Created
October 21, 2016 21:17
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BREW vs FESE
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<form action="?submit" method="post"> | |
<input type="hidden" name="contactform" value="true"> | |
<input class="hidden" name="email" value="" autocomplete="off"> | |
<input class="hidden" name="first_name" value="" autocomplete="off"> | |
<input class="hidden" name="last_name" value="" autocomplete="off"> | |
<div class="cols"> | |
<div class="col fld w1/2"> | |
<label>First Name</label> | |
<input name="onc5khko" value="" required> | |
</div> | |
<div class="col fld w1/2"> | |
<label>Last Name</label> | |
<input name="sk5tyelo" value="" required> | |
</div> | |
<div class="col fld w1/2"> | |
<label>Email</label> | |
<input type="email" name="mi0moecs" value="" required> | |
<small>Please provide a valid email address.</small> | |
</div> | |
<div class="col fld w1/2"> | |
<label>Phone <small>(optional)</small></label> | |
<input type="tel" name="telephone" value=""> | |
</div> | |
<div class="col fld w1/1"> | |
<label>Subject <small>(optional)</small></label> | |
<input name="subject" value=""> | |
</div> | |
<div class="col fld w1/1"> | |
<label>Message</label> | |
<textarea cols="32" rows="6" name="comments" required></textarea> | |
</div> | |
<div class="col fld w1/1"> | |
{opt_in} | |
</div> | |
<div class="btns"> | |
<button type="submit" class="btn positive">Send</button> | |
</div> | |
</div> | |
</form> |
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