extranet/application/views/default/scripts/evaluation/enquetec.phtml

<style>
#center p { margin:5px; padding:5px;}
.infoTitle {clear:both; float:left; width:180px; margin-left:30px; padding:0 10px 0 0;}
.infoData {float:left; width:320px; margin:2px 0;}
form { }
form em { color:#FF0000;}
fieldset {border:0; margin:0; padding:0;}
fieldset legend{ padding:0 0 0 10px;}
.fieldgrp{clear:both; width:100%; margin-bottom:.5em; overflow:hidden;}
.fieldgrp:after{content:"."; display:block; clear:both; visibility:hidden; line-height:0; height:0; }
.fieldgrp label{font-weight:bold; margin-left:30px; width:180px; clear:both; padding:0 10px 0 0;line-height:22px;_padding-top:3px; float:left; display:block; font-size:108%;}
.fieldgrp label span{font-weight:normal;}
.fieldgrp label abbr{color:#4B911C; font-size:120%; vertical-align:middle;}
.field {width:320px; float:left; padding:0 10px 0 0; line-height:22px; _padding-top:3px;}
.field .longfield{width:215px;}
.field .longfield-select{width:220px;}
.field .smallfield{width:95px;}
.field .medfield{width:110px;}
.field input, .field select{ font-size:110%; margin:2px 0; }
.field input[type="radio"] { margin:0 5px 0 5px; }
div.submit{ margin-left:200px; padding-left:0px; margin-top:1em; }
div.submit p.submit-button{margin-top:0;}
div.submit p.details{font-size:85%;color:#666;margin:0;}
div.submit p.required-note{margin-top:1em;}
div.submit p.required-note span{color:#4B911C;_color:#666;font-size:170%;vertical-align:top;}
.noborder {border:none;}
<?php if(isset($this->InfoUser['Profil']) && $this->InfoUser['Profil']=='Autre'){ ?> #autreProfil {display:block;}<?php }else{?> #autreProfil {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['PrecisionsChoix']) && $this->InfoEnq['PrecisionsChoix']=='5'){ ?> #autrePrecisions {display:block;} <?php }else{ ?> #autrePrecisions {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['PrecisionsChoix']) && ($this->InfoEnq['PrecisionsChoix']=='3' || $this->InfoEnq['PrecisionsChoix']=='4')){ ?> #fournisseur {display:block;} <?php }else{ ?> #fournisseur {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['PrecisionsChoix']) && $this->InfoEnq['PrecisionsChoix']=='1'){ ?> #credit {display:block;} <?php }else{ ?> #credit {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['ImpayeesChoix']) && $this->InfoEnq['ImpayeesChoix']=='oui'){ ?> #impayees {display:block;}<?php }else{?> #impayees {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['ImpayeesChoix']) && $this->InfoEnq['ImpayeesChoix']=='oui'){ ?> #retardpaiement {display:block;}<?php }else{?> #retardpaiement {display:none;} <?php }?>
<?php if(isset($this->InfoEnq['LitigeChoix']) && $this->InfoEnq['LitigeChoix']=='oui'){ ?> #litige {display:block;}<?php }else{?> #litige {display:none;} <?php }?>
</style>

<div id="center">
<h1 class="titre">ENQU&Ecirc;TE COMMERCIALE</h1>

<?php
if($this->commandeEnquete == false){
?>

<p class="StyleInfoLib">Nos enquêtes commerciales sont réalisées par des analystes financiers.</p>

<div id="message"><?=$this->message;?></div>

<form action="<?=$this->url(array('controller'=>'evaluation', 'action'=>'enquetec'))?>" method="post" enctype="multipart/form-data">
<input name="pays" value="<?=$pays?>" type="hidden"/>

<h2>Entreprise concernée : </h2>

<div class="infoTitle StyleInfoLib">Num&eacute;ro identifiant Siren</div>
<div class="infoData">
<?=$this->SirenTexte($this->Etab->Siren)?>
<input type="hidden" name="InfoEnq[Siren]" value="<?=$this->Etab->Siren?>"/>
</div>

