Linux SRV-16 6.18.44-paas #1 SMP PREEMPT_DYNAMIC Thu Aug 13 10:08:12 UTC 2026 x86_64
/srv/data/web/vhosts/www.taxi-78.com/htdocs/modules/
/srv/data/web/vhosts/www.taxi-78.com/htdocs/modules/pre-contact.php
 <?php include "functions/pre-contact.php"; ?>
<?=form_open("$slug#pre-contact") ?>
<div class="row">
      <div class="col-sm-12">
         <div class="form-group has-feedback <?=$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 ".(($data['lastname']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
         </div>
      </div>
      <div class="col-sm-12">
         <div class="form-group has-feedback <?=$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 ".(($data['phone']['status']=="has-success")?"fa-check":"fa-times" )." form-control-feedback'></span>" ?>
         </div>
      </div>
      <div class="col-sm-12">
         <div class="form-group has-feedback <?=$data['address']['status']?>">
            <?=form_text('address',$data['address']['value'],array('class'=>'form-control','placeholder'=>'Adresse de départ'))?>
            <?=form_feedback($form_is_submitted,$data['address']['status'])?>
         </div>
      </div>
      <div class='col-sm-12'>
         <div class="form-group has-feedback <?=$data['message']['status']?>">
            <textarea rows="6" name="message" class="form-control" id="message" placeholder='Message'><?= $data['message']['value'] ?></textarea>
         </div>
      </div>
</div>
<div class="div01"></div>
<div class="row ">
   <div class="col-xs-12 text-center">
      <button type='submit' name="precontact" class="button">
         <span class='txt'>Envoyer</span>
      </button>
   </div>
</div>
<?=form_close()?>