<!doctype html> <?php $lang=$_GET['lang']; if ( in_array ($lang, array('en_US'))){ $loc = "$lang".".utf8"; $loc1 = $lang; } else $loc = "de_DE"; $domain = "messages"; setlocale(LC_MESSAGES, $loc); setlocale(LC_ALL, $loc); $results = putenv("LC_ALL=$loc"); $results = putenv("LC_MESSAGES=$loc"); $results = bindtextdomain($domain,"./locale"); ?> <html > <head> <title>Kostenerstattungsformular</title> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <!-- Kube CSS --> <link rel="stylesheet" href="css/kube.min.css"> <link rel="stylesheet" href="addons/kube-addons.min.css" /> <link rel="stylesheet" href="master.css" /> </head> <body> <div class="page is-container"> <div class="main-sidebar"> <img alt="wikimedia logo" src="Wikimedia_Deutschland-Logo.svg"/> </div> <div class="main-content"> <h1> <?php echo _( "Antrag auf Kostenerstattung")?> </h1> <p> <?php echo _("Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines Projektes entstanden sind?")?><BR> <?php echo _("Bitte fülle dieses Formular aus. Pflichtfelder sind mit einem * gekennzeichnet.")?> </p> <form data-kube="kaform" name="theform" id="theform" action="submit.php" method="POST"> <div class="is-row"> <div class="is-col is-70"> <fieldset> <legend><?php echo _("1. Erfasse deine Stammdaten")?></legend> <div class="is-row"> <div class="is-col"> <input required type="input" size="32" id="projectid" name="project" placeholder="<?php echo _("Projekt/Zweck der Reise*")?>" /> </div> </div> <br> <div class="is-row"> <div class="is-col"> <input required type="input" size="32" ` id="realname" name="realname" placeholder="<?php echo _("Dein Realname (Vorname Nachname)*")?>" /> </div> <div class="is-col"> <input type="input" size="32" ` id="wmdecontact" name="wmdecontact" placeholder="<?= _("Deine Ansprechperson bei Wikimedia")?>" /> </div> </div> <br> <div class="is-row"> <div class="is-col"> <input type="tel" size="32" id="phone" name="phone" placeholder="<?= _("Deine Telefonnummer")?>" /> </div> <div class="is-col"> </div> </div> <br> <div class="is-row"> <div class="is-col"> <input required type="email" size="32" id="email" name="email" placeholder="<?= _("Deine E-Mail-Adresse*")?>" /> </div> <div class="is-col"> </div> </div> <br> <div class="is-row"> <div class="is-col"> <nav class="tabs" data-kube="tabs" data-equal="false"> <a href="#bank-eu" class="is-active"><?=_("Banküberweisung")?></a> <a href="#bank-noneu"><?=_("Banküberweisung (Non-EU)")?></a> <!-- <a href="#bank-paypal">PayPal</a> <a href="#bank-bar">Barauszahlung</a> --> </nav> <section id="bank-eu"> <div class="is-row"> <div class="is-col"> <input type="input" size="32" name="Owner" placeholder="<?=_("Kontoinhabende Person")?>" /> </div> <div class="is-col"> </div> </div> <br> <div class="is-row"> <div class="is-col"> <input type="input" size="32" id="iban" name="iban" placeholder="<?=_("IBAN*")?>" /> </div> <div class="is-col"> <input type="input" size="32" id="bic" name="bic" placeholder="<?=_("BIC (wenn ausländische Bank)")?>" /> </div> </div> <br> <!-- <input type="input" size="32" id="purpose" name="purpose" placeholder="Verwendungszweck" /> --> <textarea id="comments" name="comments" style="resize:both;" cols="32" rows="4" placeholder="<?=_("Weitere Anmerkungen z.B. intermediäre Bank, Grund für abweichende Kontoinhbende Person")?>"> </textarea > </section> <section id="bank-noneu"> <div class="is-row"> <div class="is-col"> <input type="input" size="32" name="Owner" placeholder="<?=_("Kontoinhabende Person")?>" /> </div> <div class="is-col"> </div> </div> <br> <div class="is-row"> <div class="is-col"> <input type="input" size="32" id="n_iban" name="n_iban" placeholder="<?=_("Kontonummer*")?>" /> </div> <div class="is-col"> <input type="input" size="32" id="n_bic" name="n_bic" placeholder="<?