<div class="infoTitle StyleInfoLib">Num&eacute;ro identifiant Siret</div>
<div class="infoData"><?=$this->SiretTexte($this->Etab->Siret)?></div>

<div class="infoTitle StyleInfoLib">Num&eacute;ro de TVA Intracom.</div>
<div class="infoData"><?=substr($this->Etab->TvaNumero,0,2).' '.substr($this->Etab->TvaNumero,2,2).' '.substr($this->Etab->TvaNumero,-9)?></div>

<div class="infoTitle StyleInfoLib">Raison Sociale</div>
<div class="infoData"><?=$this->Etab->Nom?></div>

<div class="infoTitle StyleInfoLib">Adresse</div>
<div class="infoData"><?=$this->Etab->Adresse.' '.$this->Etab->CP.' '.$this->Etab->Ville?></div>

<div class="fieldgrp">
<label class="StyleInfoLib">Téléphone <?php if (trim($this->Etab->Tel)==''){?><font color="Red">*</font><?php }?> / Fax</label>
<div class="field">
<?php if (trim($this->Etab->Tel)!=''){ print $this->Etab->Tel;  }else{?><input type="text" name="InfoEnq[Entrep][Tel]" value="<?=$this->InfoEnq['Entrep']['Tel']?>"/><?php } ?> <b>/</b>
<?php if (trim($this->Etab->Fax)!=''){ print $this->Etab->Fax; }else{?><input type="text" name="InfoEnq[Entrep][Fax]" value="<?=$this->InfoEnq['Entrep']['Fax']?>"/><?php } ?>
</div>
</div>

<?php if (trim($this->Etab->Tel)!=''){?>
<div class="fieldgrp">
<label class="StyleInfoLib"> Autre téléphone :</label>
<div class="field"><input type="text" name="InfoEnq[Entrep][AutreTel]" value="<?=$this->InfoEnq['Entrep']['AutreTel'];?>"/>  </div>
</div>
<?php } ?>

<div class="fieldgrp">
<label class="StyleInfoLib">E-mail</label>
<div class="field"><?php if (trim($this->Etab->Mail)!=''){ print $this->Etab->Mail; }else{?><input type="text" name="InfoEnq[Entrep][Mail]" value="<?=$this->InfoEnq['Entrep']['Mail']?>"/><?php }?></div>
</div>

<?php if (trim($this->Etab->Mail)!=''){ ?>
<div class="fieldgrp">
<label class="StyleInfoLib">Autre e-mail</label>
<div class="field"><input type="text" name="InfoEnq[Entrep][AutreMail]" value="<?=$this->InfoEnq['Entrep']['AutreMail']?>"/></div>
</div>
<?php }?>


<div class="fieldgrp">
<label class="StyleInfoLib">Site Web</label>
<div class="field"><?php if (trim($this->Etab->Web)!=''){ print $this->Etab->Web; }else{?><input type="text" name="InfoEnq[Entrep][Web]" value="<?=$this->InfoEnq['Entrep']['Web']?>"/><?php }?></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Domiciliation bancaire</label>
<div class="field">
<input type="text" name="InfoEnq[Entrep][Rib][Banque]" maxlength="5" size="5" value="<?=$this->InfoEnq['Entrep']['Rib']['Banque']?>"/>
<input type="text" name="InfoEnq[Entrep][Rib][Guichet]" maxlength="5" size="5" value="<?=$this->InfoEnq['Entrep']['Rib']['Guichet']?>"/>
<input type="text" name="InfoEnq[Entrep][Rib][Compte]" maxlength="11" size="11" value="<?=$this->InfoEnq['Entrep']['Rib']['Compte']?>"/>
<input type="text" name="InfoEnq[Entrep][Rib][Cle]" maxlength="2" size="2" value="<?=$this->InfoEnq['Entrep']['Rib']['Cle']?>"/>
</div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Encours demandé</label>
<div class="field"><input type="text" name="InfoEnq[Encours]" value="<?=$this->InfoEnq['Encours']?>"/> &euro;</div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Nombre d'échéances</label>
<div class="field"><input type="text" name="InfoEnq[NbEcheances]" value="<?=$this->InfoEnq['NbEcheances']?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Avis de l'assureur crédit</label>
<div class="field">
<select name="InfoEnq[AvisAssureur]">
	<option value="-" <?php if($this->InfoEnq['AvisAssureur']=='-'){ print 'checked="check"';} ?>>-</option>
	<option value="Favorable" <?php if($this->InfoEnq['AvisAssureur']=='Favorable'){ print 'checked="check"';} ?>>Favorable</option>
	<option value="Défavorable" <?php if($this->InfoEnq['AvisAssureur']=='Défavorable'){ print 'checked="check"';}  ?>>Défavorable</option>
</select>
</div>
</div>

