Ext.onReady(function() {
Ext.Direct.addProvider(sos.API);
Ext.QuickTips.init();
Ext.form.Field.prototype.msgTarget = 'side';
/* form01: particulier - word donateur */
var extForm = new Ext.form.FormPanel({
api: {
submit: sos.SOSDolfijn.submitForm
},
frame: false,
width: 610,
labelWidth: 160,
baseCls: 'x-plain',
defaultType: 'textfield',
buttonAlign: 'right',
layoutConfig:{
labelSeparator: ''
},
defaults: {
selectOnFocus: true,
msgTarget: 'side'
},
buttons:[
new Ext.Button({
text: 'Verzenden',
iconCls: 'btn-submit',
//waitMsg: 'Bezig met verzenden...',
handler: function(){
extForm.getForm().submit({
params: {
formName: 'Word Donateur'
},
success: function(form, action) {
//Ext.Msg.alert('Bedankt!', 'Uw aanvraag is ontvangen, bedankt voor Uw steun!');
window.location.href = '?id=107&f=1';
},
failure: function(form, action) {
switch (action.failureType) {
case Ext.form.Action.CLIENT_INVALID:
Ext.Msg.alert('Probleem', 'Niet alle velden van het formulier zijn ingevuld.
Controleer het formulier en probeer het nogmaals!');
break;
case Ext.form.Action.CONNECT_FAILURE:
Ext.Msg.alert('Probleem', 'De donatieserver is momenteel niet beschikbaar.
Probeer het later nog eens of neem contact met ons op!');
break;
case Ext.form.Action.SERVER_INVALID:
Ext.Msg.alert('Probleem', 'Er is een probleem opgetreden met het verwerken van Uw verzoek.');
}
}
});
}
})
],
items:[
{
xtype:'panel',
html:'Ja ik help de dolfijnen en word donateur
'
},
new Ext.form.RadioGroup({
fieldLabel: 'Betalingswijze *',
columns: 1,
allowBlank: false,
anchor: '95%',
blankText: 'U heeft geen betalingswijze geselecteerd',
items:[
/*new Ext.form.Radio({
boxLabel: 'Stuur mij een acceptgiro',
name: 'betaling',
inputValue: 'acceptgiro'
}),*/
new Ext.form.Radio({
boxLabel: 'Ik machtig SOS Dolfijn om - tot wederopzegging - het onderstaande bedrag van mijn rekening af te schrijven (minimaal 3 Euro per maand of 30 Euro per jaar).',
name: 'betaling',
inputValue: 'machtiging'
})
]
}),
new Ext.form.FieldSet({
layout: 'table',
fieldLabel: 'Indien u hierboven kiest voor machtiging (dit heeft onze voorkeur), vul dan het bedrag in, de betalingsfrequentie en uw bankrekeningnummer',
style: 'border:none;padding:0;padding-top:3px;',
labelAlign: 'top',
hideBorders: 'true',
layoutConfig:{
columns: 3
},
items:[
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Bedrag',
name: 'bedrag',
width: 74,
ctCls: 'input-txt w70'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
width: 115,
ctCls: 'input-txt w110',
overCls: 'combo-hover',
items:[
new Ext.form.ComboBox({
mode: 'local',
anchor:'95%',
value: 'Per maand',
triggerAction: 'all',
forceSelection: true,
editable: false,
fieldLabel: 'Frequentie',
name: 'frequentie',
displayField: 'name',
valueField: 'value',
store: new Ext.data.JsonStore({
fields:['name','value'],
data:[
{
name: 'Per maand',
value: 'maand'
},
/*{
name: 'Per kwartaal',
value: 'kwartaal'
},
{
name: 'Per half jaar',
value: 'halfjaar'
},*/
{
name: 'Per jaar',
value: 'jaar'
}
]
})
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Bankrekening',
