Current File : /home/digitaw/teste_ecarte/modal-contact.php

<link rel="stylesheet" href="assets/css/css-modal.css">

<div class="container-xl px-4 mt-4">


    <div class="row">

        <div class="col-xl-12">
            <!-- Account details card-->
            <div class="card mb-4">
                <div class="card-header">
                    <div class=" d-flex j justify-content-around">
                        <label class="small mb-1" for="packe">Profil : <b id="profil_i"></b> </label>
                        <label class="small mb-1" for="packe">Packe : <b id="packe_i"></b> </label>
                    </div>
                </div>



                <div class="card-body">
                    <form method="post" action="save_form_contact.php">

                        <div class="row mb-2 ">
                            <div class="col-md-6">

                                <input class="form-control" hidden id="profil" type="text" name="profil" required>
                            </div>
                            <div class="col-md-6">

                                <input hidden class="form-control" id="packe" type="text" name="packe" required>
                            </div>
                        </div>



                        <!-- Form Row-->
                        <div class="row gx-3 mb-3">
                            <!-- Form Group (first name)-->
                            <div class="col-md-6">
                                <label class="small mb-1" for="inputFirstName">Prenom</label>
                                <input class="form-control" id="inputFirstName" type="text" name="prenom" required
                                    placeholder="Enter your first name" value="Valerie">
                            </div>
                            <!-- Form Group (last name)-->
                            <div class="col-md-6">
                                <label class="small mb-1" for="inputLastName">Nom</label>
                                <input class="form-control" id="inputLastName" type="text" name="nom" required
                                    placeholder="Enter your last name" value="Luna">
                            </div>
                        </div>

                        <div class="row gx-3 mb-3">
                            <!-- Form Group (phone number)-->
                            <div class="col-md-12">
                                <label class="small mb-1" for="inputPhone">Telephone</label>
                                <input class="form-control" id="inputPhone" type="tel" name="phone" required
                                    placeholder="Entrer votre numero de telephone " value="774110215">
                            </div>

                        </div>
                        <!-- Form Group (email address)-->
                        <div class="mb-3 row">
                            <div class="col-md-6">
                                <label class="small mb-1" for="inputEmailAddress">Adresse Email</label>
                                <input class="form-control" id="inputEmailAddress" type="email" required name="email"
                                    placeholder="Entrer votre adresse email" value="name@example.com">
                            </div>
                            <div class="col-md-6">
                                <label class="small mb-1" for="password">Mot de passe</label>
                                <input class="form-control" id="password" type="password" required name="password"
                                    placeholder="Entrer votre mot de passe">
                            </div>

                        </div>
                        <!-- Form Row-->

                        <!-- Save changes button-->
                        <div class="d-flex justify-content-between">
                            <button class="btn btn-danger" class="close" data-dismiss="modal">Annuler</button>
                            <button class="btn btn-primary" name="submit_form" type="submit">Valider</button>
                        </div>

                    </form>
                </div>
            </div>
        </div>
    </div>
</div>

<script>
function getProfil(profil, duree) {
    var profil_input = document.getElementById('profil');
    profil_input.value = profil

    var duree_input = document.getElementById('packe');
    duree_input.value = duree;

    var profil_i = document.getElementById('profil_i');
    var packe_i = document.getElementById('packe_i');


    profil_i.innerText = profil;
    packe_i.innerText = duree;
}
</script>