<form id="locationCar" name="locationCar" method="post" enctype="multipart/form-data" title="Location de cars">
    <div class="well"><p class="mb-0"><strong>{{ 'label.form_mention-obligatoire'|trans }}</strong></p></div>
    <fieldset>
        <legend>Vos coordonnées</legend>
        <div class="form-group">
            <label for="locationCarNom">Nom</label>
            <input class="form-control" name="nom" type="text" id="locationCarNom" value="{{ data.nom|default('') }}"/>
        </div>
        <div class="form-group">
            <label for="locationCarAdresse">Adresse</label>
            <input class="form-control" name="adresse" type="text" id="locationCarAdresse"  value="{{ data.adresse|default('') }}"/>
        </div>

        <div class="row">
            <div class="form-group col-md-3">
                <label class="control-label" for="locationCarCP">CP</label>
                <input class="form-control" name="cp" type="text" id="locationCarCP"  value="{{ data.cp|default('') }}"/>
            </div>
            <div class="form-group col-md-9">
                <label class="control-label" for="locationCarVille">Ville</label>
                <input class="form-control" name="ville" type="text" id="locationCarVille" value="{{ data.ville|default('') }}"/>
            </div>
        </div>

        <div class="row">
            <div class="col-md-3">
                <div class="form-group">
                    <label class="control-label" for="locationCarContactNom">Nom du contact <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input class="form-control" name="contactnom" type="text" id="locationCarContactNom"  value="{{ data.contactnom|default('') }}" autocomplete="family-name" required/>
                </div>
            </div>
            <div class="col-md-9">
                <div class="form-group">
                    <label class="control-label" for="locationCarContactPrenom">Prénom du contact <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input class="form-control" name="contactprenom" type="text" id="locationCarContactPrenom" value="{{ data.contactprenom|default('') }}" autocomplete="given-name" required/>
                </div>
            </div>
        </div>

        <div class="row">
            <div class="form-group col-md-4">
                <label class="control-label" for="locationCarMail">Email du contact <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr> <small>{{ 'label.exemplemail'|trans }}</small></label>
                <input class="form-control" name="mail" type="email" id="locationCarMail" value="{{ data.mail|default('') }}" autocomplete="email" required/>
            </div>
            <div class="form-group col-md-4">
                <label class="control-label" for="locationCarTelephone">Téléphone du contact <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                <input class="form-control" name="telephone" type="text" id="locationCarTelephone" value="{{ data.telephone|default('') }}" autocomplete="tel-national" required/>
            </div>
            <div class="form-group col-md-4">
                <label class="control-label" for="locationCarFax">Fax du contact</label>
                <input class="form-control" name="fax" type="text" id="locationCarFax" value="{{ data.fax|default('') }}"/>
            </div>
        </div>
    </fieldset>

    <fieldset>
        <legend>Votre projet</legend>
        <div class="form-group">
            <label for="locationCarNbPassagers">Nombre de passagers <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
            <input class="form-control" name="nbpassagers" type="number" id="locationCarNbPassagers" value="{{ data.nbpassagers|default('') }}" required/>
        </div>
        {% if paramsModule.disableMotif is defined and paramsModule.disableMotif == false %}
            <div class="form-group">
                <p id="motif"><strong>Motif du voyage <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></strong></p>
                <div class="row" role="group" aria-labelledby="motif">
                    <div class="col-md-6">
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox1" name="projet_motif[]" value="Séminaires / Congrès / Affaires"> Séminaires / Congrès / Affaires
                            </label>
                        </div>
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox2" name="projet_motif[]" value="Voyage/sortie scolaire"> Voyage/sortie scolaire
                            </label>
                        </div>
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox3" name="projet_motif[]" value="Déplacement Sportif"> Déplacement Sportif
                            </label>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox3" name="projet_motif[]" value="Tourisme"> Tourisme
                            </label>
                        </div>
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox3" name="projet_motif[]" value="Mariage / Fête privée"> Mariage / Fête privée
                            </label>
                        </div>
                        <div class="checkbox">
                            <label>
                                <input type="checkbox" id="inlineCheckbox3" name="projet_motif[]" value=" Autre"> Autre
                            </label>
                        </div>
                    </div>
                </div>
            </div>
        {% endif %}

