<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <ol class="breadcrumb"> <li><a href="#">Sales Manager</a></li> <li class="active">Sales assitant</li> </ol> <form class="form-horizontal"> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="projectNumber">Project number</label> <div class="col-md-6"> <input id="projectNumber" name="projectNumber" type="text" placeholder="from previous" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="CustomerDepartmentProject">Customer department project name</label> <div class="col-md-6"> <input id="CustomerDepartmentProject" name="CustomerDepartmentProject" type="text" placeholder="from previous" class="form-control input-md" required=""> </div> </div> <hr /> <fieldset> <!-- Form Name --> <legend>Project & customer information</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="requestDate">Request date</label> <div class="col-md-6"> <input id="requestDate" name="requestDate" type="text" placeholder="dd/mm/yyyy" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="customerType">Customer type</label> <div class="col-md-6"> <input id="customerType" name="customerType" type="text" placeholder="fixed value" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Zsit">Zsit</label> <div class="col-md-6"> <input id="Zsit" name="Zsit" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">If the customer type is an existing Customer then ZSIT should be filled</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="requester">Requester</label> <div class="col-md-6"> <input id="requester" name="requester" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="salesOrg">Sales organisation</label> <div class="col-md-6"> <input id="salesOrg" name="salesOrg" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Customer">Customer</label> <div class="col-md-6"> <input id="Customer" name="Customer" type="text" placeholder="fixed value" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Department">Department</label> <div class="col-md-6"> <input id="Department" name="Department" type="text" placeholder="To ask" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Adress">Adress</label> <div class="col-md-6"> <input id="Adress" name="Adress" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="zipCode">Zip code</label> <div class="col-md-6"> <input id="zipCode" name="zipCode" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="City">City</label> <div class="col-md-6"> <input id="City" name="City" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="country">Country</label> <div class="col-md-6"> <input id="country" name="country" type="text" placeholder="to ask for list" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="technicalContact">Technical contact</label> <div class="col-md-6"> <input id="technicalContact" name="technicalContact" type="text" placeholder="pattern? id? name?" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="email">Email</label> <div class="col-md-6"> <input id="email" name="email" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="phone">Phone or cell phone</label> <div class="col-md-6"> <input id="phone" name="phone" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="language">Language</label> <div class="col-md-6"> <select id="language" name="language" class="form-control"> <option value="1">Dutch</option> <option value="2">English</option> <option value="3">French</option> </select> </div> </div> </fieldset> </form> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Project description & customer needs</legend> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="projectShortDescription">Project short description</label> <div class="col-md-6"> <textarea class="form-control" id="projectShortDescription" name="projectShortDescription">Placement d'un stockage CO2 pour alimentation incubatoire</textarea> </div> </div> <h4>Project type - Invest / sold</h4> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="projectType">Project type</label> <div class="col-md-6"> <input id="projectType" name="projectType" type="text" placeholder="from previous for each biz req" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="investSold">Invest / sold</label> <div class="col-md-6"> <select id="investSold" name="investSold" class="form-control"> <option value="1">Invest</option> <option value="2">Sold</option> <option value="3">N/A</option> </select> </div> </div> <h4>Quotation - information</h4> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="quotationType">Quotation type</label> <div class="col-md-6"> <select id="quotationType" name="quotationType" class="form-control"> <option value="1">Detailed</option> <option value="2">Budgetary</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Standard applicable</label> <div class="col-md-6"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">AL Standards</option> <option value="2">Custom spec</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="requestDateForQuotation">Request date for quotation</label> <div class="col-md-6"> <input id="requestDateForQuotation" name="requestDateForQuotation" type="text" placeholder="dd/mm/yyyy" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="preliminaryRiskIdentification">Premilary risk identification</label> <div class="col-md-6"> <select id="preliminaryRiskIdentification" name="preliminaryRiskIdentification" class="form-control"> <option value="1">Available</option> <option value="2">Not available</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="engSupportSiteVisitRequired">Eng support site visit required</label> <div class="col-md-6"> <select id="engSupportSiteVisitRequired" name="engSupportSiteVisitRequired" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </div> </div> <hr/> <legend>Cylinders installation design</legend> <div class="panel panel-default"> <!