<h2>Demandeur : </h2>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre profil <font color="Red">*</font></label>
<div class="field">
<select id="profil" name="InfoUser[Profil]">
<option value="Achats" <?php if($this->InfoUser['Profil']=='Achats'){print 'selected="selected"';};?>>Service Achats</option>
<option value="Commerce" <?php if($this->InfoUser['Profil']=='Commerce'){print 'selected="selected"';};?>>Commerce</option>
<option value="Recouvrement" <?php if($this->InfoUser['Profil']=='Recouvrement'){print 'selected="selected"';};?>>Recouvrement</option>
<option value="Contentieux" <?php if($this->InfoUser['Profil']=='Contentieux'){print 'selected="selected"';};?>>Contentieux</option>
<option value="Autre" <?php if($this->InfoUser['Profil']=='Autre'){print 'selected="selected"';};?>>Autre</option>
</select>
</div>
</div>

<div id="autreProfil" class="fieldgrp">
<label class="StyleInfoLib">Précisez</label>
<div class="field"><input type="text" name="InfoUser[ProfilAutre]" value="<?=$this->InfoUser['ProfilAutre']?>" /></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre Identité</label>
<div class="field"><input type="text" name="InfoUser[Identite]" value="<?php echo $this->user->getNom().' '.$this->user->getPrenom(); ?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre Téléphone <font color="Red"></font>:</label>
<div class="field"><input type="text" name="InfoUser[Tel]" value="<?php
if(isset($this->InfoUser['Tel'])){echo $this->InfoUser['Tel'];}
else echo $this->user->getTel(); ?>" /></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre Fax</label>
<div class="field"><input type="text" name="InfoUser[Fax]" value="<?php
if(isset($this->InfoUser['Fax'])){echo $this->InfoUser['Fax'];}
else echo $this->user->getFax(); ?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre E-mail <font color="Red">*</font></label>
<div class="field"><input type="text" name="InfoUser[Email]" value="<?php
if(isset($this->InfoUser['Email'])){echo $this->InfoUser['Email'];}
else echo $this->user->getEmail(); ?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Votre Référence</label>
<div class="field"><input type="text" name="InfoUser[Ref]" value="<?php
if(isset($this->InfoUser['Ref'])){echo $this->InfoUser['Ref'];}
?>"/></div>
</div>

<h2>Enquête : </h2>

<?php
if( $pays=='' )
{
?>
<div class="fieldgrp">
<label class="StyleInfoLib">Type d'enquête</label>
<div class="field">
<input class="noborder" type="radio" id="premier" name="InfoEnq[Type]" value="premier" <?php if($this->InfoEnq['Type']=='premier'){print 'checked="checked"';};?>>EXPRESS ( encours inférieur à 20K&euro; )
<br/>
<input class="noborder" type="radio" id="gold" name="InfoEnq[Type]" value="gold" <?php if($this->InfoEnq['Type']=='gold'){print 'checked="checked"';};?>>DECISION ( encours supérieur à 20K&euro; )
<br/>
<input class="noborder" type="radio" id="btp" name="InfoEnq[Type]" value="btp" <?php if($this->InfoEnq['Type']=='btp'){print 'checked="checked"';};?>>SECTEUR BTP
</div>
</div>
<?php
}
?>