name: 'bankrekening',
width: 116,
ctCls: 'input-txt w110'
})
]
})
]
}),
{
xtype:'panel',
html:'Uw gegevens
'
},
new Ext.form.TextField({
fieldLabel: 'Naam organisatie (bijv. scholen of bedrijven)',
name: 'organisatie',
width: 153,
ctCls: 'input-txt w150'
}),
new Ext.form.RadioGroup({
fieldLabel: 'Aanhef *',
columns: [50,50],
allowBlank: false,
anchor: '95%',
blankText: 'U heeft uw aanhef niet ingevuld.',
items:[
new Ext.form.Radio({
boxLabel: 'Dhr',
name: 'aanhef',
inputValue: 'dhr'
}),
new Ext.form.Radio({
boxLabel: 'Mevr',
name: 'aanhef',
inputValue: 'mevr'
})
]
}),
new Ext.form.FieldSet({
layout: 'table',
fieldLabel: 'Uw naam *',
style: 'border:none;padding:0;padding-top:3px;',
labelAlign: 'top',
hideBorders: 'true',
layoutConfig:{
columns: 3
},
items:[
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Initialen',
name: 'initialen',
allowBlank: false,
blankText: 'U heeft geen initialen ingevuld.',
invalidClass: 'txt-fld-error',
width: 55,
ctCls: 'input-txt w50'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Tussenvoegsel',
name: 'tussenvoegsel',
width: 75,
ctCls: 'input-txt w70'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Achternaam',
name: 'achternaam',
allowBlank: false,
blankText: 'U heeft geen achternaam ingevuld.',
invalidClass: 'txt-fld-error',
width: 160,
ctCls: 'input-txt w150'
})
]
})
]
}),
new Ext.form.FieldSet({
layout: 'table',
fieldLabel: 'Geboortedatum',
name: 'geboortedatum',
style: 'border:none;padding:0;padding-top:3px;',
labelAlign: 'top',
hideBorders: 'true',
layoutConfig:{
columns: 3
},
items:[
new Ext.Panel({
header: false,
layout: 'form',
width: 75,
ctCls: 'input-txt w70',
items:[
new Ext.form.ComboBox({
mode: 'local',
anchor:'95%',
value: '1',
triggerAction: 'all',
forceSelection: true,
editable: false,
fieldLabel: 'Dag',
name: 'dag',
displayField: 'name',
valueField: 'value',
store: new Ext.data.JsonStore({
fields:['name','value'],
data:[
{
name:'1',
value:'1'
},{
name:'2',
value:'2'
},{
name:'3',
value:'3'
},{
name:'4',
value:'4'
},{
name:'5',
value:'5'
},{
name:'6',
value:'6'
},{
name:'7',
value:'7'
},{
name:'8',
value:'8'
},{
name:'9',
value:'9'
},{
name:'10',
value:'10'
},{
name:'11',
value:'11'
},{
name:'12',
value:'12'
},{
name:'13',
value:'13'
},{
name:'14',
value:'14'
},{
name:'15',
value:'15'
},{
name:'16',
value:'16'
},{
name:'17',
value:'17'
},{
name:'18',
value:'18'
},{
name:'19',
value:'19'
},{
name:'20',
value:'20'
},{
name:'21',
value:'21'
},{
name:'22',
value:'22'
},{
name:'23',
value:'23'
},{
name:'24',
value:'24'
},{
name:'25',
value:'25'
},{
name:'26',
value:'26'
},{
name:'27',
value:'27'
},{
name:'28',
value:'28'
},{
name:'29',
value:'29'
},{
name:'30',
value:'30'
},{
name:'31',
value:'31'
}
]
})
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
width: 115,
ctCls: 'input-txt w110',
items:[
new Ext.form.ComboBox({
mode: 'local',
anchor:'95%',
value: 'januari',
triggerAction: 'all',
forceSelection: true,
editable: false,
fieldLabel: 'Maand',
name: 'maand',
displayField: 'name',
valueField: 'value',
