265 lines
8.5 KiB
HTML
265 lines
8.5 KiB
HTML
<!doctype html>
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<html >
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<head>
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<title>Kostenerstattungsforumlar</title>
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<meta charset="utf-8">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<!-- Kube CSS -->
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<link rel="stylesheet" href="css/kube.min.css">
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<link rel="stylesheet" href="addons/kube-addons.min.css" />
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<link rel="stylesheet" href="master.css" />
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</head>
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<body>
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<div class="page is-container">
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<div class="main-sidebar">Wikimedia Logo</div>
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<div class="main-content">
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<h1>Auslagenersatz</h1>
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<p>Du möchtest dir Kosten erstatten lassen, welche im Rahmen deines
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Projektes entstanden sind?<BR>
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Bitte fülle dieses Formular aus ...
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</p>
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<form name="theform" id="theform" action="submit.php" method="POST">
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<div class="is-row">
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<div class="is-col is-70">
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<fieldset>
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<div class="is-row">
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<div class="is-col">
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<input required type="input"
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size="32" id="nickname" name="nickname"
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placeholder="Nickname*" />
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</div>
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<div class="is-col">
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<input required type="input"
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size="32" id="projekt" name="project"
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placeholder="Projekt-ID*" />
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</div>
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</div>
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<br>
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<div class="is-row">
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<div class="is-col">
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<input required type="input" size="32"
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` name="realname" placeholder="Realname*" />
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</div>
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<div class="is-col">
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</div>
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</div>
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<br>
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<div class="is-row">
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<div class="is-col">
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<input required type="email" size="32" id="email"
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name="email" placeholder="E-Mail-Adresse*" />
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</div>
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<div class="is-col">
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</div>
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</div>
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<br>
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<div class="is-row">
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<div class="is-col">
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<input class="screen" type="radio" id="eu"
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name="bank" value="EU" checked>
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<label class="screen radio" for="eu">EU-Banküberweisung</label>
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<br>
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<input class="screen" type="radio"
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id="noneu" name="bank" value="Non-EU">
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<label class="screen radio" for="noneu">
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Non-EU-Banküberweisung</label>
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<br>
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<input class="screen" type="radio" id="paypal"
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name="bank" value="PayPal">
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<label class="screen radio" for="paypal">PayPal</label>
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<br>
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<input class="screen" type="radio" id="bar"
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name="bank" value="Bar">
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<label class="screen radio" for="bar" lang="de">
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Bargeld</label>
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<br><br>
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<label class="EU nonEU" for="owner" >Kontoinhaber</label>
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<input class="EU nonEU" type="input" size="32" id="ownerDe" name="Owner" placeholder="wenn abweichend vom Realnamen" />
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<label class="EU nonEU" for="iban" >IBAN</label>
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<input class="EU nonEU" type="input" size="32" id="iban" name="IBAN" placeholder="DE0123…" />
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<label class="EU nonEU" for="bic">BIC / SWIFT</label>
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<input class="EU nonEU" type="input" size="32" id="bic" name="BIC" placeholder="LBMU…" />
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<label class="EU nonEU" for="bank" >Name der Bank</label>
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<input class="EU nonEU" type="input" size="32" id="bank" name="Bankname" placeholder="Banky McBankface" />
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<label class="nonEU" for="bankaddress" >Bankanschrift</label>
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<textarea class="nonEU" name="bankaddress" id="bankaddress" style="resize:both;" cols="32" rows="4" placeholder="Straße und Hausnummer
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Postleitzahl und Ort
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Land"></textarea>
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<label class="nonEU" for="address" >Deine Anschrift</label>
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<textarea name="address" lang="de" class="nonEU" id="address" style="resize:both;" cols="32" rows="4" placeholder="Straße und Hausnummer
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Postleitzahl und Ort
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Land"></textarea>
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<label class="EU nonEU" for="comments" lang="de">Weitere Anmerkungen</label>
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<textarea class="EU nonEU" id="comments" name="comments"
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style="resize:both;" cols="32" rows="4" placeholder="z.B. intermdiäre Bank,
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Grund für abweichende Kontoinhaberin"></textarea>
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<label class="paypal" for="accountnumber">
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PayPal account</label>
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<input class="paypal" type="input" size="32"
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id="paypal" placeholder="paypal@example.com" />
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</div> <!-- i-col -->
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</div> <!-- is-row -->
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</fieldset>
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</div>
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<div class="is-col ">
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Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext Hilfetext
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</div>
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</div> <!-- is row -->
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Hallo
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</div>