<?php
if( isset($pays) && $pays!='' )
{
?>
<div class="fieldgrp">
<label class="StyleInfoLib">Délais de livraison</label>
<div class="field">
<input class="noborder" type="radio" name="InfoEnq[Delai]" value="normal" <?php if($this->InfoEnq['Delai']=='normal'){print 'checked="checked"';};?>>Normal
<input class="noborder" type="radio" name="InfoEnq[Delai]" value="urgent" <?php if($this->InfoEnq['Delai']=='urgent'){print 'checked="checked"';};?>>Urgent
</div>
</div>
<?php
}else{
?>
<div class="fieldgrp">
<label class="StyleInfoLib">Délais de livraison</label>
<div class="field">
<input class="noborder" type="radio" name="InfoEnq[Delai]" value="1" <?php if($this->InfoEnq['Delai']=='1'){print 'checked="checked"';};?>>24 h
<input class="noborder" type="radio" name="InfoEnq[Delai]" value="2" <?php if($this->InfoEnq['Delai']=='2'){print 'checked="checked"';};?>>72 h
<input class="noborder" type="radio" name="InfoEnq[Delai]" value="5" <?php if($this->InfoEnq['Delai']=='5'){print 'checked="checked"';};?>>5 jours ou +
</div>
</div>
<?php
}
?>

<div class="fieldgrp">
<label class="StyleInfoLib">Précisions sur la demande</label>
<div class="field">
<select id="precision" name="InfoEnq[PrecisionsChoix]">
<option value="">Choisissez...</option>
<option value="1" <?php if($this->InfoEnq['PrecisionsChoix']=='1'){print 'selected="selected"';};?>>Enquête sur un client (contrôle crédit)</option>
<option value="2" <?php if($this->InfoEnq['PrecisionsChoix']=='2'){print 'selected="selected"';};?>>Enquête sur un prospect (ouverture de compte)</option>
<option value="3" <?php if($this->InfoEnq['PrecisionsChoix']=='3'){print 'selected="selected"';};?>>Enquête sur un fournisseur stratégique</option>
<option value="4" <?php if($this->InfoEnq['PrecisionsChoix']=='4'){print 'selected="selected"';};?>>Enquête sur un fournisseur non stratégique</option>
<option value="5" <?php if($this->InfoEnq['PrecisionsChoix']=='5'){print 'selected="selected"';};?>>Autre type d'enquête (Précisez...)</option>
</select>
</div>
</div>

<div id="fournisseur" class="fieldgrp">
<label class="StyleInfoLib">CA réalisé avec le fournisseur</label>
<div class="field"><input type="text" name="InfoEnq[Precisions][MontantCA]" value="<?=$this->InfoEnq['Precisions']['MontantCA']?>" /> &euro;</div>
</div>

<div id="credit" class="fieldgrp">
<label class="StyleInfoLib">Motif du contrôle</label>
<div class="field"><textarea name="InfoEnq[Precisions][Motif]"><?=$this->InfoEnq['Precisions']['Motif']?></textarea></div>
</div>

<div id="autrePrecisions" class="fieldgrp">
<label class="StyleInfoLib">Précisez</label>
<div class="field"><textarea name="InfoEnq[Precisions][Autre]"><?=$this->InfoEnq['Precisions']['Autre']?></textarea></div>
</div>


<div class="fieldgrp">
<label class="StyleInfoLib">Ancienneté de la relation :</label>
<div class="field">
<input type="text" name="InfoEnq[Anciennete]" size="2" value="<?=$this->InfoEnq['Anciennete']?>"/>
<input class="noborder" type="radio" name="InfoEnq[AncienneteDuree]" value="Mois" <?php if($this->InfoEnq['AncienneteDuree']=='Mois'){ print 'checked="checked"';}?>/>Mois
<input class="noborder" type="radio" name="InfoEnq[AncienneteDuree]" value="Annees" <?php if($this->InfoEnq['AncienneteDuree']=='Annees'){ print 'checked="checked"';}?>/>Années
</div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Impayées :</label>
<div class="field">
<input class="noborder" type="radio" name="InfoEnq[ImpayeesChoix]" value="oui" <?php if($this->InfoEnq['ImpayeesChoix']=='oui'){ print 'checked="checked"';}?>/>Oui
<input class="noborder" type="radio" name="InfoEnq[ImpayeesChoix]" value="non" <?php if($this->InfoEnq['ImpayeesChoix']=='non'){ print 'checked="checked"';}?>/>Non
</div>
</div>