store: new Ext.data.JsonStore({
fields:['name','value'],
data:[
{
name:'januari',
value:'januari'
},{
name:'februari',
value:'februari'
},{
name:'maart',
value:'maart'
},{
name:'april',
value:'april'
},{
name:'mei',
value:'mei'
},{
name:'juni',
value:'juni'
},{
name:'juli',
value:'juli'
},{
name:'augustus',
value:'augustus'
},{
name:'september',
value:'september'
},{
name:'oktober',
value:'oktober'
},{
name:'november',
value:'november'
},{
name:'december',
value:'december'
}
]
})
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
width: 90,
ctCls: 'input-txt w70',
items:[
new Ext.form.ComboBox({
mode: 'local',
anchor:'95%',
value: '1970',
triggerAction: 'all',
forceSelection: true,
editable: false,
fieldLabel: 'Jaar',
name: 'jaar',
displayField: 'name',
valueField: 'value',
width: 250,
store: new Ext.data.JsonStore({
fields:['name','value'],
data:[
{
name:'1910',
value:'1910'
},{
name:'1911',
value:'1911'
},{
name:'1912',
value:'1912'
},{
name:'1913',
value:'1913'
},{
name:'1914',
value:'1914'
},{
name:'1915',
value:'1915'
},{
name:'1916',
value:'1916'
},{
name:'1917',
value:'1917'
},{
name:'1918',
value:'1918'
},{
name:'1919',
value:'1919'
},{
name:'1920',
value:'1920'
},{
name:'1921',
value:'1921'
},{
name:'1922',
value:'1922'
},{
name:'1923',
value:'1923'
},{
name:'1924',
value:'1924'
},{
name:'1925',
value:'1925'
},{
name:'1926',
value:'1926'
},{
name:'1927',
value:'1927'
},{
name:'1928',
value:'1928'
},{
name:'1929',
value:'1929'
},{
name:'1930',
value:'1930'
},{
name:'1931',
value:'1931'
},{
name:'1932',
value:'1932'
},{
name:'1933',
value:'1933'
},{
name:'1934',
value:'1934'
},{
name:'1935',
value:'1935'
},{
name:'1936',
value:'1936'
},{
name:'1937',
value:'1937'
},{
name:'1938',
value:'1938'
},{
name:'1939',
value:'1939'
},{
name:'1940',
value:'1940'
},{
name:'1941',
value:'1941'
},{
name:'1942',
value:'1942'
},{
name:'1943',
value:'1943'
},{
name:'1944',
value:'1944'
},{
name:'1945',
value:'1945'
},{
name:'1946',
value:'1946'
},{
name:'1947',
value:'1947'
},{
name:'1948',
value:'1948'
},{
name:'1949',
value:'1949'
},{
name:'1950',
value:'1950'
},{
name:'1951',
value:'1951'
},{
name:'1952',
value:'1952'
},{
name:'1953',
value:'1953'
},{
name:'1954',
value:'1954'
},{
name:'1955',
value:'1955'
},{
name:'1956',
value:'1956'
},{
name:'1957',
value:'1957'
},{
name:'1958',
value:'1958'
},{
name:'1959',
value:'1959'
},{
name:'1960',
value:'1960'
},{
name:'1961',
value:'1961'
},{
name:'1962',
value:'1962'
},{
name:'1963',
value:'1963'
},{
name:'1964',
value:'1964'
},{
name:'1965',
value:'1965'
},{
name:'1966',
value:'1966'
},{
name:'1967',
value:'1967'
},{
name:'1968',
value:'1968'
},{
name:'1969',
value:'1969'
},{
name:'1970',
value:'1970'
},{
name:'1971',
value:'1971'
},{
name:'1972',
value:'1972'
},{
name:'1973',
value:'1973'
},{
name:'1974',
value:'1974'
},{
name:'1975',
value:'1975'
},{
name:'1976',
value:'1976'
},{
name:'1977',
value:'1977'
},{
name:'1978',
value:'1978'
},{
name:'1979',
value:'1979'
},{
name:'1980',
value:'1980'
},{
name:'1981',
value:'1981'
},{
name:'1982',
