templates/Partial/registration.html.twig line 1

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  1. {% for flashError in app.flashes('verify_email_error') %}
  2. <div class="alert alert-danger" role="alert">{{ flashError }}</div>
  3. {% endfor %}
  4. <form action="{{ path('presta_access') }}" name="register" id="register" method="post" enctype="multipart/form-data" novalidate>
  5. <fieldset>
  6. <legend>Votre compte</legend>
  7. <div class="table-form row">
  8. <div class="col-sm-6 register-form-email">
  9. <div class="form-label">
  10. <label class="required" for="email">Adresse email</label>
  11. </div>
  12. <div class="form-fields clearfix">
  13. <input type="email" id="email" name="email" required="required" autocomplete="false" onchange="emailVerification();">
  14. </div>
  15. </div>
  16. <div class="col-sm-6 register-form-email-verification">
  17. <div class="form-label">
  18. <label class="required" for="email_verification">Adresse email (vérification)</label>
  19. </div>
  20. <div class="form-fields clearfix">
  21. <input type="email" id="email_verification" name="email_verification" required="required" autocomplete="false" onchange="emailVerification();">
  22. </div>
  23. </div>
  24. </div>
  25. <div class="table-form row">
  26. <div class="col-sm-6 register-form-password">
  27. <div class="form-label">
  28. <label class="required" for="password">Mot de passe</label>
  29. </div>
  30. <div class="form-fields clearfix">
  31. <input type="password" id="password" name="password" required="required" minlength="6" onchange="passwordVerification();">
  32. </div>
  33. </div>
  34. <div class="col-sm-6 register-form-password-verification">
  35. <div class="form-label">
  36. <label class="required" for="password_verification">Mot de passe (vérification)</label>
  37. </div>
  38. <div class="form-fields clearfix">
  39. <input type="password" id="password_verification" name="password_verification" required="required" onchange="passwordVerification();">
  40. </div>
  41. </div>
  42. </div>
  43. </fieldset>
  45. <fieldset>
  46. <legend>Vos informations</legend>
  47. <div class="table-form row">
  48. <div class="col-sm-6">
  49. <div class="form-label">
  50. <label class="required" for="entreprise">Nom de l'entreprise</label>
  51. </div>
  52. <div class="form-fields clearfix">
  53. <input type="text" id="entreprise" name="entreprise" required="required" >
  54. </div>
  55. </div>
  56. <div class="col-sm-6">
  57. <div class="form-label">
  58. <label class="required" for="siret">SIRET (14 chiffres sans espace)</label>
  59. </div>
  60. <div class="form-fields clearfix">
  61. <input type="text" id="siret" name="siret" required="required" minlength="14" maxlength="14" pattern=".{14,}" onchange="siretVerification();">
  62. </div>
  63. </div>
  64. </div>
  65. <div class="table-form row">
  66. <div class="col-sm-6">
  67. <div class="form-label">
  68. <label class="required" for="responsable">Nom du responsable</label>
  69. </div>
  70. <div class="form-fields clearfix">
  71. <input type="text" id="responsable" name="responsable" required="required" >
  72. </div>
  73. </div>
  74. <div class="col-sm-6">
  75. <div class="form-label">
  76. <label for="website">Site internet</label>
  77. </div>
  78. <div class="form-fields clearfix">
  79. <input type="url" id="website" name="website">
  80. </div>
  81. </div>
  82. </div>
  83. <div class="table-form row">
  84. <div class="col-sm-4">
  85. <div class="form-label">
  86. <label class="required" for="address">Adresse</label>
  87. </div>
  88. <div class="form-fields clearfix">
  89. <input type="text" id="address" name="address" required="required" >
  90. </div>
  91. </div>
  92. <div class="col-sm-4">
  93. <div class="form-label">
  94. <label class="required" for="zipcode">Code postal</label>
  95. </div>
  96. <div class="form-fields clearfix">
  97. <input type="number" id="zipcode" class="auto_cp" name="zipcode" required="required" >
  98. </div>
  99. </div>
  100. <div class="col-sm-4">
  101. <div class="form-label">
  102. <label class="required" for="city">Ville</label>
  103. </div>
  104. <div class="form-fields clearfix">
  105. <input type="text" id="city" class="auto_ville" name="city" required="required" >
  106. </div>
  107. </div>
  108. </div>
  109. <div class="table-form row">
  110. <div class="col-sm-6">
  111. <div class="form-label">
  112. <label class="required" for="phone">Téléphone</label>
  113. </div>
  114. <div class="form-fields clearfix">
  115. <input type="tel" id="phone" name="phone" required="required" >
  116. </div>
  117. </div>
  118. <div class="col-sm-6">
  119. <div class="form-label">
  120. <label for="fax">Fax</label>
  121. </div>
  122. <div class="form-fields clearfix">
  123. <input type="number" id="fax" name="fax">
  124. </div>
  125. </div>
  126. </div>
