CHIEFSOFT\ameye
59 lines
2.6 KiB
PHP
59 lines
2.6 KiB
PHP
<?php $this->extend('layouts/master') ?>
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<?php $this->section('content') ?>
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<div id="breadcrumbs">
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<a title="Home" href="#">Home »</a> Contacts
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</div><!--/ breadcrumbs-->
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<div class="contacts-wrapper">
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<div class="content-wrapper"><h3>Contacts</h3></div>
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<div class="content-wrapper">
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<h3>Send Us Mail - Email: icarementalhealth@gmail.com</h3>
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<div id="contact">
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<div id="message"></div>
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<form method="post" action="contact.php" id="contactform">
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<fieldset>
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<div class="alignleft">
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<div class="row">
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<label for="name"><span class="required">*</span>Your Name:</label>
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<input type="text" name="name" id="name" />
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</div><!--/ row-->
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<div class="row">
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<label for="email"><span class="required">*</span>E-mail:</label>
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<input type="text" name="email" id="email" />
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</div><!--/ row-->
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<div class="row">
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<label for="phone">Phone:</label>
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<input type="text" name="phone" id="phone" />
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</div><!--/ row-->
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<div class="row">
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<label for="subject">Subject</label>
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<select name="subject" id="subject">
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<option value="Support">Support</option>
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<option value="a Sale">Sales</option>
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<option value="a Bug fix">Report a bug</option>
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</select>
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</div><!--/ row-->
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<div class="row">
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<img src="image.php" alt="" style="vertical-align: middle;" /><input name="verify" type="text" id="verify" size="6" value="" style="width: 50px; margin: 0 0 0 8px; vertical-align: middle;" />
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</div><!--/ row-->
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<input type="submit" class="button green small" id="submit" value="Submit" />
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</div><!--/ textfield-->
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<div class="alignright">
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<label for="comments">Message:</label>
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<textarea name="comments" id="comments" cols="30" rows="10"></textarea>
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</div><!--/ areafield-->
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</fieldset>
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</form>
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</div><!--/ contact-->
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<div class="clear"></div>
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</div><!--/ .content-wrapper-->
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</div><!--/ contacts-wrapper-->
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<?= $this->endSection() ?>
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