value:'1982'
},{
name:'1983',
value:'1983'
},{
name:'1984',
value:'1984'
},{
name:'1985',
value:'1985'
},{
name:'1986',
value:'1986'
},{
name:'1987',
value:'1987'
},{
name:'1988',
value:'1988'
},{
name:'1989',
value:'1989'
},{
name:'1990',
value:'1990'
},{
name:'1991',
value:'1991'
},{
name:'1992',
value:'1992'
},{
name:'1993',
value:'1993'
},{
name:'1994',
value:'1994'
},{
name:'1995',
value:'1995'
},{
name:'1996',
value:'1996'
},{
name:'1997',
value:'1997'
},{
name:'1998',
value:'1998'
},{
name:'1999',
value:'1999'
},{
name:'2000',
value:'2000'
},{
name:'2001',
value:'2001'
},{
name:'2002',
value:'2002'
},{
name:'2003',
value:'2003'
},{
name:'2004',
value:'2004'
},{
name:'2005',
value:'2005'
}
]
})
})
]
})
]
}),
new Ext.form.FieldSet({
layout: 'table',
fieldLabel: 'Adres *',
style: 'border:none;padding:0;padding-top:3px;',
labelAlign: 'top',
hideBorders: 'true',
layoutConfig:{
columns: 3
},
items:[
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Straat',
name: 'straat',
allowBlank: false,
blankText: 'U heeft geen straatnaam ingevuld.',
invalidClass: 'txt-fld-error',
width: 115,
ctCls: 'input-txt w110'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Huisnr',
name: 'huisnummer',
allowBlank: false,
blankText: 'U heeft geen huisnummer ingevuld.',
invalidClass: 'txt-fld-error',
width: 38,
ctCls: 'input-txt w34'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Toevoeging',
name: 'toevoeging',
width: 53,
ctCls: 'input-txt w50'
})
]
})
]
}),
new Ext.form.FieldSet({
layout: 'table',
fieldLabel: 'Postcode en plaats *',
style: 'border:none;padding:0;padding-top:3px;',
labelAlign: 'top',
hideBorders: 'true',
layoutConfig:{
columns: 2
},
items:[
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Postcode',
name: 'postcode',
allowBlank: false,
blankText: 'U heeft geen postcode ingevuld.',
invalidClass: 'txt-fld-error',
width: 75,
ctCls: 'input-txt w70'
})
]
}),
new Ext.Panel({
header: false,
layout: 'form',
items:[
new Ext.form.TextField({
fieldLabel: 'Plaats',
name: 'plaats',
allowBlank: false,
blankText: 'U heeft geen plaatsnaam ingevuld.',
invalidClass: 'txt-fld-error',
width: 160,
ctCls: 'input-txt w150'
})
]
})
]
}),
new Ext.form.ComboBox({
mode: 'local',
value: 'Nederland',
triggerAction: 'all',
forceSelection: true,
editable: false,
width: 155,
ctCls: 'input-txt w150',
fieldLabel: 'Land *',
displayField: 'val',
valueField: 'val',
name: 'land',
store: new Ext.data.JsonStore({
fields:['code','val'],
data:[
{
"code":"AF",
"val":"Afghanistan"
},{
"code":"AX",
"val":"Alandeilanden"
},{
"code":"AL",
"val":"Albanië"
},{
"code":"DZ",
"val":"Algerije"
},{
"code":"AS",
"val":"Amerikaans Samoa"
},{
"code":"VI",
"val":"Amerikaanse Maagdeneilanden"
},{
"code":"UM",
"val":"Amerikaanse kleinere afgelegen eilanden"
},{
"code":"AD",
"val":"Andorra"
},{
"code":"AO",
"val":"Angola"
},{
"code":"AI",
"val":"Anguilla"
},{
"code":"AQ",
"val":"Antarctica"
},{
"code":"AG",
"val":"Antigua en Barbuda"
},{
"code":"AR",
"val":"Argentinië"
},{
"code":"AM",
"val":"Armenië"
},{
"code":"AW",
"val":"Aruba"
},{