=_("BIC/SWIFT*")?>" /> </div> </div> <br> <input class="EU nonEU" type="input" size="32" id="n_bank" name="n_bankname" placeholder="<?="Name der Bank*"?>" /> <br> <textarea class="nonEU" name="n_bankaddress" id="n_bankaddress" style="resize:both;" cols="32" rows="4" placeholder="<?=_("Adresse der Bank (Straße und Hausnummer/Postleitzahl/Land)")?>"></textarea> <br> <textarea name="n_address" lang="de" class="nonEU" id="n_address" style="resize:both;" cols="32" rows="4" placeholder="<?=_("Deine Anschrift (Srtaße und Hausnummer/Postleitzahl/Land)")?>"> </textarea> <br> <!-- <input type="input" size="32" id="n_purpose" name="n_purpose" placeholder="Verwendungszweck" /> --> <textarea id="n_comments" name="n_comments" style="resize:both;" cols="32" rows="4" placeholder="<?=_("Weitere Anmerkungen z.B. intermediäre Bank,Grund für abweichende kontoinhabende Person")?>"> </textarea> </section> <!-- <section id="bank-paypal"> <input name="paypal" type="input" size="32" id="paypal" placeholder="Dein PayPal Account (paypal@example.com)" /> </section> --> <!-- <section id="bank-bar"> </section> --> </div> <!-- i-col --> </div> <!-- is-row --> </fieldset> </div> <div class="is-col "> <?php $ct = @file_get_contents( "./locale/$loc1/h1.php"); if ($ct==false) $ct = file_get_contents( "h1.php"); echo $ct; ?> </div> </div> <!-- is row --> <br> <div class="is-row"> <div class="is-col is-70"> <fieldset id="fieldset2"> <legend><?=_("2. Erfasse deine Ausgaben")?></legend> <div class="is-col is-70"> <?=_("Währung:")?> </div> <div class="is-col is-20"> <select onchange="renumberTableRows()" id="currency" > <option value="EUR">EUR</option> <option value="USD">USD</option> <option value="CHF">CHF</option> <option value="XBT">XBT</option> </select> </div> <table id="tabtab" class="is-bordered is-striped"> <thead> <tr> <th><?=_("Pos.")?></th> <th><?=_("Datum")?></th> <th><?=_("Beschreibung")?></th> <th><?=_("Betrag")?></th> <th><?=_("Währung")?></th> <th><?=_("Belege")?></th> <th><?=_("Löschen")?></th> </tr> </thead> <tbody id="tabbody"> </tbody> </table> <div class="is-col"> <button id="add_issue" type="button" onclick="addRow();" class="button is-green"><?=_("Ausgabe hinzufügen")?></button> </div> </fieldset> <br> <fieldset> <legend><?=_("3. Vorschuss und Sonstiges")?></legend> <div class="is-row"> <div class="is-col valign="center""> <?=_("Ich habe bereits einen Vorschuss erhalten in Höhe von:")?> </div> <div class="is-col"> <input input name="advance" id="advance" type="text" placeholder="0,00 EUR"/> </div> </div> <br> <div class="is-row"> <div class="is-col valign="center""> <?=_("Hiermit bestätige ich die Vollständig- und Richtigkeit meiner Angaben:")?>* </div> <div class="is-col"> <input id="agree" type="checkbox" /> </div> </div> </fieldset> <button type="button" onclick="downloadDocument(true);" class="button is-green"><?=_("Antrag elektronisch direkt an WMDE schicken")?></button> <button type="button" onclick="downloadDocument(false);" class="button is-orange"><?=_("Antrag herunterladen und später einreichen")?></button> </div> <div class="is-col"> <?php $ct = @file_get_contents( "./locale/$loc1/h2.php"); if ($ct==false) $ct = file_get_contents( "h2.php"); echo $ct; ?> </div> </div> </div> </div> <input type="hidden" id="banktype" name="banktype"/> <input type="hidden" id="sendmail" name="sendmail"/> <!-- <input type="submit" style="display:none" name="submitButton" /> --> </form> <!-- Kube JS (optional if you are using Kube CSS only) --> <script src="js/kube.min.js"></script> <script src="addons/upload/kube.upload.min.js"></script> <script src="addons/kube-addons.min.js"></script> <script src="kaform.js"></script> <script src="iban.js/iban.js"></script> </div> </div> </body> </html>