62 lines
2.8 KiB
PHP
62 lines
2.8 KiB
PHP
<? \S::set_session( 'form-token', bin2hex( random_bytes( 32 ) ) );?>
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<div class="contact-new-form">
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<form action="" method="POST" id="contact-form">
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<input type="hidden" name="action" value="send-services">
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<input type="hidden" name="token" value="<?= \S::get_session( 'form-token' );?>">
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<input type="hidden" name="website" value="">
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<div class="form-row">
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<div class="form-group col-md-6">
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<input type="text" class="form-control" id="inputName" name="inputName" placeholder="Imię i nazwisko" required>
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</div>
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<div class="form-group col-md-6">
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<input type="text" class="form-control" id="inputCompanyName" name="inputCompanyName" placeholder="Nazwa firmy">
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-md-12">
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<input type="text" class="form-control" id="inputEmail" name="inputInvoiceNumber" placeholder="Numer faktury sprzedażowej" required>
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</div>
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<div class="form-group col-md-12">
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<input type="tel" class="form-control" id="inputContactNumber" name="inputContactNumber" placeholder="Numer kontaktowy" required>
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</div>
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<div class="form-group col-md-12">
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<input type="email" class="form-control" id="inputEmail" name="inputEmail" placeholder="Email" required>
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</div>
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<div class="form-group col-md-12">
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<input type="text" class="form-control" id="inputAdres" name="inputAdres" placeholder="Adres zgłoszenia" required>
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-12">
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<textarea class="form-control" id="message" name="message" rows="5" placeholder="Opis zgłoszenia" required></textarea>
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</div>
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</div>
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<div class="form-group">
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<div class="form-check">
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<input class="form-check-input" type="checkbox" id="gridCheck" required>
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<label class="form-check-label" for="gridCheck">
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Wyrażam zgodę na przetwarzanie moich danych osobowych podanych przeze mnie powyżej w celu przygotowania stosownej oferty.
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</label>
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</div>
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<div class="form-check">
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<input class="form-check-input" type="checkbox" id="gridCheck2" required>
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<label class="form-check-label" for="gridCheck2">
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Wyrażam zgodę na przetwarzanie moich danych osobowych podanych przeze mnie powyżej w celu otrzymywania materiałów reklamowych.
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</label>
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</div>
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<p><a href="/polityka-prywatnosci">Polityka prywatnosci</a></p>
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</div>
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<button type="submit" name="sumbit" class="btn4">Wyślij</button>
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</form>
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</div>
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<script class="footer" type="text/javascript">
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$( 'body' ).on( 'submit', '#contact-form', function(e)
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{
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window.dataLayer = window.dataLayer || [];
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window.dataLayer.push({
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'event': 'formSent'
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});
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});
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</script>
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