"code":"AU",
"val":"Australië"
},{
"code":"AZ",
"val":"Azerbeidzjan"
},{
"code":"BS",
"val":"Bahama.s"
},{
"code":"BH",
"val":"Bahrein"
},{
"code":"BD",
"val":"Bangladesh"
},{
"code":"BB",
"val":"Barbados"
},{
"code":"BE",
"val":"België"
},{
"code":"BZ",
"val":"Belize"
},{
"code":"BJ",
"val":"Benin"
},{
"code":"BM",
"val":"Bermuda"
},{
"code":"BT",
"val":"Bhutan"
},{
"code":"BO",
"val":"Bolivia"
},{
"code":"BA",
"val":"Bosnië en Herzegovina"
},{
"code":"BW",
"val":"Botswana"
},{
"code":"BV",
"val":"Bouveteiland"
},{
"code":"BR",
"val":"Brazilië"
},{
"code":"IO",
"val":"Britse Gebieden in de Indische Oceaan"
},{
"code":"VG",
"val":"Britse Maagdeneilanden"
},{
"code":"BN",
"val":"Brunei"
},{
"code":"BG",
"val":"Bulgarije"
},{
"code":"BF",
"val":"Burkina Faso"
},{
"code":"BI",
"val":"Burundi"
},{
"code":"KH",
"val":"Cambodja"
},{
"code":"CA",
"val":"Canada"
},{
"code":"KY",
"val":"Caymaneilanden"
},{
"code":"CF",
"val":"Centraal-Afrikaanse Republiek"
},{
"code":"CL",
"val":"Chili"
},{
"code":"CN",
"val":"China"
},{
"code":"CX",
"val":"Christmaseiland"
},{
"code":"CC",
"val":"Cocoseilanden"
},{
"code":"CO",
"val":"Colombia"
},{
"code":"KM",
"val":"Comoren"
},{
"code":"CG",
"val":"Congo"
},{
"code":"CD",
"val":"Congo-Kinshasa"
},{
"code":"CK",
"val":"Cookeilanden"
},{
"code":"CR",
"val":"Costa Rica"
},{
"code":"CU",
"val":"Cuba"
},{
"code":"CY",
"val":"Cyprus"
},{
"code":"DK",
"val":"Denemarken"
},{
"code":"DJ",
"val":"Djibouti"
},{
"code":"DM",
"val":"Dominica"
},{
"code":"DO",
"val":"Dominicaanse Republiek"
},{
"code":"DE",
"val":"Duitsland"
},{
"code":"EC",
"val":"Ecuador"
},{
"code":"EG",
"val":"Egypte"
},{
"code":"SV",
"val":"El Salvador"
},{
"code":"GQ",
"val":"Equatoriaal-Guinea"
},{
"code":"ER",
"val":"Eritrea"
},{
"code":"EE",
"val":"Estland"
},{
"code":"ET",
"val":"Ethiopië"
},{
"code":"FO",
"val":"Faeröer"
},{
"code":"FK",
"val":"Falklandeilanden"
},{
"code":"FJ",
"val":"Fiji"
},{
"code":"PH",
"val":"Filipijnen"
},{
"code":"FI",
"val":"Finland"
},{
"code":"FR",
"val":"Frankrijk"
},{
"code":"GF",
"val":"Frans-Guyana"
},{
"code":"PF",
"val":"Frans-Polynesië"
},{
"code":"TF",
"val":"Franse Gebieden in de zuidelijke Indische Oceaan"
},{
"code":"GA",
"val":"Gabon"
},{
"code":"GM",
"val":"Gambia"
},{
"code":"GE",
"val":"Georgië"
},{
"code":"GH",
"val":"Ghana"
},{
"code":"GI",
"val":"Gibraltar"
},{
"code":"GD",
"val":"Grenada"
},{
"code":"GR",
"val":"Griekenland"
},{
"code":"GL",
"val":"Groenland"
},{
"code":"GP",
"val":"Guadeloupe"
},{
"code":"GU",
"val":"Guam"
},{
"code":"GT",
"val":"Guatemala"
},{
"code":"GG",
"val":"Guernsey"
},{
"code":"GN",
"val":"Guinee"
},{
"code":"GW",
"val":"Guinee-Bissau"
},{
"code":"GY",
"val":"Guyana"
},{
"code":"HT",
"val":"Haïti"
},{
"code":"HM",
"val":"Heard- en McDonaldeilanden"
},{
"code":"HN",
"val":"Honduras"
},{
"code":"HU",
"val":"Hongarije"
},{
"code":"HK",
"val":"Hongkong SAR van China"
},{
"code":"IS",
"val":"IJsland"
},{
"code":"IE",
"val":"Ierland"
},{
"code":"IN",
"val":"India"
},{
"code":"ID",
"val":"Indonesië"
},{
"code":"IQ",
"val":"Irak"