-- Default panel contents --> <div class="panel-heading">Panel heading</div> <div class="panel-body"> <table class="table"> <thead> <tr> <th>Unit</th> <th>Product 1</th> <th>Product 2</th> <th>Product 3</th> </tr> </thead> <tbody> <tr> <th scope="row">Gas</th> <td> <select id="gas" name="gas" class="form-control"> <option value="1">Oxygen</option> <option value="2">Argon</option> <option value="">Carbon dioxyde</option> <option value="">Hydrogen</option> <option value="">Flamel</option> <option value="">Ammoniac</option> <option value="">N/A</option> </select> </td> <td> <select id="gas" name="gas" class="form-control"> <option value="1">Oxygen</option> <option value="2">Argon</option> <option value="">Carbon dioxyde</option> <option value="">Hydrogen</option> <option value="">Flamel</option> <option value="">Ammoniac</option> <option value="">N/A</option> </select> </td> <td> <select id="gas" name="gas" class="form-control"> <option value="1">Oxygen</option> <option value="2">Argon</option> <option value="">Carbon dioxyde</option> <option value="">Hydrogen</option> <option value="">Flamel</option> <option value="">Ammoniac</option> <option value="">N/A</option> </select> </td> </tr> <tr> <th scope="row">Purity</th> <td> <input id="textinput" name="textinput" type="text" placeholder="purity" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="purity" class="form-control input-md"> </td> <td> <input id="textinput" name="textinput" type="text" placeholder="purity" class="form-control input-md"> </td> </tr> <tr> <th scope="row">Consumtion <select id="gas" name="gas" class="form-control"> <option value="1">L/month</option> <option value="2">Kg/month</option> <option value="3">Sm³/month</option> </select> </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Consumtion" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Consumtion" class="form-control input-md"> </td> <td> <input id="textinput" name="textinput" type="text" placeholder="Consumtion" class="form-control input-md"> </td> </tr> <tr> <th scope="row">Average flow <select id="gas" name="gas" class="form-control"> <option value="1">L/hour</option> <option value="2">Kg/hour</option> <option value="3">Sm³/hour</option> </select> </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Average flow" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Average flow" class="form-control input-md"> </td> <td> <input id="textinput" name="textinput" type="text" placeholder="Average flow" class="form-control input-md"> </td> </tr> <tr> <th scope="row">Peak flow <select id="gas" name="gas" class="form-control"> <option value="1">L/hour</option> <option value="2">Kg/hour</option> <option value="3">Sm³/hour</option> </select> </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak flow" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak flow" class="form-control input-md"> </td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak flow" class="form-control input-md"> </td> </tr> <tr> <th scope="row">Peak frequence <select id="gas" name="gas" class="form-control"> <option value="1">nb/min</option> <option value="1">nb/hour</option> <option value="1">nb/day</option> <option value="1">nb/month</option> </select> </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak frequence" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak frequence" class="form-control input-md"> </td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak frequence" class="form-control input-md"> </td> </tr> <tr> <th scope="row">Peak duration <select id="gas" name="gas" class="form-control"> <option value="1">mmin</option> <option value="1">hour</option> <option value="1">day</option> <option value="1">month</option> </select> </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak duration" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak duration" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Peak duration" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Process profile <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Process profile" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Process profile" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Process profile" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Gass min temp <input id="textinput" name="textinput" type="text" placeholder="C°" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Gass min temp" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Gass min temp" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Gass min temp" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Presssure <input id="textinput" name="textinput" type="text" placeholder="barg°" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Presssure tol <input id="textinput" name="textinput" type="text" placeholder="barg°" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure tol" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure tol" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Presssure tol" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Max pressure adminstrate <input id="textinput" name="textinput" type="text" placeholder="barg°" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Max pressure adminstrate" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Max pressure adminstrate" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Max pressure adminstrate" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Min pressure adminstrate <input id="textinput" name="textinput" type="text" placeholder="barg°" class="form-control input-md" > </th> <td> <input id="textinput" name="textinput" type="text" placeholder="Min pressure adminstrate" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Min pressure adminstrate" class="form-control input-md" ></td> <td> <input id="textinput" name="textinput" type="text" placeholder="Min pressure adminstrate" class="form-control input-md" ></td> </tr> <tr> <th scope="row">Tank specific requirement</th> <th><input id="textinput" name="textinput" type="text" class="form-control input-md" ></th> </tr> <tr> <th scope="row">Accessability</th> <th><input id="accessability" name="accessability" type="text" class="form-control input-md" ></th> </tr> <tr> <th scope="row">Accessability for trucks</th> <th><input id="AccessabilityForTrucks" name="AccessabilityForTrucks" type="text" class="form-control input-md" ></th> </tr> </tbody> </table> </div> </div> <div class="panel panel-default"> <!