30 lines
1.8 KiB
Plaintext
30 lines
1.8 KiB
Plaintext
<%@include file="jspf/enteteJSPF.jspf" %>
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<br /><br />
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<table style='border: 0px solid white;'>
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<tr>
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<td style='border :0px;'>
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<fieldset><legend>Coordonnées Pompier</legend>
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<table>
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<tr><th>Nom :<input type="text" name="ztNom" size="20" maxlength="30"></th></tr>
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<tr><th>Prénom :<input type="text" name="ztPrenom" size="20" maxlength="30"></th></tr>
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<tr><th>Adresse :<input type="text" name="ztAdr" size="20" maxlength="30"></th></tr>
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<tr><th>Ville :<input type="text"name="ztVille" size="20" maxlength="30"></th></tr>
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<tr><th>Code postal :<input type="text" name="ztCp" size="20" maxlength="30"></th></tr>
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<tr><th>Téléphone :<input type="text" name="ztTel" size="20" maxlength="30"></th></tr>
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<tr><th>Mail :<input type="text" name="ztMail" size="20" maxlength="30"></th></tr>
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<tr><th>Statut :<input type="text" name="ztStatut" size="20" maxlength="30"></th></tr>
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<tr><th>Grade :<input type="text" name="ztGrade" size="20" maxlength="30"></th></tr>
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</table>
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</fieldset>
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<fieldset><legend>Coordonnées Employeur</legend>
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<table>
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<tr><th>Nom employeur : <input type="text" name="ztNomEmp" size="20" maxlength="30"></th></tr>
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<tr><th>Téléphone employeur : <input type="text" name="ztTelEmp" size="20" maxlength="30"></th></tr>
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<tr><th>Adresse employeur : <input type="text" name="ztadrEmp" size="20" maxlength="30"></th></tr>
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<tr><th>Mail employeur : <input type="text" name="ztMailEmp" size="20" maxlength="30"></th></tr>
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</table>
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</fieldset>
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</td>
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</tr>
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</table>
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