Preview: enqform.php
Size: 2.40 KB
/home/urbanman/hindustansecurity.in/enqform.php
<?php
error_reporting(0);
include("admin/common/app_function.php");
include("admin/config.php");
include("header.php");
//index_header($title);
?>
<br/>
<div>
<div class="container-fluid">
<div class="row" >
<div class="col-sm-6" style="padding:10px;margin-bottom:-15px;">
<img src="img/enq.jpg" style="width:100%;" class="img-fluid img-thumbnail">
</div>
<div class="col-sm-6 formcolom" style="margin-top:10px;">
<h4>Enquiry Form</h4>
<?php if($_GET[flag]=="send") {?>
<tr>
<td colspan="3" >
<font color="red"><i>
Your Enquiry Successfully Send !</i></td>
</font>
</tr>
<?php } ?>
<form class="container" autocomplete="off" action="submit-enquiry.php" method="post" enctype="multipart/form-data">
<div class="row" style="margin-bottom:15px;">
<div class="col-md-12">
<input type="text" class="form-control" id="fname" name="fname" placeholder="Your Name" maxlength="50" size="50" required="">
</div>
</div>
<div class="row">
<div class="col-md-6 mb-3">
<input type="email" class="form-control" id="email" name="email" placeholder="Email Id*" maxlength="50" size="50" required="">
</div>
<div class="col-md-6 mb-3">
<input type="text" class="form-control" id="mobile" name="mobile" placeholder="Mobile Number*" maxlength="10" size="10" required="">
</div>
</div>
<div class="row" style="margin-bottom:15px;">
<div class="col-md-12">
<textarea class="form-control" id="address" name="address" rows="2" placeholder="Enter Location / Address" maxlength="100" size="100" required=""></textarea>
</div>
</div>
<div class="row" style="margin-bottom:15px;">
<div class="col-md-12">
<textarea class="form-control" id="message" name="message" rows="4" placeholder="Enter Any Message" size="100" required=""></textarea>
</div>
</div>
<input type="hidden" name="edate" value=""<?php echo date('Y/m/d');?> />
<center> <button class="btn btn-primary" type="submit">Submit Form</button></center>
</form>
</div>
</div>
</div>
</div>
<BR/>
<?php include("footer.php");?>
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