2024-02-22 06:51:56 +00:00
|
|
|
+++
|
|
|
|
|
date = '2024-02-21T13:22:03Z'
|
|
|
|
|
draft = false
|
|
|
|
|
title = 'Zusatzmodule Freiberufliche'
|
|
|
|
|
+++
|
|
|
|
|
|
|
|
|
|
{{% veruaslider height="450px" %}}
|
|
|
|
|
{{% slide image="../bestellungen-header.jpg" first="true " %}}
|
|
|
|
|
{{% /veruaslider %}}
|
|
|
|
|
{{% section %}}
|
|
|
|
|
{{% aligncenter %}}
|
|
|
|
|
#### Bestellformular
|
|
|
|
|
## VeruA ** Verwaltung und Abrechnung
|
2024-02-23 08:27:33 +00:00
|
|
|
### Zusatzmodule für Freiberufliche
|
2024-02-22 06:51:56 +00:00
|
|
|
<br>
|
|
|
|
|
|
|
|
|
|
---
|
|
|
|
|
|
|
|
|
|
<br>
|
|
|
|
|
|
|
|
|
|
{{% /aligncenter %}}
|
|
|
|
|
|
2024-02-23 08:27:33 +00:00
|
|
|
<form action="https://verua.dev-1.andreashnida.de/php/ajaxmail.php" method="POST" id="formular">
|
|
|
|
|
<div id="formPartOne">
|
|
|
|
|
<input type="hidden" name="formularart" value="Zusatzmodule Freiberufliche">
|
|
|
|
|
<div>
|
|
|
|
|
<label for="gender">Geschlecht</label>
|
|
|
|
|
<select id="gender" name="gender" required >
|
|
|
|
|
<option value="weiblich">Frau</option>
|
|
|
|
|
<option value="männlich">Mann</option>
|
|
|
|
|
<option value="divers">Divers</option>
|
|
|
|
|
</select>
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="sprache">Sprache</label>
|
|
|
|
|
<select id="sprache" name="sprache" required >
|
|
|
|
|
<option value="deutsch">Deutsch</option>
|
|
|
|
|
<option value="franzoesisch">Französisch</option>
|
|
|
|
|
</select>
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="name">Nachname</label>
|
|
|
|
|
<input type="text" id="name" name="name" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="vorname">Vorname</label>
|
|
|
|
|
<input type="text" id="vorname" name="vorname" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<input type="text" id="hobbies" name="hobbies" >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="strasse">Strasse</label>
|
|
|
|
|
<input type="text" id="strasse" name="strasse" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<input type="text" id="age" name="age">
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="plz_ort">PLZ Ort</label>
|
|
|
|
|
<input type="text" id="plz_ort" name="plz_ort" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="telefon">Telefon</label>
|
|
|
|
|
<input type="text" id="telefon" name="telefon" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="email">Email</label>
|
|
|
|
|
<input type="email" id="email" name="email" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<input type="verify_email" id="verify_email" name="verify_email" >
|
|
|
|
|
</div>
|
|
|
|
|
<div id="zsr-tooltip" data-tooltip="Bitte geben Sie eine gültie ZSR-Nummer, oder 'beantragt' ein.">
|
|
|
|
|
<label for="zsr_nummer">ZSR Nummer</label>
|
|
|
|
|
<input type="text" id="zsr_nummer" name="zsr_nummer" required >
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
<label for="checkbox-group">Welche Erweiterungen möchten Sie hinzubuchen?</label>
|
|
|
|
|
<div id="checkbox-group">
|
|
|
|
|
<input type="checkbox" id="zusatzmodul-pop2" name="zusatzmodul-pop2" value="Zusatzmodul POP2">
|
|
|
|
|
<label for="zusatzmodul-pop2">Zusatzmodul POP2 für 480 CHF</label>
|
|
|
|
|
<br>
|
|
|
|
|
<input type="checkbox" id="zusatzmodul-materialverwaltung" name="zusatzmodul-materialverwaltung" value="Zusatzmodul Materialverwaltung">
|
|
|
|
|
<label for="zusatzmodul-materialverwaltung">Zusatzmodul Materialverwaltung für 480 CHF</label>
|
|
|
|
|
<br>
|
|
|
|
|
<input type="checkbox" id="zusatzmodul-qr-code" name="zusatzmodul-qr-code" value="Zusatzmodul QR-Code">
|
|
|
|
|
<label for="zusatzmodul-qr-code">Zusatzmodul QR-Code für 36.00 CHF jährlich, Ausschaltgebühr einmalig pro Instanz 50.00 CHF</label>
|
|
|
|
|
<br>
|
|
|
|
|
<input type="checkbox" id="zusatzmodul-perigon" name="zusatzmodul-perigon" value="Zusatzmodul Perigon">
|
|
|
|
|
<label for="zusatzmodul-perigon">Zusatzmodul Perigon, Ausschaltgebühr einmalig 50.00 CHF</label>
|
|
|
|
|
</div>
|
|
|
|
|
<div>
|
|
|
|
|
</div>
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
<div class="w-full flex justify-center">
|
|
|
|
|
<button id="bestellformular-btn" type="submit" class="submitbutton text-white mx-auto submit-after-valid-captcha-bak">Kostenpflichtig bestellen</button>
|
|
|
|
|
<div id="notification" class="bg-blue-500 text-white rounded invisible opacity-0 hidden">Notification</div>
|
|
|
|
|
</div>
|
|
|
|
|
</form>
|
2024-02-22 06:51:56 +00:00
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
{{% /section %}}
|