},{
"code":"IR",
"val":"Iran"
},{
"code":"IM",
"val":"Isle of Man"
},{
"code":"IL",
"val":"Israël"
},{
"code":"IT",
"val":"Italië"
},{
"code":"CI",
"val":"Ivoorkust"
},{
"code":"JM",
"val":"Jamaica"
},{
"code":"JP",
"val":"Japan"
},{
"code":"YE",
"val":"Jemen"
},{
"code":"JE",
"val":"Jersey"
},{
"code":"JO",
"val":"Jordanië"
},{
"code":"CV",
"val":"Kaapverdië"
},{
"code":"CM",
"val":"Kameroen"
},{
"code":"KZ",
"val":"Kazachstan"
},{
"code":"KE",
"val":"Kenia"
},{
"code":"KG",
"val":"Kirgizië"
},{
"code":"KI",
"val":"Kiribati"
},{
"code":"KW",
"val":"Koeweit"
},{
"code":"HR",
"val":"Kroatië"
},{
"code":"LA",
"val":"Laos"
},{
"code":"LS",
"val":"Lesotho"
},{
"code":"LV",
"val":"Letland"
},{
"code":"LB",
"val":"Libanon"
},{
"code":"LR",
"val":"Liberia"
},{
"code":"LY",
"val":"Libië"
},{
"code":"LI",
"val":"Liechtenstein"
},{
"code":"LT",
"val":"Litouwen"
},{
"code":"LU",
"val":"Luxemburg"
},{
"code":"MO",
"val":"Macao SAR van China"
},{
"code":"MK",
"val":"Macedonië"
},{
"code":"MG",
"val":"Madagaskar"
},{
"code":"MW",
"val":"Malawi"
},{
"code":"MV",
"val":"Maldiven"
},{
"code":"MY",
"val":"Maleisië"
},{
"code":"ML",
"val":"Mali"
},{
"code":"MT",
"val":"Malta"
},{
"code":"MA",
"val":"Marokko"
},{
"code":"MH",
"val":"Marshalleilanden"
},{
"code":"MQ",
"val":"Martinique"
},{
"code":"MR",
"val":"Mauritanië"
},{
"code":"MU",
"val":"Mauritius"
},{
"code":"YT",
"val":"Mayotte"
},{
"code":"MX",
"val":"Mexico"
},{
"code":"FM",
"val":"Micronesië"
},{
"code":"MD",
"val":"Moldavië"
},{
"code":"MC",
"val":"Monaco"
},{
"code":"MN",
"val":"Mongolië"
},{
"code":"ME",
"val":"Montenegro"
},{
"code":"MS",
"val":"Montserrat"
},{
"code":"MZ",
"val":"Mozambique"
},{
"code":"MM",
"val":"Myanmar"
},{
"code":"NA",
"val":"Namibië"
},{
"code":"NR",
"val":"Nauru"
},{
"code":"NL",
"val":"Nederland"
},{
"code":"AN",
"val":"Nederlandse Antillen"
},{
"code":"NP",
"val":"Nepal"
},{
"code":"NI",
"val":"Nicaragua"
},{
"code":"NC",
"val":"Nieuw-Caledonië"
},{
"code":"NZ",
"val":"Nieuw-Zeeland"
},{
"code":"NE",
"val":"Niger"
},{
"code":"NG",
"val":"Nigeria"
},{
"code":"NU",
"val":"Niue"
},{
"code":"KP",
"val":"Noord-Korea"
},{
"code":"MP",
"val":"Noordelijke Marianeneilanden"
},{
"code":"NO",
"val":"Noorwegen"
},{
"code":"NF",
"val":"Norfolkeiland"
},{
"code":"UG",
"val":"Oeganda"
},{
"code":"UA",
"val":"Oekraïne"
},{
"code":"UZ",
"val":"Oezbekistan"
},{
"code":"OM",
"val":"Oman"
},{
"code":"TL",
"val":"Oost-Timor"
},{
"code":"AT",
"val":"Oostenrijk"
},{
"code":"PK",
"val":"Pakistan"
},{
"code":"PW",
"val":"Palau"
},{
"code":"PS",
"val":"Palestijns Gebied"
},{
"code":"PA",
"val":"Panama"
},{
"code":"PG",
"val":"Papoea-Nieuw-Guinea"
},{
"code":"PY",
"val":"Paraguay"
},{
"code":"PE",
"val":"Peru"
},{
"code":"PN",
"val":"Pitcairn"
},{
"code":"PL",
"val":"Polen"
},{
"code":"PT",
"val":"Portugal"
},{
"code":"PR",
"val":"Puerto Rico"
},{
"code":"QA",
"val":"Qatar"
},{
"code":"RO",
"val":"Roemenië"
},{
"code":"RU",
"val":"Rusland"
},{
"code":"RW",
"val":"Rwanda"
},{
"code":"RE",
"val":"Réunion"
},{
"code":"BL",
