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/pages/
/srv/data/web/vhosts/www.taxi-78.com/htdocs/pages/reservation12.php
 <?php
  //start_block('title','keywords','description')
  start_block('','','');
  ?>
<?php include "functions/devis.php" ?>

<section class="bg-gray">
  <div class="container">
    <div id="devis">
      <?php if ($form_has_errors): ?>
      <div class='alert alert-danger alert-dismissable'>
        <button type='button' class='close' data-dismiss='alert' aria-hidden='true'>&times;</button>
        Nous n'avons pas reçu votre demande, merci de vérifier que les champs obligatoires du formulaire sont correctement renseignés.
      </div>
      <?php endif ?>
      <div class="row">
        <div class="col-sm-12 text-center">
          <h1>Demande de <strong>réservation en ligne</strong></h1>
          <div class="pad20"></div>
        </div>
        <div class="col-sm-12">
          <?=form_open($routes['reservation'],array('enctype'=>'multipart/form-data'))?>
          <div class="row">
            <div class="col-sm-12">
              <div class="row">
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$data['firstname']['status']?>">
                    <?=form_label($data['firstname']['label'],'firstname')?>
                    <?=form_text('firstname',$data['firstname']['value'],array('class'=>'form-control','placeholder'=>'Prénom'))?>
                    <?=form_feedback($form_is_submitted,$data['firstname']['status'])?>
                  </div>
                </div>
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$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>
              <div class="row">
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$data['email']['status']?>">
                    <?=form_label($data['email']['label'],'email')?>
                    <?=form_text('email',$data['email']['value'],array('class'=>'form-control','placeholder'=>'texte@exemple.fr'))?>
                    <?=form_feedback($form_is_submitted,$data['email']['status'])?>
                  </div>
                </div>
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$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>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-12">
                  <div class="form-group has-feedback <?=$data['adressdep']['status']?>">
                    <?=form_label($data['adressdep']['label'],'adressdep')?>
                    <?=form_text('adressdep',$data['adressdep']['value'],array('class'=>'form-control','placeholder'=>'Adresse'))?>
                    <?=form_feedback($form_is_submitted,$data['adressdep']['status'])?>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$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>
                </div>
                <div class='col-sm-6'>
                  <div class="form-group has-feedback <?=$data['hour1']['status']?>">
                    <label for="hour1">Heure (aller)</label>
                    <div class="input-group clockpicker">
                      <span class="input-group-addon"><span class="fa fa-clock-o fa-fw"></span></span>
                      <?=form_text('hour1',$data['hour1']['value'],array('class'=>'form-control','placeholder'=>date("H:i")))?>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class='col-sm-12'>
                  <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,$data['address2']['status'])?>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$data['date2']['status']?>">
                    <?=form_label($data['date2']['label'],'date2')?>
                    <div class="input-group bootstrap-datepicker">
                      <?=form_text('date2',$data['date2']['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>
                </div>
                <div class='col-sm-6'>
                  <div class="form-group has-feedback <?=$data['hour2']['status']?>">
                    <label for="hour2">Heure (retour) (facultatif)</label>
                    <div class="input-group clockpicker">
                      <span class="input-group-addon"><span class="fa fa-clock-o fa-fw"></span></span>
                      <?=form_text('hour2',$data['hour2']['value'],array('class'=>'form-control','placeholder'=>date("H:i")))?>
                    </div>
                  </div>
                </div>
              </div>
              <div class='row'>
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$data['select1']['status']?>">
                    <?=form_label($data['select1']['label'],'select1')?>
                    <?=form_select('select1',$data['select1']['value'],array("1","2","3", "4","5","6"),array('class'=>'form-control'))?>
                  </div>
                </div>
                <div class="col-sm-6">
                  <div class="form-group has-feedback <?=$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>
              </div>
              <div class='row'>
                <div class="col-sm-12">
                  <div class="form-group has-feedback <?=$data['message']['status']?>">
                    <label for="message">Informations complémentaire (facultatif)</label>
                    <textarea rows="6" name="message" class="form-control" id="message"><?= $data['message']['value'] ?></textarea>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="form-group has-feedback group-rgpd <?=$data['rgpd']['status']?>">
            <div class="checkbox info-rgpd"> <?=form_checkbox('rgpd',$data['rgpd']['value'],$data['rgpd']['label'],array('class'=>'check-rgpd'))?>
            </div>
            <?=form_feedback($form_is_submitted,$data['rgpd']['status'])?>
          </div>
          <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>
          <br>
          <div class="buttondevis text-center">
            <button type="submit" name="devis" value="envoyer" class="button"><span class="txt">Envoyer</span></button>
          </div>
          <?=form_close()?>
        </div>
      </div>
    </div>
  </div>
</section>
<?php end_block(); ?>