 <div class="div02"></div>
 <div class="row">
   <div class="col-xs-12 text-center">
   <button type='submit' name="devis2" class='button2 btn3'> Envoyer  </button>
   </div>
 </div>
 </div>
<?=form_close()?>