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Diffstat (limited to 'addons/crm/scripts/php/form.php')
| -rw-r--r-- | addons/crm/scripts/php/form.php | 74 |
1 files changed, 74 insertions, 0 deletions
diff --git a/addons/crm/scripts/php/form.php b/addons/crm/scripts/php/form.php new file mode 100644 index 00000000000..2d255e87cb3 --- /dev/null +++ b/addons/crm/scripts/php/form.php @@ -0,0 +1,74 @@ +<html> +<head> +<title>Contact form</title> +</head> +<body> + <h4>Contact Form</h4> + <form method="post" action="crmlead.php"> + <label for="firstname">Firstname</label> + <input type="text" name="name" value="" id="firstname" class="required text" title="Please, fill in your firstname" data-required="true"><br /> + <label for="company">Company</label> + <input type="text" name="company" value="" id="company" class="required text" title="Please, fill in your company name" data-required="true"><br /> + <label for="jobtitle">Jobtitle</label> + <input type="text" name="jobtitle" value="" id="jobtitle" class="required text" title="Please, fill in your job title" data-required="true"><br /> + <label for="email">Email</label> + <input type="text" name="email" value="" id="email" class="required email text" title="Please, enter a valid email address" data-required="true"><br /> + <label for="phone">Phone</label> + <input type="text" name="phone" value="" id="phone" class="required phone text" title="Please use international format (eg: +32...)" data-required="true"> + + <label for="city">City</label> + <input type="text" name="city" value="" id="city" class="required text" title="Please, fill in your city" data-required="true"><br /> + <label for="zip">Zipcode</label> + <td><input type="text" name="zip" value="" id="zip" class="required text" title="Please, fill in your zipcode" data-required="true"><br /> + <label for="state">State</label><input type="text" name="state" value="" id="state" class="text" title="Please, fill in your state"> <br /> + <label> Country : <?php include('countrylist.php'); ?></label> <br /> + <label for="employees">No.of employees</label> + + <select class="required" name="employees" title="Please, select the No. of employees" data-required="true"> + <option value=""> -- select an option -- </option> + <option value="1-5">1-5</option> + <option value="5-10">5-10</option> + <option value="10-20">10-20</option> + + <option value="20-100">20-100</option> + <option value="100-500">100-500</option> + <option value="500+">500+</option> + </select><br /> + + <label for="industry">Industry expertise</label> + <select class="required select" name="industry" title="Please, select an industry" data-required="true"> + <option value=""> -- select an option -- </option> + <option value="auction">Auction Houses</option> + <option value="bank">Bank</option> + <option value="distribution">Distribution</option> + <option value="education">Education</option> + + <option value="entertainment">Entertainment</option> + <option value="erp_integrator">ERP Integrator</option> + <option value="food_industries">Food industries</option> + <option value="hotels_restaurants">Hotels & restaurants</option> + <option value="insurance">Insurance</option> + <option value="manufacturing">Manufacturing</option> + <option value="non_profit">Non-Profit</option> + <option value="public">Public</option> + + <option value="services">Services</option> + <option value="telecommunication">Telecommunication</option> + <option value="others">Others</option> + </select><br /> + <p> + <label> About : <textarea name="about"></textarea></textarea></label> + </p> + <p> + <input type="submit" value="Send"/> <input type="reset" /> + </p> + </form> + +</body> +</html> + + + + + + |