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Current File : /home/meir5web/public_html/f/form_inc_2025.php
<form action="/stripe/public/checkout.php#top" method="POST" name="validation" id="validation" onsubmit="return verif_form();">
    <input type="hidden" name="type_don" value="ponctuel" />

    <div class="form-note text-center">
        <span class="required-note">* Champs obligatoires</span><br>
        <span class="small-note">Les informations ci-dessous seront utilisées dans le CERFA.</span>
    </div>

    <div class="form-group">
        <label for="form_titre"><span class="required">*</span> Titre :</label>
        <select name="titre" id="form_titre" required>
            <option value="Mr">Mr</option>
            <option value="Mme">Mme</option>
            <option value="Mlle">Mlle</option>
            <option value="Mr & Mme">Mr & Mme</option>
        </select>
        <input type="hidden" name="MPreffers" value="<?= $MPreffers ?>">
        <input type="hidden" name="MPbanner" value="<?= $MPbanner ?>">
    </div>

    <div class="form-group">
        <label for="form_nom"><span class="required">*</span> Nom :</label>
        <input type="text" name="nom" id="form_nom" value="<?php echo $_COOKIE['nom']; ?>" required>
    </div>

    <div class="form-group">
        <label for="form_prenom"><span class="required">*</span> Prénom :</label>
        <input type="text" name="prenom" id="form_prenom" value="<?php echo $_COOKIE['prenom']; ?>" required>
    </div>

    <div class="form-group">
        <label for="form_adresse"><span class="required">*</span> Adresse :</label>
        <input type="text" name="adresse" id="form_adresse" value="<?php echo $_COOKIE['adresse']; ?>" maxlength="50" required>
    </div>

    <div class="form-row">
        <div class="form-group half">
            <label for="form_cp"><span class="required">*</span> Code postal :</label>
            <input type="text" name="cp" id="form_cp" value="<?php echo $_COOKIE['cp']; ?>" maxlength="10" required>
        </div>
        <div class="form-group half">
            <label for="form_ville"><span class="required">*</span> Ville :</label>
            <input type="text" name="ville" id="form_ville" value="<?php echo $_COOKIE['ville']; ?>" maxlength="50" required>
        </div>
    </div>

    <div class="form-group">
        <label for="form_pays"><span class="required">*</span> Pays :</label>
        <input type="text" name="pays" id="form_pays" value="<?php echo $_COOKIE['pays']; ?>" maxlength="20" required>
    </div>
	
	<div class="form-row">
		<div class="form-group half">
			<label for="form_tel">Téléphone :</label>
			<input type="text" class="form-control" name="tel" id="form_tel" maxlength="20" value="<?php echo $_COOKIE['tel']; ?>">
		</div>

		<div class="form-group half">
			<label for="form_portable">Portable :</label>
			<input type="text" class="form-control" name="portable" id="form_portable" maxlength="20" value="<?php echo $_COOKIE['portable']; ?>">
		</div>
	</div>

    <div class="form-group">
        <label for="form_email"><span class="required">*</span> Email :</label>
        <input type="email" name="email" id="form_email" value="<?php echo $_COOKIE['email']; ?>" required>
    </div>

    <div class="form-group">
        <label for="form_montant"><span class="required">*</span> Montant en EUROS :</label>
        <input type="number" name="montant" id="form_montant" step="0.01" value="<?php echo $_COOKIE['montant']; ?>" required>
    </div>

    <div class="form-group text-center">
		<div class="cerfa-note">
			Un cerfa vous sera envoyé dès validation du paiement.
		</div>
		<div class="alert-note">
			Merci de vérifier la validité des informations renseignées.
		</div>
    </div>
	
	<div class="form-section">
	  <h4>Autre adresse d'expédition à préciser :</h4>

	  <div class="form-group">
		<label for="form_nom_autre">Nom :</label>
		<input type="text" class="form-control" name="nom_autre" id="form_nom_autre" value="<?php echo $_COOKIE['nom2']; ?>">
	  </div>

	  <div class="form-group">
		<label for="form_prenom_autre">Prénom :</label>
		<input type="text" class="form-control" name="prenom_autre" id="form_prenom_autre" value="<?php echo $_COOKIE['prenom2']; ?>">
	  </div>

	  <div class="form-group">
		<label for="form_adresse_autre">Adresse :</label>
		<input type="text" class="form-control" name="adresse_autre" id="form_adresse_autre" maxlength="50" value="<?php echo $_COOKIE['adresse2']; ?>">
	  </div>

	  <div class="form-group">
		<label for="form_cp_autre">Code postal :</label>
		<input type="text" class="form-control" name="cp_autre" id="form_cp_autre" size="10" maxlength="10" value="<?php echo $_COOKIE['cp2']; ?>">
	  </div>

	  <div class="form-group">
		<label for="form_ville_autre">Ville :</label>
		<input type="text" class="form-control" name="ville_autre" id="form_ville_autre" maxlength="50" value="<?php echo $_COOKIE['ville2']; ?>">
	  </div>
	</div>


    <div class="form-group text-center">
        <button type="submit">Envoyer</button>
    </div>
</form>


<script>
function verif_form() {
  const champsObligatoires = [
    'form_titre',
    'form_nom',
    'form_prenom',
    'form_adresse',
    'form_cp',
    'form_ville',
    'form_pays',
    'form_email',
    'form_montant'
  ];

  for (let id of champsObligatoires) {
    const champ = document.getElementById(id);
    if (!champ || champ.value.trim() === '') {
      alert('Vous devez remplir tous les champs obligatoires. (Champ manquant : ' + id.replace('form_', '') + ')');
      champ.focus();
      return false;
    }
  }

  return true; // ok
}
</script>

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