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Directory :  /home/computer3/lachocolateriedevirginie.fr/business/business/

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Current File : /home/computer3/lachocolateriedevirginie.fr/business/business/reserv.tpl
<div style="border:1px #5D5D5D solid; border-radius: 4px;margin-bottom: 20px;padding: 20px 0 20px 0;background:transparent;color:#5D5D5D;font-size:14pt">
<form class="form-horizontal filet1" style="padding: 20px;border: 0px #ddd solid; border-radius: 4px; background:transparent;width:100%" id="contact-form" name="contact-form" method="post" enctype="multipart/form-data" action="rappel/reservation.php">
	<input type="hidden" name="from" value="contact">
	<div class="row two-col">
		<div class="col-md-6 col-1">
		
			
			
			<div style="text-align:center">			
  <div style="border:1px #5D5D5D solid; border-radius: 4px;margin-bottom: 20px;padding: 20px 0 20px 0;background:transparent;color:#5D5D5D;font-size:16pt">
			<h2 style="font-size:16pt;padding:0;margin:0;line-height:20pt">Informations sur le rendez-vous *</h2>			
			</div>	
			</div>
   <br />
			
          
		<div class="col-md-6 col-1" style="padding-right: 5px;padding-left: 5px;">
    
			 {if !empty($er_date_debut)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> Date non valide !
			</div>
			 {/if}       
Choisissez une date *                        
      <div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group" style="">
					<div class="input-group-addon" style="padding: 6px 14px;">
						<i class="fa fa-calendar"></i>
					</div>
					<input class="form-control" style="border-radius: 0 4px 4px 0;width:100%;color:#cc0000;font-size:14pt;height:40px" required type="text" name="date_debut" placeholder="Date *"  id="from"  value="{$rdate_debut}" />
	           </div>
  			</div>
		</div>




		<div class="col-md-6 col-1" style="padding-right: 5px;padding-left: 5px;">    
		 {if !empty($er_heure_debut)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_heure_debut}
			</div>
			 {/if}		
<b>Pr&eacute;cisez l'heure *</b>    	
      <div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;">
						<i class="fa fa-clock-o"></i>
					</div>
					<input class="form-control" style="border-radius: 0 4px 4px 0;width: 100%;color:#cc0000;font-size:14pt;height:40px" required type="time" name="heure_debut" placeholder="Heure *"  id="from"  value="{$rheure_debut}" />
	           </div>
  			</div>	
</div>

 
 
 
 
 
 
		<div class="col-md-6 col-1" style="padding-right: 5px;padding-left: 5px;">		
		 {if !empty($er_pers)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_pers}
			</div>
			 {/if}		
<!---- <b>Personne(s) &agrave; prendre en charge *</b>	
      <div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;">
						<i class="fa fa-plus-circle"></i>
					</div>
					<input class="form-control" style="border-radius: 0 4px 4px 0;width: 100%;color:#cc0000;font-size:14pt;height:40px" required type="number" name="pers" placeholder="Nombre de personne *"  id="from"  value="{$rpers}" />
	           </div>
  			</div>----->

   <br />
</div>

		<div class="col-md-6 col-1" style="padding-right: 5px;padding-left: 5px;">
&nbsp;
</div>


  
  
  
		<div class="col-md-12 col-1" style="padding-right: 5px;padding-left: 5px;"> 
    		 {if !empty($er_lieu)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_lieu}
			</div>
			 {/if}
<b>Vos informations sur le rendez-vous *</b>		
			<div class="form-group">
				<div class="" style="padding: 0">
					<div style="text-align:center">
						<textarea class="form-control" required placeholder="Vos informations" style="border-radius: 4px;width: 100%;color:#cc0000;font-size:14pt;" name="lieu" id="lieu" rows="3">{$rlieu}</textarea>
					</div>
				</div>
			</div>
<br/>
</div>

			
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
			
		</div>
		<div class="col-md-6 col-2">
			<div style="text-align:center">
 <div style="border:1px #5D5D5D solid; border-radius: 4px;margin-bottom: 20px;padding: 20px 0 20px 0;background:transparent;color:#5D5D5D;">						
				<h2 style="font-size:16pt;padding:0;margin:0;line-height:20pt">Vos coordonn&eacute;es * </h2>
			</div>				
				
			</div>
<br />			
			
			 {if !empty($er_nom)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_nom}
			</div>
			 {/if}
			 
			<div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;">
						<i class="fa fa-user"></i>
					</div>
					<input type="text" name="nom"  style="border-radius: 0 4px 4px 0;width: 100%;color:#cc0000;font-size:14pt;height:40px" placeholder="{$form_1_prenom}, {$form_2_nom} *" value="{$rnom}" required class="form-control"/>
				</div>
			</div>
			
			
			
