extranet/application/views/default/scripts/dashboard/prestation.phtml

<style type="text/css">
.close {
	display: none;
}

.open {
	display: block;
}

.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%;
}

.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;
}

fieldset { margin:10px 0;}
fieldset legend { font-weight:bold; font-size: 108%; }

div.submit {
	clear: both;
	text-align: center;
}

</style>
<div id="center">
<h1>Prestations fichier client (idClient=<?=$this->idClient?>)</h1>
<div class="paragraph">

<form>
<input type="hidden" name="idClient" value="<?=$this->idClient?>"/>

<div class="fieldgrp">
<label>Type de prestation : </label>
<div class="field">
<select name="typeprestation">
<option>-</option>
<option value="Diffusion">Diffusion</option>
<option value="Surveillance">Surveillance</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Source</label>
<div class="field">
<select name="source">
<option>-</option>
<option value="Bodacc">Bodacc</option>
<option value="Insee">Insee</option>
<option value="Rncs">Rncs</option>
<option value="Bilans">Bilans</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Date de mise en place</label>
<div class="field">
<input type="text" name="datemiseenplace" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Date première facture</label>
<div class="field">
<input type="text" name="datepremierefacture" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Fréquence de facturation (en mois)</label>
<div class="field">
<select name="freqfacturation">
<option value="Unitaire">Unitaire</option>
<option value="Quotidien">Quotidien</option>
<option value="Hebdo">Hebdo</option>
<option value="Mensuel">Mensuel</option>
<option value="Trimestriel">Trimestriel</option>
<option value="Semestriel">Semestriel</option>
<option value="Annuel">Annuel</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Date de fin</label>
<div class="field">
<input type="text" name="datefinprestation" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Test</label>
<div class="field">
<select name="prestatest">
<option value="0">Non</option>
<option value="1">Oui</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Identifiant</label>
<div class="field">
<input type="text" name="identifiantPrestation" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Password</label>
<div class="field">
<input type="text" name="passwordprestation" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Support de livraison</label>
<div class="field">
<select name="supportprestation">
<option value="FTP">FTP</option>
<option value="Email">EMAIL</option>
<option value="CD/DVD">CD/DVD</option>
<option value="CFT">CFT</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Identifiant CFT</label>
<div class="field">
<input type="text" name="identifiantCFT" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Durée du contrat</label>
<div class="field">
<input type="text" name="dureecontrat" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Montant annuel facturation</label>
<div class="field">
<input type="text" name="montantannuelfact" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Fréquence des envois</label>
<div class="field">
<select name="freqenvois">
<option value="Unitaire">Unitaire</option>
<option value="Quotidien">Quotidien</option>
<option value="Hebdo">Hebdo</option>
<option value="Mensuel">Mensuel</option>
<option value="Trimestriel">Trimestriel</option>
<option value="Semestriel">Semestriel</option>
<option value="Annuel">Annuel</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Options (format INI)</label>
<div class="field">
<textarea name="optionsprestation"></textarea>
</div>
</div>

<div class="fieldgrp">
<label>Active</label>
<div class="field">
<select name="prestationactive">
<option value="oui">Oui</option>
<option value="non">Non</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Options support (format INI)</label>
<div class="field">
<textarea name="optionssupport"></textarea>
</div>

</div>

<div class="fieldgrp">
<label>Main d'info fichier entrant</label>
<div class="field">
<input type="text" name="mailIN" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>Main d'info fichier sortant</label>
<div class="field">
<input type="text" name="mailOUT" value=""/>
</div>
</div>

<div class="fieldgrp">
<label>osClient</label>
<div class="field">
<select name="osClient">
<option value="WINDOWS">WINDOWS</option>
<option value="LINUX">LINUX</option>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Compression</label>
<div class="field">
<select name="compression">
<option value="none">none</option>
<option value="zip">zip</option>
<option value="gzip">gzip</option>
<option value="bzip2">bzip2</option>
</select>
</div>
</div>

<div class="submit">
<p class="submit-button">
<input type="submit" class="button" value="<?=$this->submitValue?>" />
</p>
</div>
</form>


</div>

</div>