<!doctype html> <html > <head> <title>Kostenerstattungsforumlar</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>Antrag auf Kostenerstattung</h1> <p>Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines Projektes entstanden sind?<BR> 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>1. Erfasse deine Stammdaten</legend> <div class="is-row"> <div class="is-col"> <input required type="input" size="32" id="projectid" name="project" placeholder="Projekt/Zweck der Reise*" /> </div> </div> <!-- <div class="is-row"> <div class="is-col"> <input required type="input" size="32" id="nickname" name="nickname" placeholder="Nickname*" /> </div> <div class="is-col"> <input required type="input" size="32" id="projectid" name="project" placeholder="Projekt-ID*" /> </div> </div> --> <br> <div class="is-row"> <div class="is-col"> <input required type="input" size="32" ` id="realname" name="realname" placeholder="Dein Realname (Vorname Nachname)*" /> </div> <div class="is-col"> <input required 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 include "h1.php"; ?> </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-row"> <div class="is-col is-70"> <div class="is-row"> <div class="is-col is-60"> <input id="a_date" type="date" name="a_date" placeholder="Datum*"/> <!-- <input id="a_type" type="text" name="type" placeholder="Auslagenart*"/> --> </div> <div class="is-col is-40"> </div> </div> <br> <input id="a_description" type="text" name="description" placeholder="Beschreibung*"/> <br> <div class="is-row"> <div class="is-col"> <input id="a_amount" type="text" name="amount" placeholder="Betrag*"/> </div> <div class="is-col"> <select disabled id="a_currency" name="currency" > <option value="EUR">EUR</option> <option value="USD">USD</option> <option value="CHF">CHF</option> <option value="BTC">BTC</option> </select> <!-- <input id="a_currency" type="text" name="curreny" placeholder="Waehrung*"/> --> </div> <div class="is-col"> <button type="button" onclick="addTableRow();" class="button is-green">Ausgabe hinzufügen</button> </div> </div> </div> <div class="is-col is-30"> <div id="uploadfield" class="form-item"> </div> </div> </div> <br> <table id="tabtab" class="is-bordered is-striped"> <thead> <tr> <!-- <th>Auslagenart</th>--> <th>Datum</th> <th>Beschreibung</th> <th>Betrag</th> <th>Währung</th> <th>Löschen</th> </tr> </thead> <tbody id="tabbody"> </tbody> </table> </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""> Ich versichere, dass ich alle Angaben nach bestem Wissen und Gewissen gemacht habe: </div> <div class="is-col"> <input id="agree" type="checkbox" /> </div> </div> </fieldset> </div> <div class="is-col"> <?php include "h2.php"; ?> </div> </div> <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> <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>