forked from verdnatura/hedera-web
50 lines
1.2 KiB
XML
50 lines
1.2 KiB
XML
<vn>
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<div id="title">
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<h1><t>IWantCustomer</t></h1>
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</div>
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<div id="form" class="contact">
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<div class="box form vn-w-xs vn-pa-lg">
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<p><t>FillFormData</t></p>
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<p><t>OrCallUs</t></p>
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<form id="contact-form">
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<input type="hidden" name="srv" value="json:client/contact"/>
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<div class="form-group">
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<label><t>Name</t></label>
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<input type="text" name="name"/>
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</div>
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<div class="form-group">
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<label><t>City</t></label>
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<input type="text" name="city"/>
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</div>
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<div class="form-group">
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<label><t>PC</t></label>
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<input type="text" name="pc"/>
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</div>
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<div class="form-group">
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<label><t>Phone</t></label>
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<input type="text" name="phone"/>
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</div>
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<div class="form-group">
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<label><t>EMail</t></label>
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<input type="text" name="email"/>
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</div>
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<div class="form-group">
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<label><t>Message</t></label>
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<textarea name="message"/>
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</div>
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<div class="form-group captcha">
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<label><t>Anti-Spam</t></label>
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<input type="text" name="captcha"/>
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<img alt="Captcha" id="captcha-img"/>
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</div>
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<p class="mandatory-message">
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<t>AllFieldsMandatory</t>
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</p>
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<button>
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<t>Send</t>
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</button>
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</form>
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</div>
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</div>
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</vn>
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