<div class="box box--bordered">
<div class="box__content">
<h3 class="headline headline--headline-1">Gleich ausfüllen und mehr Infos bekommen
</h3>
<form class="form">
<div class="form__inner">
<fieldset class="form-group form-group--fullwide">
<legend class="label u-hidden-visually">Mitgliedschaft</legend>
<div class="form-group__inner">
<label class="radio radio--nextline">
<input class="radio__input" type="radio" value="membership" required="required" id="radio-6225" name="subject"/><span class="radio__indicator"></span><span class="radio__label">Ja, ich möchte Mitglied der Krankenkasse hkk werden.</span>
</label>
<label class="radio radio--nextline">
<input class="radio__input" type="radio" value="info" required="required" id="radio-cd78" name="subject"/><span class="radio__indicator"></span><span class="radio__label">Ja, ich möchte mehr über die Krankenkasse hkk wissen. Senden Sie mir bitte Infomaterial zu.</span>
</label>
</div>
</fieldset>
<fieldset class="form-group form-group--fullwide">
<legend class="label label--required label--large">Ich bin</legend>
<div class="form-group__inner">
<label class="radio radio--nextline">
<input class="radio__input" type="radio" value="employee" required="required" id="radio-7ec6" name="status"/><span class="radio__indicator"></span><span class="radio__label">Arbeitnehmer oder selbstständig tätig.</span>
</label>
<label class="radio radio--nextline">
<input class="radio__input" type="radio" value="student" required="required" id="radio-7e01" name="status"/><span class="radio__indicator"></span><span class="radio__label">Student oder sonstiges (z.B. Künstler, Beamter).</span>
</label>
</div>
</fieldset>
<fieldset class="form-group form-group--fullwide">
<legend class="label label--required label--large">Persönliche Informationen</legend>
<div class="form-group__inner">
<label class="radio">
<input class="radio__input" type="radio" value="female" id="radio-4081" name="gender"/><span class="radio__indicator"></span><span class="radio__label">Frau</span>
</label>
<label class="radio">
<input class="radio__input" type="radio" value="male" id="radio-b5e2" name="gender"/><span class="radio__indicator"></span><span class="radio__label">Herr</span>
</label>
</div>
</fieldset>
<fieldset class="form-group form-group--fullwide form-group--inline">
<legend class="label u-hidden-visually">Name</legend>
<div class="form-group__inner">
<input class="input input--text" type="text" placeholder="Vorname*" required="required" autocomplete="fname" id="input-7d0a" name="name" />
<input class="input input--text" type="text" placeholder="Nachname*" required="required" autocomplete="lname" id="input-326f" name="name" />
</div>
</fieldset>
<div class="form-group form-group--fullwide">
<label class="label" for="birthdate">Geburtsdatum</label>
<div class="form-group__inner">
<input class="input input--date" type="date" placeholder="Geburtsdatum*" required="required" autocomplete="birthdate" id="birthdate" name="birthdate" />
</div>
</div>
<div class="form-group form-group--fullwide">
<label class="label u-hidden-visually" for="address-1">Straße, Hausnummer</label>
<div class="form-group__inner">
<input class="input input--text" type="text" placeholder="Straße, Nr.*" required="required" autocomplete="address-line1" id="address-1" name="address-1" />
</div>
</div>
<fieldset class="form-group form-group--fullwide form-group--inline">
<legend class="label u-hidden-visually">PLZ und Ort</legend>
<div class="form-group__inner">
<input class="input input--text input--25" type="text" placeholder="PLZ*" required="required" autocomplete="zipcode" id="input-57f5" name="address-2" />
<input class="input input--text input--75" type="text" placeholder="Ort*" required="required" autocomplete="city" id="input-3818" name="address-2" />
</div>
</fieldset>
<fieldset class="form-group form-group--fullwide form-group--inline">
<legend class="label u-hidden-visually">E-Mail-Addresse und Telefonnummer</legend>
<div class="form-group__inner">
<input class="input input--email" type="email" placeholder="E-Mail-Adresse" autocomplete="email" id="input-51f9" name="contact" />
<input class="input input--tel" type="tel" placeholder="Telefonnummer" autocomplete="telephone" id="input-516a" name="contact" />
</div>
</fieldset>
<div class="form-group form-group--fullwide">
<label class="label u-hidden-visually" for="privacy-policy">Datenschutzerklärung</label>
<div class="form-group__inner">
<label class="checkbox">
<input class="checkbox__input" type="checkbox" value="1" required="required" id="privacy-policy" name="privacy-policy"/><span class="checkbox__indicator"></span><span class="checkbox__label"><span class="formatted-text">Ich akzeptiere die <a href="#">Datenschutzerklärung</a>.*</span></span>
</label>
</div>
</div>
<div class="form__submit">
<input class="button button--blue" type="submit" value="Abschicken" />
</div>
</div>
</form>
</div>
</div>
-
//- Prepare attr object
attr = attr || {};
attr.class = classList(attr.class);
attr.class.push(`box--${color || 'light-blue'}`);
//- Tool box
if (tool) attr.class.push('box--tool');
//- Growing box
if (grow) attr.class.push('box--grow');
//- Render box
.box&attributes(attr)
//- Icon
if icon
.box__icon
!= include('@icon', {icon})
//- Box content
.box__content
//- Headline
if headline
.box__headline
- headlineOptions = Object.assign({}, {text: headline, hkkPlus}, headlineOptions)
!= include('@headline--headline-1', headlineOptions)
//- Content
if content
!= renderPug(content)
//- More link
if link
.box__more
!= include('@teaser-link', {link, text: more || 'Weitere Informationen'})
{
"headline": null,
"color": "bordered",
"more": "Weitere Informationen",
"link": null,
"hkkPlus": null,
"headlineOptions": {
"level": 3
},
"content": "!= include('@form--info')\n"
}
.box {
background-color: $color-steelgrey-light;
display: flex;
font-size: 1.5rem;
margin-bottom: 3rem;
padding: 2.5rem 2.5rem 1rem;
@include mq($from: m) {
display: block;
}
}
.box--tool {
.box__content {
margin: 0 auto;
}
@include mq($from: m) {
padding: 4rem 5rem 3rem;
}
}
.box--bordered {
background-color: transparent;
border: 0.5rem solid $color-steelgrey-light;
padding: 2rem 2rem 0.5rem;
}
.box--sand {
background-color: $color-sand;
.form-micro {
margin-top: 3rem;
}
}
.box--grow {
@include mq($from: m) {
height: 100%;
margin: 0;
}
}
.box__icon {
color: rgba(#333, 0.2);
font-size: 8rem;
line-height: 1;
margin-left: 1.5rem;
order: 1;
width: 8rem;
@include mq($from: m) {
margin-left: 0;
padding-bottom: 2.5rem;
padding-top: 0.5rem;
text-align: center;
width: 100%;
}
}
.box__content {
flex-shrink: 1;
max-width: 100%;
}
.box__more {
margin-bottom: 1.5rem;
}
There are no notes for this item.