  127. <div class="table-form row">
  128. <div class="col-sm-8">
  129. <div class="form-label">
  130. <label for="logo">Insérer votre logo (10&nbsp;Mo max)</label>
  131. </div>
  132. <div class="form-fields clearfix">
  133. <span class="browse-button row">
  134. <span class="col-md-6">
  135. <input class="hide" type="file" id="logo" name="logo">
  136. <button class="browse" type="button">Parcourir</button>
  137. </span>
  138. <span class="file col-md-6">Aucun fichier sélectionné.</span>
  139. </span>
  140. </div>
  141. </div>
  142. </div>
  143. </fieldset>
  145. <fieldset>
  146. <legend>Votre activité</legend>
  147. <div class="form-table row">
  148. <div id="departements" class="register-form-departements col-sm-6">
  149. <div class="form-label">
  150. <label class="required" for="register_departements">Secteurs d'intervention</label>
  151. </div>
  152. <div class="form-fields">
  153. <div id="register_departements">
  154. {% for departement in departements %}
  155. <div class="choice">
  156. <input type="checkbox" class="departements_checkbox" id="departement_{{ departement.id }}" name="departements[]" value="{{ departement.id }}" >
  157. <label for="departement_{{ departement.id }}">{{ departement.code }} – {{ departement.nom }}</label>
  158. </div>
  159. {% endfor %}
  160. </div>
  161. </div>
  162. </div>
  163. <div id="categories" class="register-form-categories col-sm-6">
  164. <div class="form-label">
  165. <label class="required">Domaines d'intervention</label>
  166. </div>
  167. <div class="form-fields">
  168. <div class="opt-group">
  169. <div class="opt-group-label">
  170. Diagnostics immobiliers
  171. </div>
  172. <div class="opt-group-content">
  173. <div class="choice"><input type="checkbox" class="categories_checkbox" id="category_72"
  174. name="categories[]" value="72"> <label for="category_72" >Amiante,
  175. DPE, Électrique, Gaz, Plomb, ERP, Termites, Loi Carrez, Loi Boutin, DTG, PPPT</label>
  176. </div>
  178. </div>
  179. </div>
  180. <div class="opt-group">
  181. <div class="opt-group-label">
  182. Expertises du bâtiment
  183. </div>
  184. <div class="opt-group-content cols">
  185. {% for category in categories.expertises|slice(1) %}
  186. <div class="choice">
  187. <input type="checkbox" class="categories_checkbox" id="category_{{ category.id }}" name="categories[]" value="{{ category.id }}" >
  188. <label for="category_{{ category.id }}">{{ category.nom }}</label>
  189. </div>
  190. {% endfor %}
  191. </div>
  192. </div>
  193. <div class="opt-group">
  194. <div class="opt-group-label">
  195. Études énergétiques
  196. </div>
  197. <div class="opt-group-content cols">
  198. {% for category in categories.etudes|slice(1) %}
  199. <div class="choice">
  200. <input type="checkbox" class="categories_checkbox" id="category_{{ category.id }}" name="categories[]" value="{{ category.id }}">
  201. <label for="category_{{ category.id }}">{{ category.nom }}</label>
  202. </div>
  203. {% endfor %}
  204. </div>
  205. </div>
  206. <div class="opt-group">
  207. <div class="opt-group-label">
  208. Solutions énergétiques
  209. </div>
  210. <div class="opt-group-content cols">
  211. {% for category in categories.solutions|slice(1) %}
  212. <div class="choice">
  213. <input type="checkbox" class="categories_checkbox" id="category_{{ category.id }}" name="categories[]" value="{{ category.id }}">
  214. <label for="category_{{ category.id }}">{{ category.nom }}</label>
  215. </div>
  216. {% endfor %}
  217. </div>
  218. </div>
  219. <div class="opt-group">
  220. <div class="opt-group-label">
  221. Énergies renouvelables
  222. </div>
  223. <div class="opt-group-content cols">
  224. {% for category in categories.energies|slice(1) %}
  225. <div class="choice">
  226. <input type="checkbox" class="categories_checkbox" id="category_{{ category.id }}" name="categories[]" value="{{ category.id }}">
  227. <label for="category_{{ category.id }}">{{ category.nom }}</label>
  228. </div>
  229. {% endfor %}
  230. </div>
  231. </div>
  232. </div>
  233. </div>
  234. </div>
  235. </fieldset>
  237. <div class="declaration row">
  238. <div class="form-fields col-sm-12">
  239. <input type="checkbox" id="cgu" name="cgu" required="required" onclick="dataVerification();">
  240. <label id="label_cgu" for="cgu" class="required"><p>J’ai lu et j’accepte les <a href="/cguv.html">CGUV</a> du site ExaCompare.fr<p></label>
  241. </div>
  242. </div>
  244. <div class="row">
  245. <p class="form-required-legend form-message col-sm-12">
  246. <span id="form-required-legend-text"><span class="required form-required-mark">*</span> Champ obligatoire.</span>
  247. </p>
  248. <div class="form-buttons col-sm-12">
  249. <input type="hidden" name="register_submit" value="1">
  250. <button type="submit" id="register_submit">S'inscrire</button>
  251. </div>
  252. </div>
  253. </form>