        <fieldset>
            <legend>Départ</legend>
            <div class="row">
                <div class="form-group col-md-12 has-feedback">
                    <label class="control-label" for="depart_adresse">Adresse de départ <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.depart_adresse|default('') }}" class="form-control autocompleteaddress" name="depart_adresse" id="depart_adresse"/>
                </div>
                <div class="form-group col-md-6 has-feedback">
                    <label class="control-label" for="depart_cp">Code postal de départ <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.depart_cp|default('') }}" class="form-control autocompleteaddress" name="depart_cp" id="depart_cp"/>
                </div>
                <div class="form-group col-md-6 has-feedback">
                    <label class="control-label" for="depart_ville">Ville de départ <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.depart_ville|default('') }}" class="form-control autocompleteaddress" name="depart_ville" id="depart_ville"/>
                </div>
                <div class="form-group col-md-12">
                    <label class="control-label" for="datedepart">Date de départ <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.datedepart|default('') }}" class="datepicker form-control" name="datedepart" id="datedepart" required=""/>
                </div>
                <div class="form-group col-md-12">
                    <label class="control-label" for="heuredepart">Heure de départ <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <div class="row">
                        <div class="col-xs-6">
                            <select class="form-control selectpicker" id="heuredepart" name="heuredepart" required="">
                                {% for i in range(0, 23) %}
                                    <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}h</option>
                                {% endfor %}
                            </select>
                        </div>
                        <div class="col-xs-6">
                            <label class="control-label sr-only" for="mindepart">minutes <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                            <select class="form-control selectpicker" id="mindepart" name="mindepart" required="">
                                {% for i in range(0, 59) %}
                                    <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
            </div>
        </fieldset>

        <fieldset>
            <legend>Destination</legend>
            <div class="row">
                <div class="form-group col-md-12 has-feedback">
                    <label class="control-label" for="destination_adresse">Adresse de destination <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.destination_adresse|default('') }}" class="form-control autocompleteaddress" name="destination_adresse" id="destination_adresse"/>
                </div>
                <div class="form-group col-md-6 has-feedback">
                    <label class="control-label" for="destination_cp">Code postal de destination <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.destination_cp|default('') }}" class="form-control autocompleteaddress" name="destination_cp" id="destination_cp"/>
                </div>
                <div class="form-group col-md-6 has-feedback">
                    <label class="control-label" for="destination_ville">Ville de destination <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.destination_ville|default('') }}" class="form-control autocompleteaddress" name="destination_ville" id="destination_ville"/>
                </div>
                <div class="form-group col-md-12">
                    <label class="control-label" for="dateretour">Date de retour <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <input type="text" value="{{ data.dateretour|default('') }}" class="datepicker form-control" name="dateretour" id="dateretour" required=""/>
                </div>
                <div class="form-group col-md-12">
                    <label class="control-label" for="heureretour">Heure de retour <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                    <div class="row">
                        <div class="col-xs-6">
                            <select class="form-control selectpicker" id="heureretour" name="heureretour" required="">
                                {% for i in range(0, 23) %}
                                    <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}h</option>
                                {% endfor %}
                            </select>
                        </div>
                        <div class="col-xs-6">
                            <label class="control-label sr-only" for="minretour">minutes <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></label>
                            <select class="form-control selectpicker" id="minretour" name="minretour" required="">
                                {% for i in range(0, 59) %}
                                    <option value="{{ "%02d"|format(i) }}">{{ "%02d"|format(i) }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
            </div>
        </fieldset>

        <hr/>
        <div class="form-group">
            <div class="row">
                <div class="col-xs-6">
                    <label for="locationCarFichier">Joindre un fichier si nécessaire</label>
                    <input name="fichier" type="file" id="locationCarFichier"/>
                </div>
                <div class="col-xs-6">
                    <button type="button" class="btn btn-primary btn-block removeUploadFileSelected" data-filetargetId="locationCarFichier">Supprimer le fichier</button>
                </div>
            </div>
        </div>

        <div class="form-group">
            <label for="description">Message</label>
            <span class="help-block"><i class="icon-info-sign"></i>Précisez votre besoin <abbr tabindex="0" title="{{ 'label.obligatoire'|trans }}">*</abbr></span>
            <textarea id="description" rows="5" class="form-control" name="description" required="">{{ data.message|default('') }}</textarea>
        </div>

        {{ GetRgpdForModule(5)|raw}}
        {{ CaptchaService.getHtmlCaptcha|raw }}
    </fieldset>

    <div class="row">
        <div class="col-sm-6 col-sm-offset-6">
            <button type="submit" class="btn btn-primary btn-lg btn-block" name="button" id="submitLocationCarForm">Envoyer votre demande</button>
        </div>
    </div>
</form>
