112 lines
7.1 KiB
PHP
112 lines
7.1 KiB
PHP
<section>
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<h2 class="mt-0 text-center">OH Nein ... alle Tester sind bereits vergriffen!</h2>
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<p class="text-center mb-4">ERINNERUNGS-SERVICE:<br>
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Lass Deine Kontaktdaten da, damit wir Dich informieren können, wenn es Nachschub gibt ...</p>
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<div class="row justify-content-md-center">
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<div class="col-lg-8">
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<div class="row">
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<div class="col-12">
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<div class="form-group {{ $errors->has('salutation') ? 'error' : '' }}">
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<label for="salutation">Anrede <span class="required">*</span></label>
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<select id="salutation" name="salutation" class="form-control selectpicker revalidat"
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data-style="btn-default" data-error="#error-salutation" required>
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{!! HTMLHelper::getSalutation(old('salutation')) !!}
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</select>
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<div id="error-salutation" class="text-left"></div>
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@if ($errors->has('billing_salutation'))
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<label for="billing_salutation" class="error text-danger small"
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style="display: block;">{{ $errors->first('billing_salutation') }}</label>
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@endif
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group">
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<label for="firstname">Vorname <span class="required">*</span></label>
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{!! Form::text('firstname', '', ['class' => 'form-control ' . ($errors->has('firstname') ? 'error' : ''), 'id' => 'firstname', 'required' => true]) !!}
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@if ($errors->has('firstname'))
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<label for="firstname" class="error text-danger small"
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style="display: block;">{{ $errors->first('firstname') }}</label>
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@endif
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group">
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<label for="lastname">Nachname <span class="required">*</span></label>
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{!! Form::text('lastname', '', ['class' => 'form-control ' . ($errors->has('lastname') ? 'error' : ''), 'id' => 'lastname', 'required' => true]) !!}
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@if ($errors->has('lastname'))
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<label for="lastname" class="error text-danger small"
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style="display: block;">{{ $errors->first('lastname') }}</label>
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@endif
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group">
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<label for="zipcode">PLZ <span class="required">*</span></label>
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{!! Form::text('zipcode', '', ['class' => 'form-control ' . ($errors->has('zipcode') ? 'error' : ''), 'id' => 'zipcode', 'required' => true]) !!}
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@if ($errors->has('zipcode'))
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<label for="zipcode" class="error text-danger small"
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style="display: block;">{{ $errors->first('zipcode') }}</label>
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@endif
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group">
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<label for="city">Stadt <span class="required">*</span></label>
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{!! Form::text('city', '', ['class' => 'form-control ' . ($errors->has('city') ? 'error' : ''), 'id' => 'city', 'required' => true]) !!}
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@if ($errors->has('city'))
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<label for="city" class="error text-danger small"
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style="display: block;">{{ $errors->first('city') }}</label>
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@endif
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</div>
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</div>
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<div class="col-12">
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<div class="form-group">
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<label for="email">E-Mail <span class="required">*</span></label>
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{!! Form::email('email', '', ['class' => 'form-control ' . ($errors->has('email') ? 'error' : ''), 'id' => 'email', 'required' => true]) !!}
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@if ($errors->has('email'))
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<label for="email" class="error text-danger small"
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style="display: block;">{{ $errors->first('email') }}</label>
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@endif
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<i>Aus Sicherheitsgründen erhälst du eine E-Mail als Bestätigung, die Du über einen Link bestätigen musst.</i>
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</div>
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</div>
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<div class="col-12">
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<div class="form-group">
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<label class="switcher switcher-success">
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{!! Form::checkbox('accepted_data', 1, '', ['id' => 'accepted_data', 'class' => 'switcher-input', 'data-error' => '#error-accepted_data', 'required' => true]) !!}
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<span class="switcher-indicator">
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<span class="switcher-yes">
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<span class="ion ion-md-checkmark"></span>
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</span>
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<span class="switcher-no">
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</span>
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</span>
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<span class="switcher-label">Mit Klick auf "Absenden" akzeptiere ich die
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<a href="https://www.gruene-seele.bio/agb/" target="_blank"
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class="text-secondary">Allgemeinen
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Geschäftsbedingungen</a> und die
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<a href="https://www.gruene-seele.bio/datenschutzerklaerung/" target="_bank"
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class="text-secondary">Datenschutzbelehrung</a>, damit für den Reminder
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meine Daten verarbeitet werden können. <span class="required">*</span>
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</label>
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<div id="error-accepted_data"></div>
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</div>
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<div class="text-center">
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{!! Form::hidden("action", "submit-reminder-service") !!}
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<button type="submit" class="btn btn-primary btn-lg mt-4 mb-4 button-prevent-multiple-submits">
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<i class="ion ion-ios-paper-plane"></i> Absenden <i class="spinner fa fa-spinner fa-spin"></i>
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</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-12">
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<hr class="">
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</div>
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</div>
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</section>
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