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73 lines
4.8 KiB
73 lines
4.8 KiB
<div class="enterwell-prize">
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<form method="post" action="<?php echo rest_url('enterwell-prize/v1/submit'); ?>" class="enterwell-prize__form" enctype="multipart/form-data" novalidate>
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<img src="<?php echo plugin_dir_url( dirname( __FILE__ ) ) . 'images/image-sticker.png'; ?>" alt="Enterwell Sticker" class="sticker-image">
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<fieldset class="fieldset">
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<div class="input-wrap image fade-in-left delay_01">
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<div class="image-container drop-zone">
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<img src="<?php echo plugin_dir_url( dirname( __FILE__ ) ) . 'images/icon-upload.svg'; ?>" alt="Upload icon" class="upload-icon">
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<figure class="image-container__preview">
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<img class="preview-image" src="#" alt="Preview Image">
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<figcaption class="preview-name"></figcaption>
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</figure>
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<label for="image" class="drop-zone__label"><?php echo __('Povuci i ispusti datoteku kako bi započeo prijenos <br><br><span>ili pretraži računalo.</span>', 'enterwell'); ?></label>
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<span class="drop-zone__label-drag"><?php echo __('Ispusti datoteku', 'enterwell'); ?></span>
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<input type="file" accept=".pdf, .png, .jpg" id="image" class="drop-zone__input input" required>
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<p class="support-notice"><?php echo __('PODRŽANI FORMATI <br>pdf, png, jpg', 'enterwell'); ?></p>
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</div>
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</div>
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<div class="input-wrap receipt-number required fade-in-left delay_02">
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<label for="receipt_number" class="label"><?php echo __('Broj računa', 'enterwell'); ?></label>
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<input type="text" id="receipt_number" class="input" name="receipt_number" required>
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</div>
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</fieldset>
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<fieldset class="fieldset">
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<div class="input-wrap first-name required fade-in-right delay_01">
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<label for="first_name" class="label"><?php echo __('Ime', 'enterwell'); ?></label>
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<input type="text" id="first_name" class="input" name="first_name" required>
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</div>
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<div class="input-wrap last-name required fade-in-right delay_02">
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<label for="last_name" class="label"><?php echo __('Prezime', 'enterwell'); ?></label>
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<input type="text" id="last_name" class="input" name="last_name" required>
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</div>
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<div class="input-wrap address required fade-in-right delay_03">
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<label for="address" class="label"><?php echo __('Adresa', 'enterwell'); ?></label>
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<input type="text" id="address" class="input" name="address" required>
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</div>
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<div class="input-wrap house-number required fade-in-right delay_04">
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<label for="house_number" class="label"><?php echo __('Kućni broj', 'enterwell'); ?></label>
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<input type="text" id="house_number" class="input" name="house_number" required>
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</div>
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<div class="input-wrap city required fade-in-right delay_05">
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<label for="city" class="label"><?php echo __('Mjesto', 'enterwell'); ?></label>
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<input type="text" id="city" class="input" name="city" required>
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</div>
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<div class="input-wrap zip required fade-in-right delay_06">
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<label for="zip" class="label"><?php echo __('Poštanski broj', 'enterwell'); ?></label>
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<input type="number" id="zip" class="input" name="zip" required>
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</div>
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<div class="input-wrap country required has-value fade-in-right delay_07">
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<label for="country" class="label"><?php echo __('Država', 'enterwell'); ?></label>
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<input type="text" id="country" class="input" name="country" value="Hrvatska" required>
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<input type="hidden" id="country_code">
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</div>
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<div class="input-wrap phone required fade-in-right delay_08">
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<label for="phone" class="label"><?php echo __('Kontakt telefon', 'enterwell'); ?></label>
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<input type="text" id="phone" class="input" name="phone" required>
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</div>
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<div class="input-wrap email required fade-in-right delay_09">
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<label for="email" class="label"><?php echo __('Email', 'enterwell'); ?></label>
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<input type="email" id="email" class="input" name="email" required>
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</div>
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<input type="hidden" name="id" value="<?php echo $entry['id']; ?>">
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</fieldset>
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<div class="enterwell-prize__buttons fade-in-right delay_10">
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<button type="submit" aria-label="Submit button" class="button button-primary" id="enterwell-prize-submit"><?php echo __('Pošalji', 'enterwell'); ?></button>
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</div>
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</form>
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<div class="enterwell-prize__message"></div>
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</div>
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