-- Default panel contents --> <div class="panel-heading">Options</div> <div class="panel-body"> </div> <!-- Table --> <table class="table"> <thead> <tr> <th></th> <th>Product 1</th> <th>Product 2</th> <th>Product 3</th> </tr> </thead> <tbody> <tr> <th scope="row">Optimal/basic</th> <td> <select id="optimalBasicProd1" name="optimalBasicProd1" class="form-control"> <option value="1">Optimal</option> <option value="2">Basic</option> <option value="3">N/A</option> </select> </td> <td> <select id="optimalBasicProd2" name="optimalBasicProd2" class="form-control"> <option value="1">Optimal</option> <option value="2">Basic</option> <option value="3">N/A</option> </select> </td> <td> <select id="optimalBasicProd3" name="optimalBasicProd3" class="form-control"> <option value="1">Optimal</option> <option value="2">Basic</option> <option value="3">N/A</option> </select> </td> </tr> <tr> <th scope="row">Datal customer transmission</th> <td> <select id="datalCustomerTransmission1" name="datalCustomerTransmission1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="datalCustomerTransmission2" name="datalCustomerTransmission2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="datalCustomerTransmission3" name="datalCustomerTransmission3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Vap auto inversion</th> <td> <select id="vapAutoInversion1" name="vapAutoInversion1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="vapAutoInversion2" name="vapAutoInversion2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="vapAutoInversion3" name="vapAutoInversion3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Phargalis / HACCP cabinet</th> <td> <select id="phargalisHaccpCabinet1" name="phargalisHaccpCabinet1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="phargalisHaccpCabinet2" name="phargalisHaccpCabinet2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="phargalisHaccpCabinet3" name="phargalisHaccpCabinet3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Local liquid pou</th> <td> <select id="localLiquidPoo1" name="localLiquidPoo1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="localLiquidPoo2" name="localLiquidPoo2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="localLiquidPoo3" name="localLiquidPoo3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Cold embrittlement</th> <td> <select id="coldEmbrittlement1" name="coldEmbrittlement1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="coldEmbrittlemen2" name="coldEmbrittlement2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="coldEmbrittlement3" name="coldEmbrittlement3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Pressure reduction</th> <td> <select id="pressureReduction1" name="pressureReduction1" class="form-control"> <option value="1">Simple</option> <option value="2">Double</option> <option value="3">No</option> </select> </td> <td> <select id="pressureReduction2" name="pressureReduction2" class="form-control"> <option value="1">Simple</option> <option value="2">Double</option> <option value="3">No</option> </select> </td> <td> <select id="pressureReduction3" name="pressureReduction3" class="form-control"> <option value="1">Simple</option> <option value="2">Double</option> <option value="3">No</option> </select> </td> </tr> <tr> <th scope="row">Tank line filling</th> <td> <select id="tankLineFilling1" name="tankLineFilling1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="tankLineFilling2" name="tankLineFilling2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="tankLineFilling3" name="tankLineFilling3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">Other</th> <td> <select id="other1" name="other1" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="other2" name="other2" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> <td> <select id="other3" name="other3" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </td> </tr> <tr> <th scope="row">HACCP risk (CO2)</th> <td> <select id="haccpRisk1" name="haccpRisk1" class="form-control"> <option value="xx">N/A</option> <option value="4"> Level 4 : Customer produces CO2 in the process</option> <option value="3">Level 3 : P Customer > P Storage</option> <option value="2">Level 2 : P Customer could be > P Storage</option> <option value="1">Level 1 : P Storage > P customer > P atm</option> <option value="0">Level 0 : P Customer = P atm</option> </select> </td> <td> <select id="haccpRisk2" name="haccpRisk2" class="form-control"> <option value="xx">N/A</option> <option value="4"> Level 4 : Customer produces CO2 in the process</option> <option value="3">Level 3 : P Customer > P Storage</option> <option value="2">Level 2 : P Customer could be > P Storage</option> <option value="1">Level 1 : P Storage > P customer > P atm</option> <option value="0">Level 0 : P Customer = P atm</option> </select> </td> <td> <select id="haccpRisk3" name="haccpRisk3" class="form-control"> <option value="xx">N/A</option> <option value="4"> Level 4 : Customer produces CO2 in the process</option> <option value="3">Level 3 : P Customer > P Storage</option> <option value="2">Level 2 : P Customer could be > P Storage</option> <option value="1">Level 1 : P Storage > P customer > P atm</option> <option value="0">Level 0 : P Customer = P atm</option> </select> </td> </tr> </tbody> </table> </div> </fieldset> </form>