			
			 {if $erreur_mail == '100'}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_email}
			</div>
			 {/if}
			<div class="form-group" style="margin-bottom: 22px;">
				<div class="input-group">
					<div class="input-group-addon">
						<i class="fa fa-envelope"></i>
					</div>
					<input type="email" name="email"  style="border-radius: 0 4px 4px 0;width: 100%;color:#cc0000;font-size:14pt;height:40px" placeholder="{$form_3_mail} *" required value="{$remail}" class="form-control"/>
				</div>
			</div>
			
			
			
			
			 {if !empty($er_telephone)}
			<div class="alert alert-danger" style="text-align:left">
				<i class="fa fa-info-circle"></i> {$er_telephone}
			</div>
			 {/if}
       
       			
			<div class="form-group">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 13px 6px 13px;">
						<i class="fa fa-phone"></i>
					</div>
									<input type="tel" name="telephone"  style="border-radius: 0 4px 4px 0;width: 100%;color:#cc0000;font-size:14pt;height:40px" required placeholder="{$form_4_tel} *" {literal} pattern="^((\+\d{1,3}(-| )?\(?\d\)?(-| )?\d{1,5})|(\(?\d{2,6}\)?))(-| )?(\d{3,4})(-| )?(\d{4})(( x| ext)\d{1,5}){0,1}$" {/literal} value="{$rtelephone}" class="form-control"/>
				</div>
			</div>
			<br/> 
      
      
			<div class="form-group">
				<div class="" style="padding: 0">
					<div style="text-align:center">
						<textarea class="form-control"  style="border-radius: 4px;margin-top: 15px;width: 100%;color:#cc0000;font-size:14pt;" placeholder="Commentaires" style="width:100%" name="texte_message" id="texte_message" rows="3">{$rtexte_message}</textarea>
					</div>
				</div>
			</div>
<br/>      
      
      
	 </div>      
</div>
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      
      <br/>			

{if $cle_gg_site !==''} 
  {if !empty($er_captcha)}           
            <div class="alert alert-danger" style="text-align:left"><i class="fa fa-info-circle"></i> 
            Veuillez valider le syst&egrave;me anti robot et cocher la case RGPD !  
            </div>                                           
{/if}	
<div style="text-align: center;">
<div class="g-recaptcha" 
          data-sitekey="{$cle_gg_site}" style="display: inline-block;">
      </div>   
</div> 
{else}
			<div style="text-align:center">
				 {if !empty($er_captcha)}
				<div class="alert alert-danger" style="text-align:left">
					<i class="fa fa-info-circle"></i> {$er_captcha}
				</div>
				 {/if} {$capchaTXT} :
				<div class="captcha">
					<code>{$captcha}</code>
				</div>
				<input class="form-control" style="width:180px; text-align:center;margin-left:auto;margin-right:auto" required type="text" name="captcha" id="captcha"/>
				<br/>
			</div>
{/if} 








	
	
<!-- RGPD -->  
<br/>		
		<div style="text-align:center">
		<div class="form-group">
		
<div class="tabcenter" style="text-align: center">
<div class="control-label" style="color : #CC3300;font-size: 16px; visibility: visible;text-align:center;margin-left:auto;margin-right:auto">Veuillez cocher la case ci-dessous</div>
<table class="filet1" style="background:#transparent; text-align:center;max-width:645px; margin-left:auto;margin-right:auto;border-spacing:3px;border-collapse:collapse;">
	<tbody>
		<tr>
			<td style="border:0;text-align:center;padding:10px;display: block;"> 			
							<input type="checkbox" id="edit-6" name="all" value="1" class="" required />              
              <label class="" for="edit-6"><span class=""></span></label>
			</td>
      			
			<td style="border:0;padding-bottom:10px;text-align:center;font-size:10pt;color: #CC3300;display: block;">
		<span>En soumettant ce formulaire, j'accepte que les informations saisies soient exploit&eacute;es dans le cadre de ma demande d'information et de la relation commerciale qui peut en d&eacute;couler.</span>
			</td>
		</tr>		
		<tr> 	
			<td colspan="2" style="border:0;padding:10px;text-align:center;font-size:10pt;display: block;">
		<span><i>Pour conna&icirc;tre et exercer vos droits, notamment de retrait de votre consentement &agrave; l'utilisation des donn&eacute;es collect&eacute;es par ce formulaire, veuillez consulter <a style="font-size:10pt" href="mentions-legales">notre politique de confidentialit&eacute;</a></i></span>
			</td>
		</tr>				
	</tbody>
</table>          
				</div>
			</div>
</div>
			

<div style="text-align:center">		
		<button type="submit" name="envoi_message">R&eacute;server maintenant !</button>
		<br/><br/>
		
		<h3 style="font-size: 14pt">Une confirmation vous sera envoy&eacute;e !</h3>		
		<h4 style="font-size: 14px">{$Champs_obligatoires} </h4>
		<br/>
</div>
	
	
</form>
</div>				<br/>
				<br/>
				<br/>
				<br/>

Anon7 - 2022
AnonSec Team