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/modules/

/srv/data/trash/vhost_www.sanimoderne.fr_1511970463/htdocs/modules/pre-devis.php

 <?php include "functions/devis-ligne.php"; ?>
 
      <!--   <h2>Ne perdez plus de temps, réservez votre chauffeur ! </h2> -->
<?=form_open($routes['home']) ?>
  <div class=" col-sm-4 col-sm-offset-8">
 <div class="row pad1">
    <div class="col-sm-12 ">
      <div class="form-group has-feedback <?=$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-12">
      <div class="form-group has-feedback <?=$data['email']['status']?>">
        
        <input type="text" class="form-control " id="email" name="email" value="<?=$data['email']['value']?>" placeholder="Mail">
        <?php if($form_is_submitted)echo"<span class='fa ".(($data['email']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
       <!--    <label for="email">E-mail</label> -->
      </div>
    </div>
    <div class="col-sm-12">
      <div class="form-group has-feedback <?=$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>
     <div class="col-sm-12 text-center">
          <button type='submit' name="devis" class='button '><span>Envoyer</span>  </button>
    </div>

    
  



<?=form_close()?>