| Current Path : /home1/savoy/public_html/unova.in/test/application/views/site/ |
Linux gator3171.hostgator.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 |
| Current File : /home1/savoy/public_html/unova.in/test/application/views/site/feedback.php |
<?php
$this->load->view('site/header');
?>
<div class="banner">
<div class="banner_top"></div><!--banner_top end-->
<div class="banner_mid_inner"><img src="<?=base_url()?>/assets/images/feedback.jpg" alt="Feedback"/></div><!--banner_mid end-->
<div class="banner_bot"></div><!--banner_bot end-->
</div><!--banner end-->
<div class="content">
<div class="content_left">
<h1>Feedback</h1>
<script src="<?=base_url()?>/assets/js/formscript.js" type="text/javascript"></script>
<script type="text/javascript">
JotForm.init(function(){
$('input_16').hint('ex: myname@example.com');
});
</script>
<link href="<?=base_url()?>/assets/css/formstyle.css" rel="stylesheet" type="text/css" />
<form class="jotform-form" action="<?=site_url();?>/site/insert_feedback" method="post" name="form_12283725187" id="12283725187" accept-charset="utf-8">
<input type="hidden" name="formID" value="12283725187" />
<div class="form-all">
<ul class="form-section">
<li class="form-line" id="id_15">
<label class="form-label-top" id="label_15" for="input_15">
Name<span class="form-required">*</span>
</label>
<div id="cid_15" class="form-input-wide"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q15_name[first]" id="first_15" />
<label class="form-sub-label" for="first_15" id="sublabel_first"> First Name </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q15_name[last]" id="last_15" />
<label class="form-sub-label" for="last_15" id="sublabel_last"> Last Name </label></span>
</div>
</li>
<li class="form-line" id="id_16">
<label class="form-label-top" id="label_16" for="input_16">
E-mail<span class="form-required">*</span>
</label>
<div id="cid_16" class="form-input-wide">
<input type="email" class="form-textbox validate[required, Email]" id="input_16" name="q16_email" size="20" />
</div>
</li>
<li class="form-line" id="id_20">
<label class="form-label-top" id="label_20" for="input_20"> Contact No </label>
<div id="cid_20" class="form-input-wide">
<input type="text" class="form-textbox" id="input_20" name="q20_contactNo" size="20" />
</div>
</li>
<li class="form-line" id="id_19">
<label class="form-label-top" id="label_19" for="input_19">
Subject<span class="form-required">*</span>
</label>
<div id="cid_19" class="form-input-wide">
<input type="text" class="form-textbox validate[required]" id="input_19" name="q19_subject" size="20" />
</div>
</li>
<li class="form-line" id="id_17">
<label class="form-label-top" id="label_17" for="input_17">
Your Message<span class="form-required">*</span>
</label>
<div id="cid_17" class="form-input-wide">
<textarea id="input_17" class="form-textarea validate[required]" name="q17_yourMessage" cols="60" rows="9"></textarea>
</div>
</li>
<li class="form-line" id="id_14">
<div id="cid_14" class="form-input-wide">
<div style="text-align:center" class="form-buttons-wrapper">
<button id="input_14" type="submit" class="form-submit-button">
Submit
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<input type="hidden" id="simple_spc" name="simple_spc" value="12283725187" />
<script type="text/javascript">
document.getElementById("si" + "mple" + "_spc").value = "12283725187-12283725187";
</script>
</form>
</div><!--content_left end-->
<?php
$this->load->view('site/right');
?>
</div><!--content end-->
<?php
$this->load->view('site/footer');
?>