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- <div class="container">
- <div class="py-5 text-center">
- <h2>Kasse</h2>
- </div>
- <div class="row">
- </div>
- <div class="col-md-10 order-md-1">
- <h4 class="mb-3">Adresse</h4>
- <form class="needs-validation" novalidate>
- <div class="row">
- <div class="col-md-6 mb-3">
- <label for="vorname">Vorname</label>
- <input type="text" class="form-control" id="vorname" placeholder="Max" required>
- <div class="invalid-feedback">
- Vorname ist ein Pflichtfeld.
- </div>
- </div>
- <div class="col-md-6 mb-3">
- <label for="nachname">Nachname</label>
- <input type="text" class="form-control" id="nachname" placeholder="Mustermann" required>
- <div class="invalid-feedback">
- Nachname ist ein Pflichtfeld.
- </div>
- </div>
- </div>
- <div class="mb-3">
- <label for="email">E-Mail <span class="text-muted"> </span></label>
- <input type="email" class="form-control" id="email" placeholder="mustermann@web.de">
- <div class="invalid-feedback">
- Geben Sie bitte Ihre gültige E-Mail Adresse ein.
- </div>
- </div>
- <div class="row">
- <div class="form-group col-sm-6">
- <label for="strasse">Straße</label>
- <input type="text" class="form-control" id="strasse" placeholder="Geben Sie Ihre Straße ein" required>
- </div>
- <div class="form-group col-sm-6">
- <label for="hausnummer">Hausnummer</label>
- <input type="text" class="form-control" id="hausnummer" placeholder="Geben Sie Ihre Hausnummer ein" required>
- </div>
- </div>
- <div class="row">
- <div class="form-group col-sm-6">
- <label for="plz">PLZ</label>
- <input type="text" class="form-control" id="plz" placeholder="Geben Sie Ihren PLZ ein" required>
- </div>
- <div class="form-group col-sm-6">
- <label for="ort">Ort</label>
- <input type="text" class="form-control" id="ort" placeholder="Geben Sie Ihren Wohnort ein" required>
- </div>
- </div>
- <h4 class="mb-3">Zahlung</h4>
- <div class="d-block my-3">
- <div class="custom-control custom-radio">
- <input id="credit" name="paymentMethod" type="radio" class="custom-control-input" required>
- <label class="custom-control-label" for="credit">Kreditkarte</label>
- </div>
- <div class="custom-control custom-radio">
- <input id="paypal" name="paymentMethod" type="radio" class="custom-control-input" required>
- <label class="custom-control-label" for="paypal">Paypal</label>
- </div>
- </div>
- <div class="row">
- <div class="col-md-6 mb-3">
- <label for="karteninhaber">Karteninhaber</label>
- <input type="text" class="form-control" id="karteninhaber" required>
- <small class="text-muted">Name, wie auf der Karte angegeben ist</small>
- <div class="invalid-feedback">
- Karteninhaber ist ein Pflichtfeld
- </div>
- </div>
- <div class="col-md-6 mb-3">
- <label for="kartennummer">Kartennummer</label>
- <input type="text" class="form-control" id="kartennummer" required>
- <div class="invalid-feedback">
- Kartennummer ist ein Pflichtfeld
- </div>
- </div>
- </div>
- <div class="row">
- <div class="col-md-3 mb-3">
- <label for="karteablaufdatum">Ablaufdatum</label>
- <input type="text" class="form-control" id="karteablaufdatum" required>
- <div class="invalid-feedback">
- Ablaufdatum ist ein Pflichtfeld
- </div>
- </div>
- <div class="col-md-3 mb-3">
- <label for="kartesicherheitscode">CVV</label>
- <input type="text" class="form-control" id="kartesicherheitscode" required>
- <div class="invalid-feedback">
- Sicherheitscode ist ein Pflichtfeld
- </div>
- </div>
- </div>
- <hr class="mb-4">
- <button class="btn btn-info btn-lg btn-block" type="submit">Buchen</button>
- </form>
- </div>
- </div>
- </div>
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