84 lines
2.3 KiB
PHP
84 lines
2.3 KiB
PHP
<form action="index.php?<?php echo $_SERVER['QUERY_STRING']; ?>" method="post" />
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<fieldset>
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<legend>Kunde hinzufügen</legend>
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<h2>Kundendaten</h2>
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<input type="hidden" name="new" value="new" />
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<input type="hidden" name="DSchutz" value="0" />
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<label>Firma</label>
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<input type="text" name="Firma" />
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<br />
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<label>Anrede</label>
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<select name="Anrede">
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<option value="Herr">Herr</option>
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<option value="Frau">Frau</option>
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</select>
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<br />
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<label>Vorname</label>
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<input type="text" name="Vorname" />
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<br />
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<label>Nachname</label>
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<input type="text" name="Nachname" />
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<br />
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<label>Strasse</label>
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<input type="text" name="Strasse" />
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<br />
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<label>Hausnummer</label>
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<input type="text" name="Nummer" />
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<br />
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<label>PLZ</label>
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<input type="text" name="PLZ" />
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<br />
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<label>Ort</label>
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<input type="text" name="Ort" />
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<br />
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<label>Land</label>
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<input type="text" name="Land" />
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<br />
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<label>Geburtsdatum</label>
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<input type="text" name="Geb_Datum" />
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<img src="img/small_info.png" alt="Datum der Form: <TT.MM.JJJJ>" title="Datum der Form: <TT.MM.JJJJ>" />
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<br />
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<label>Telefon</label>
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<input type="text" name="Telefon" />
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<br />
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<label>Fax</label>
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<input type="text" name="Fax" />
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<br />
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<label>Mobil</label>
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<input type="text" name="Mobil" />
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<br />
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<label>Email</label>
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<input type="text" name="Email" />
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<br />
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<label>Homepage</label>
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<input type="text" name="Homepage" />
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<br />
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<label>Registergericht</label>
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<input type="text" name="Gericht" />
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<br />
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<label>USt-ID / SteuerNr.</label>
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<input type="text" name="SteuerNr" />
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<br />
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<h2>Bankverbindung</h2>
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<label>Inhaber</label>
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<input type="text" name="Kto_Inhaber" />
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<br />
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<label>IBAN</label>
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<input type="text" name="Kto_Nummer" />
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<br />
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<label>BIC</label>
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<input type="text" name="BLZ" />
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<br />
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<label>Bank</label>
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<input type="text" name="Bank" />
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<br />
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<label>Datenschutzerklärung</label>
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<input type="checkbox" name="DSchutz" value="1" />
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<br />
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</fieldset>
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<fieldset>
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<legend>Kunde speichern</legend>
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<input type="submit" class="button_save" name="formaction" value="save" title="Kunde speichern" />
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<br />
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</fieldset>
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</form> |