affinitylive-php-contact-form/index.html.example

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2014-09-03 16:37:26 +00:00
<form method="POST" action="affinitylive.php">
<fieldset class="checkbox">
<legend>I need:</legend>
<label>
<input type="checkbox" name="selection[]" value="quote">
A Quote
</label>
<label>
<input type="checkbox" name="selection[]" value ="help">
Help
</label>
</fieldset>
<fieldset class ="user-input">
<legend>Contact Info:</legend>
<input type="text" name="company_name" class="input" placeholder="Company Name">
<input type="text" name="contact_firstname" class="input" placeholder="First Name">
<input type="text" name="contact_surname" class="input" placeholder="Last Name">
<input type="email" name="email" class="input" placeholder="Email">
<input type="tel" name="phone_number" class="input" placeholder="Phone Number">
<div><button name="submit">Submit</button></div>
</fieldset>
</form>