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May 23rd, 2019
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  1. <div class="container">
  2. <div class="py-5 text-center">
  3. <h2>Kasse</h2>
  4. </div>
  5.  
  6. <div class="row">
  7.  
  8. </div>
  9. <div class="col-md-10 order-md-1">
  10. <h4 class="mb-3">Adresse</h4>
  11. <form class="needs-validation" novalidate>
  12. <div class="row">
  13. <div class="col-md-6 mb-3">
  14. <label for="vorname">Vorname</label>
  15. <input type="text" class="form-control" id="vorname" placeholder="Max" required>
  16. <div class="invalid-feedback">
  17. Vorname ist ein Pflichtfeld.
  18. </div>
  19. </div>
  20. <div class="col-md-6 mb-3">
  21. <label for="nachname">Nachname</label>
  22. <input type="text" class="form-control" id="nachname" placeholder="Mustermann" required>
  23. <div class="invalid-feedback">
  24. Nachname ist ein Pflichtfeld.
  25. </div>
  26. </div>
  27. </div>
  28.  
  29.  
  30.  
  31. <div class="mb-3">
  32. <label for="email">E-Mail <span class="text-muted"> </span></label>
  33. <input type="email" class="form-control" id="email" placeholder="mustermann@web.de">
  34. <div class="invalid-feedback">
  35. Geben Sie bitte Ihre gültige E-Mail Adresse ein.
  36. </div>
  37. </div>
  38.  
  39.  
  40.  
  41. <div class="row">
  42. <div class="form-group col-sm-6">
  43. <label for="strasse">Straße</label>
  44. <input type="text" class="form-control" id="strasse" placeholder="Geben Sie Ihre Straße ein" required>
  45. </div>
  46. <div class="form-group col-sm-6">
  47. <label for="hausnummer">Hausnummer</label>
  48. <input type="text" class="form-control" id="hausnummer" placeholder="Geben Sie Ihre Hausnummer ein" required>
  49. </div>
  50. </div>
  51.  
  52.  
  53. <div class="row">
  54. <div class="form-group col-sm-6">
  55. <label for="plz">PLZ</label>
  56. <input type="text" class="form-control" id="plz" placeholder="Geben Sie Ihren PLZ ein" required>
  57. </div>
  58. <div class="form-group col-sm-6">
  59. <label for="ort">Ort</label>
  60. <input type="text" class="form-control" id="ort" placeholder="Geben Sie Ihren Wohnort ein" required>
  61. </div>
  62.  
  63. </div>
  64.  
  65.  
  66.  
  67. <h4 class="mb-3">Zahlung</h4>
  68.  
  69. <div class="d-block my-3">
  70. <div class="custom-control custom-radio">
  71. <input id="credit" name="paymentMethod" type="radio" class="custom-control-input" required>
  72. <label class="custom-control-label" for="credit">Kreditkarte</label>
  73. </div>
  74.  
  75. <div class="custom-control custom-radio">
  76. <input id="paypal" name="paymentMethod" type="radio" class="custom-control-input" required>
  77. <label class="custom-control-label" for="paypal">Paypal</label>
  78. </div>
  79. </div>
  80. <div class="row">
  81. <div class="col-md-6 mb-3">
  82. <label for="karteninhaber">Karteninhaber</label>
  83. <input type="text" class="form-control" id="karteninhaber" required>
  84. <small class="text-muted">Name, wie auf der Karte angegeben ist</small>
  85. <div class="invalid-feedback">
  86. Karteninhaber ist ein Pflichtfeld
  87. </div>
  88. </div>
  89. <div class="col-md-6 mb-3">
  90. <label for="kartennummer">Kartennummer</label>
  91. <input type="text" class="form-control" id="kartennummer" required>
  92. <div class="invalid-feedback">
  93. Kartennummer ist ein Pflichtfeld
  94. </div>
  95. </div>
  96. </div>
  97. <div class="row">
  98. <div class="col-md-3 mb-3">
  99. <label for="karteablaufdatum">Ablaufdatum</label>
  100. <input type="text" class="form-control" id="karteablaufdatum" required>
  101. <div class="invalid-feedback">
  102. Ablaufdatum ist ein Pflichtfeld
  103. </div>
  104. </div>
  105. <div class="col-md-3 mb-3">
  106. <label for="kartesicherheitscode">CVV</label>
  107. <input type="text" class="form-control" id="kartesicherheitscode" required>
  108. <div class="invalid-feedback">
  109. Sicherheitscode ist ein Pflichtfeld
  110. </div>
  111. </div>
  112. </div>
  113. <hr class="mb-4">
  114. <button class="btn btn-info btn-lg btn-block" type="submit">Buchen</button>
  115. </form>
  116. </div>
  117. </div>
  118.  
  119.  
  120. </div>
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