<div id="impayees">

<div class="fieldgrp">
<label class="StyleInfoLib">Montant :</label>
<div class="field"><input type="text" name="InfoEnq[Impayees][Montant]" value="<?=$this->InfoEnq['Impayees']['Montant']?>"/> &euro;</div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Nombre :</label>
<div class="field"><input type="text" name="InfoEnq[Impayees][Nombre]" value="<?=$this->InfoEnq['Impayees']['Nombre']?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Date :</label>
<div class="field"><input type="text" name="InfoEnq[Impayees][Date]" value="<?=$this->InfoEnq['Impayees']['Date']?>"/> (Format : JJ/MM/AAAA)</div>
</div>

</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Retard de paiement :</label>
<div class="field">
<input class="noborder" type="radio" name="InfoEnq[RetardPaiementChoix]" value="oui" <?php if($this->InfoEnq['RetardPaiementChoix']=='oui'){ print 'checked="checked"';}?>/>Oui
<input class="noborder" type="radio" name="InfoEnq[RetardPaiementChoix]" value="non" <?php if($this->InfoEnq['RetardPaiementChoix']=='non'){ print 'checked="checked"';}?>/>Non
</div>
</div>

<div id="retardpaiement">

<div class="fieldgrp">
<label class="StyleInfoLib">Montant :</label>
<div class="field"><input type="text" name="InfoEnq[RetardPaiement][Montant]" value="<?=$this->InfoEnq['RetardPaiement']['Montant']?>"/> &euro;</div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Nombre :</label>
<div class="field"><input type="text" name="InfoEnq[RetardPaiement][Nombre]" value="<?=$this->InfoEnq['RetardPaiement']['Nombre']?>"/></div>
</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Date :</label>
<div class="field"><input type="text" name="InfoEnq[RetardPaiement][Date]" value="<?=$this->InfoEnq['RetardPaiement']['Date']?>"/> (Format : JJ/MM/AAAA)</div>
</div>

</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Litiges techniques ou commerciaux :</label>
<div class="field">
<input class="noborder" type="radio" name="InfoEnq[LitigeChoix]" value="oui" <?php if($this->InfoEnq['LitigeChoix']=='oui'){ print 'checked="checked"';}?>/>Oui
<input class="noborder" type="radio" name="InfoEnq[LitigeChoix]" value="non" <?php if($this->InfoEnq['LitigeChoix']=='non'){ print 'checked="checked"';}?>/>Non
</div>
</div>


<div id="litige">

<div class="fieldgrp">
<label class="StyleInfoLib">Précisions :</label>
<div class="field">
<textarea name="InfoEnq[Litige][Precisions]"><?=$this->InfoEnq['Litige']['Precisions']?></textarea>
</div>
</div>

</div>

<div class="fieldgrp">
<label class="StyleInfoLib">Observations ou questions spéciales</label>
<div class="field"><textarea name="InfoEnq[Observation]"><?=$this->InfoEnq['Observation']; ?></textarea></div>
</div>

<div class="submit"><p class="submit-button"><input type="submit" name="submit" value="Envoyer" /></p></div>

</form>
<?php
}

if($this->commandeEnquete == true)
{
	?>
	<p>
	Votre demande à été prise en compte le <?=$this->jour.'/'.$this->mois.'/'.$this->annee?> à <?=$this->heure?> h <?=$this->minutes?> sous la référence <b><?=$this->ref?></b> pour le siren <b><?=$this->siren?></b>.
	</p>
	<?php
}
?>
</div>