<form method="POST">
<h3>Vertrag</h3>

<label>Vertragsnummer</label>
<input
    type="text"
    class="form-control mb-2 bg-light"
    placeholder="Wird automatisch vergeben"
    disabled>

<label>Vertragsvariante</label>
<input
    type="number"
    name="vertragsvariante"
    class="form-control mb-2"
    placeholder="z. B. 1, 2 oder 3"
    required>
<h3>Persönliche Daten</h3>
<input name="vorname" placeholder="Vorname" required>
<input name="nachname" placeholder="Nachname" required>

<label>Geburtsdatum</label>
<input type="date" name="geburtsdatum" required>

<h3>Adresse</h3>
<input name="strasse" placeholder="Straße">
<input name="hausnummer" placeholder="Hausnummer">
<input name="plz" placeholder="PLZ">
<input name="ort" placeholder="Ort">
<input name="land" placeholder="Land">

<h3>Kontakt</h3>
<input name="mobil" placeholder="Mobilnummer">
<input name="telefon" placeholder="Telefonnummer">
<input name="email" type="email" placeholder="E-Mail">

<h3>SEPA Lastschrift</h3>
<input name="kontoinhaber" placeholder="Kontoinhaber">
<input name="iban" placeholder="IBAN">
<input name="bic" placeholder="BIC">
<input name="mandatsreferenz" placeholder="Mandatsreferenz">

<button>Speichern</button>
</form>
