55 lines
1.8 KiB
PHP
55 lines
1.8 KiB
PHP
<div id='ac'>
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<div class='edit-row' style='background: #e32d2c; color: #FFF; text-align: center;'>Zadaj pytanie naszemu ekspertowi.</div>
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<form method="POST" action="" id="ac-form" enctype="multipart/form-data">
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<input type="hidden" name="rw" value="send-ac-form" />
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<input type="hidden" name="check" value="<?= mktime();?>" />
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<div class='edit-row'>
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<label class="red">Imię i nazwisko:*</label>
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<div class='input'>
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<input type='text' name='ac-name' id='ac-name' class="require" />
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</div>
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</div>
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<div class="edit-row">
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<label>Nazwa firmy:</label>
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<div class="input">
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<input type="text" name="ac-firm" id="ac-firm" />
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</div>
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</div>
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<div class='edit-row'>
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<label class="red">Email:*</label>
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<div class='input'>
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<input type='text' name='ac-email' id='ac-email' class="require" />
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</div>
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</div>
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<div class="edit-row">
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<label>Roczna ilość:</label>
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<div class="input">
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<input type="text" name="ac-quantity" id="ad-quantity" />
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</div>
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</div>
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<div class='edit-row'>
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<label class="red">Treść:*</label>
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<div class='input'>
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<textarea name='ac-text' id='ac-text' style='height: 120px;' class="require"></textarea>
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</div>
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</div>
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<div class="edit-row">
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<label>Zdjęcie:</label>
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<div class="input">
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<input type="file" name="ac-file" id="ac-file" />
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</div>
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</div>
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<div class="edit-row">
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<label></label>
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<div class="input red" style="font-size: 11px;">
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* pola wymagane
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</div>
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</div>
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<div class='edit-row'>
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<label></label>
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<div class='input' style='margin-left: 125px;'>
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<a class='button' href='#' onclick="checkForm( 'ac-form' );">wyślij zapytanie</a>
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</div>
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</div>
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</form>
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</div> |