"val":"Saint Barthélemy"
},{
"code":"KN",
"val":"Saint Kitts en Nevis"
},{
"code":"LC",
"val":"Saint Lucia"
},{
"code":"PM",
"val":"Saint Pierre en Miquelon"
},{
"code":"VC",
"val":"Saint Vincent en de Grenadines"
},{
"code":"SB",
"val":"Salomonseilanden"
},{
"code":"WS",
"val":"Samoa"
},{
"code":"SM",
"val":"San Marino"
},{
"code":"ST",
"val":"Sao Tomé en Principe"
},{
"code":"SA",
"val":"Saoedi-Arabië"
},{
"code":"SN",
"val":"Senegal"
},{
"code":"RS",
"val":"Servië"
},{
"code":"SC",
"val":"Seychellen"
},{
"code":"SL",
"val":"Sierra Leone"
},{
"code":"SG",
"val":"Singapore"
},{
"code":"SH",
"val":"Sint-Helena"
},{
"code":"MF",
"val":"Sint-Maarten"
},{
"code":"SI",
"val":"Slovenië"
},{
"code":"SK",
"val":"Slowakije"
},{
"code":"SD",
"val":"Soedan"
},{
"code":"SO",
"val":"Somalië"
},{
"code":"ES",
"val":"Spanje"
},{
"code":"LK",
"val":"Sri Lanka"
},{
"code":"SR",
"val":"Suriname"
},{
"code":"SJ",
"val":"Svalbard en Jan Mayen"
},{
"code":"SZ",
"val":"Swaziland"
},{
"code":"SY",
"val":"Syrië"
},{
"code":"TJ",
"val":"Tadzjikistan"
},{
"code":"TW",
"val":"Taiwan"
},{
"code":"TZ",
"val":"Tanzania"
},{
"code":"TH",
"val":"Thailand"
},{
"code":"TG",
"val":"Togo"
},{
"code":"TK",
"val":"Tokelau"
},{
"code":"TO",
"val":"Tonga"
},{
"code":"TT",
"val":"Trinidad en Tobago"
},{
"code":"TD",
"val":"Tsjaad"
},{
"code":"CZ",
"val":"Tsjechië"
},{
"code":"TN",
"val":"Tunesië"
},{
"code":"TR",
"val":"Turkije"
},{
"code":"TM",
"val":"Turkmenistan"
},{
"code":"TC",
"val":"Turks- en Caicoseilanden"
},{
"code":"TV",
"val":"Tuvalu"
},{
"code":"UY",
"val":"Uruguay"
},{
"code":"VU",
"val":"Vanuatu"
},{
"code":"VA",
"val":"Vaticaanstad"
},{
"code":"VE",
"val":"Venezuela"
},{
"code":"GB",
"val":"Verenigd Koninkrijk"
},{
"code":"AE",
"val":"Verenigde Arabische Emiraten"
},{
"code":"US",
"val":"Verenigde Staten"
},{
"code":"VN",
"val":"Vietnam"
},{
"code":"WF",
"val":"Wallis en Futuna"
},{
"code":"EH",
"val":"Westelijke Sahara"
},{
"code":"BY",
"val":"Wit-Rusland"
},{
"code":"ZM",
"val":"Zambia"
},{
"code":"ZW",
"val":"Zimbabwe"
},{
"code":"ZA",
"val":"Zuid-Afrika"
},{
"code":"GS",
"val":"Zuid-Georgië en Zuidelijke Sandwicheilanden"
},{
"code":"KR",
"val":"Zuid-Korea"
},{
"code":"SE",
"val":"Zweden"
},{
"code":"CH",
"val":"Zwitserland"
}
]
})
}),
new Ext.form.TextField({
fieldLabel: 'Telefoon',
name: 'telefoon',
width: 153,
ctCls: 'input-txt w150'
}),
new Ext.form.TextField({
fieldLabel: 'Mobiel',
name: 'mobiel',
width: 153,
ctCls: 'input-txt w150'
}),
new Ext.form.TextField({
fieldLabel: 'Email *',
name: 'email',
vtype:'email',
vtypeText: 'U heeft een ongeldig emailadres ingevoerd.',
invalidClass: 'txt-fld-error',
width: 153,
ctCls: 'input-txt w150'
}),
new Ext.form.CheckboxGroup({
fieldLabel: 'Nieuwsbrief',
columns: 1,
items:[
new Ext.form.Checkbox({
boxLabel: 'Ja, ik wil graag op de hoogte te worden gehouden via de nieuwsbrief (4 maal per jaar).',
name: 'receivenewsletter',
inputValue: 'yes'
})
]
}),
{xtype:'panel',html:'De met een sterretje (*) aangegeven velden zijn verplicht.'}
]
});
extForm.render('form01');
});