extranet/application/views/default/scripts/saisie/lienetranger.phtml

<div class="fieldgrp">
<label>Pays</label>
<div class="field">
<select>
<option>-</option>
<?php foreach($this->countries as $code => $lib) {?>
<option value="<?=$code?>"><?=$lib?></option>
<?php }?>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Identifiant local</label>
<div class="field">
<input type="text"/> <select></select> <a href="#">[+]</a>
</div>
</div>



<div class="fieldgrp">
<label>Adresse</label>
<div class="field">
<input type="text" name="adresse_num" size="4"/>
<input type="text" name="adresse_btq" size="1"/>
<input type="text" name="adresse_codvoie" size="4"/>
<input type="text" name="adresse_libvoie" size="32"/>
</div>
</div>

<div class="fieldgrp">
<label>Adresse complément</label>
<div class="field">
<input type="text" name="adresse_comp" size="40"/>
</div>
</div>

<div class="fieldgrp">
<label>CP</label>
<div class="field">
<input type="text"/>
</div>
</div>

<div class="fieldgrp">
<label>Ville</label>
<div class="field">
<input type="text"/>
</div>
</div>