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</div>
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<fieldset>
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<legend>Deine Ansprechperson bei Wikimedia</legend>
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<input required type="input" size="32" id="wmdecontact"
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name="wmdecontact" placeholder="John Doe" />
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</fieldset>
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<fieldset>
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<legend>Deine Kontaktdaten</legend>
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<label for="realname" >Dein Realname</label>
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<input required type="input" size="32"
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name="realname" placeholder="Corinna Commonsuser" />
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<label for="email">E-Mail-Adresse</label>
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<input required type="email" size="32" id="email"
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name="email" placeholder="name@example.org" />
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<label for="phone" >Telefonnummer</label>
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<input required type="tel" size="32" "phone" name="phone"
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placeholder="0123-456789" />
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</fieldset>
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<fieldset id="bankdetails">
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<legend>Auszahlungsweg</legend>
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<input class="screen" type="radio" id="eu"
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name="bank" value="EU" checked>
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<label class="screen radio" for="eu">EU-Banküberweisung</label>
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<br>
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<input class="screen" type="radio"
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id="noneu" name="bank" value="Non-EU">
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<label class="screen radio" for="noneu">
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Non-EU-Banküberweisung</label>
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<br>
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<input class="screen" type="radio" id="paypal"
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name="bank" value="PayPal">
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<label class="screen radio" for="paypal">PayPal</label>
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<br>
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<input class="screen" type="radio" id="bar"
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name="bank" value="Bar">
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<label class="screen radio" for="bar" lang="de">
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Bargeld</label>
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<br><br>
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<label class="EU nonEU" for="owner" >Kontoinhaber</label>
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<input class="EU nonEU" type="input" size="32" id="ownerDe" name="Owner" placeholder="wenn abweichend vom Realnamen" />
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<label class="EU nonEU" for="iban" >IBAN</label>
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<input class="EU nonEU" type="input" size="32" id="iban" name="IBAN" placeholder="DE0123…" />
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<label class="EU nonEU" for="bic">BIC / SWIFT</label>
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<input class="EU nonEU" type="input" size="32" id="bic" name="BIC" placeholder="LBMU…" />
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<label class="EU nonEU" for="bank" >Name der Bank</label>
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<input class="EU nonEU" type="input" size="32" id="bank" name="Bankname" placeholder="Banky McBankface" />
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<label class="nonEU" for="bankaddress" >Bankanschrift</label>
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<textarea class="nonEU" name="bankaddress" id="bankaddress" style="resize:both;" cols="32" rows="4" placeholder="Straße und Hausnummer
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Postleitzahl und Ort
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Land"></textarea>
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<label class="nonEU" for="address" >Deine Anschrift</label>
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<textarea name="address" lang="de" class="nonEU" id="address" style="resize:both;" cols="32" rows="4" placeholder="Straße und Hausnummer
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Postleitzahl und Ort
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Land"></textarea>
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<label class="EU nonEU" for="comments" lang="de">Weitere Anmerkungen</label>
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<textarea class="EU nonEU" id="comments" name="comments"
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style="resize:both;" cols="32" rows="4" placeholder="z.B. intermdiäre Bank,
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Grund für abweichende Kontoinhaberin"></textarea>
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<label class="paypal" for="accountnumber">
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PayPal account</label>
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<input class="paypal" type="input" size="32"
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id="paypal" placeholder="paypal@example.com" />
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</fieldset>
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<label>Dein Projekt / Zweck der Reise</label>
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<input type="text" name="projekt"/>
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<br>
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<h2>Bitte trage deine einzelnen Kostenpositionen ein.</h2>
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<p>
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Bitte trage nur eine Ausgabe pro Zeile ein, lege den
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Originalbeleg dem Antrag bei und kennzeichne den Beleg
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mit der entsprechenden Zeilennummer. Aus der Beschreibung
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soll zu ersehen sein, ob es sich um Transport, Dienstleistung,
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Materialien, Verpflegung oder ähnliches handelt.
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</p>
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<table id="tabtab" class="is-bordered">
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<thead>
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<tr>
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<th>Pos.</th>
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<th>Beschreibung</th>
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<th>Belegdatum</th>
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<th>Betrag</th>
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<th>Beleg</th>
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</tr>
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</thead>
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<tbody id="tabbody">
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</tbody>
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</table>
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<input type="submit" style="display:none" name="submitButton" />
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</form>
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<button onclick="addTableRow();"
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class="button">Position hinzufügen</button>
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<button onclick="document.theform.submitButton.click();"
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class="button">Absenden</button>
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<!-- Kube JS (optional if you are using Kube CSS only) -->
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<script src="js/kube.min.js"></script>
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<script src="addons/upload/kube.upload.min.js"></script>
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<script src="addons/kube-addons.min.js"></script>
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<script src="kaform.js"></script>
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</div>
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</div>
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</body>
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</html>
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