Parašė pandevix· 2011 Geg. 30 12:05:44
#1
Sweiki, gal kas galetu padeti patvarkyti shita forma kad ji butu veikianti.
Man reikai kad i shita forma ivestus duomenys siustu i tam tikra email adresa.
Buciau labai dekingas
<table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#D7D7D7">
<tr>
<td style="" colspan="2">
<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">ONLINE BOOKING</b><br />
<br /></font>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Title</b></font>
</td>
<td style="">
<select id="element_0" name="element_0" class="validate[optional]">
<option value="Title" selected="selected">
Title
</option>
<option value="---------">
---------
</option>
<option value="Mr">
Mr
</option>
<option value="Mrs">
Mrs
</option>
<option value="Miss">
Miss
</option>
<option value="Ms">
Ms
</option>
<option value="Dr">
Dr
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Name</b></font>
</td>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Address</b></font>
</td>
<td style="">
<textarea id="element_2" name="element_2" cols="45" rows="4" class="validate[optional]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Post Code</b></font>
</td>
<td style="">
<input id="element_3" name="element_3" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Home Telephone</b></font>
</td>
<td style="">
<input id="element_4" name="element_4" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Work Telephone</b></font>
</td>
<td style="">
<input id="element_5" name="element_5" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Mobile Telephone</b></font>
</td>
<td style="">
<input id="element_6" name="element_6" value="+44" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Email Addres</b></font>
</td>
<td style="">
<input id="element_7" name="element_7" class="validate[optional,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Description of work required</b></font>
</td>
<td style="">
<textarea id="element_8" name="element_8" cols="45" rows="5" class="validate[optional]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>When would you like your appointment?</b></font>
</td>
<td style="">
<select id="element_9" name="element_9" class="validate[optional]">
<option value="-- Chose Day --" selected="selected">
-- Chose Day --
</option>
<option value="Monday">
Monday
</option>
<option value="Tuesday">
Tuesday
</option>
<option value="Wednesday">
Wednesday
</option>
<option value="Thursday">
Thursday
</option>
<option value="Friday">
Friday
</option>
<option value="Saturday">
Saturday
</option>
<option value="Sunday">
Sunday
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left"></td>
<td style="">
<select id="element_10" name="element_10" class="validate[optional]">
<option value="-- Choose Date --" selected="selected">
-- Choose Date --
</option>
<option value="1">
1
</option>
<option value="2">
2
</option>
<option value="3">
3
</option>
<option value="4">
4
</option>
<option value="5">
5
</option>
<option value="6">
6
</option>
<option value="7">
7
</option>
<option value="8">
8
</option>
<option value="9">
9
</option>
<option value="10">
10
</option>
<option value="11">
11
</option>
<option value="12">
12
</option>
<option value="13">
13
</option>
<option value="14">
14
</option>
<option value="15">
15
</option>
<option value="16">
16
</option>
<option value="17">
17
</option>
<option value="18">
18
</option>
<option value="19">
19
</option>
<option value="20">
20
</option>
<option value="21">
21
</option>
<option value="22">
22
</option>
<option value="23">
23
</option>
<option value="24">
24
</option>
<option value="25">
25
</option>
<option value="26">
26
</option>
<option value="27">
27
</option>
<option value="28">
28
</option>
<option value="29">
29
</option>
<option value="30">
30
</option>
<option value="31">
31
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left"></td>
<td style="">
<select id="element_11" name="element_11" class="validate[optional]">
<option value="-- Choose Month --" selected="selected">
-- Choose Month --
</option>
<option value="January">
January
</option>
<option value="February">
February
</option>
<option value="March">
March
</option>
<option value="April">
April
</option>
<option value="May">
May
</option>
<option value="June">
June
</option>
<option value="July">
July
</option>
<option value="August">
August
</option>
<option value="September">
September
</option>
<option value="October">
October
</option>
<option value="November">
November
</option>
<option value="December">
December
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>What time will you be available?</b></font>
</td>
<td style="">
<select id="element_12" name="element_12" class="validate[optional]">
<option value="-- Choose Time --" selected="selected">
-- Choose Time --
</option>
<option value="8:30am - 12:00pm">
8:30am - 12:00pm
</option>
<option value="12:00pm - 5:00pm">
12:00pm - 5:00pm
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>Property Description</b></font>
</td>
<td style="">
<textarea id="element_13" name="element_13" cols="45" rows="4" class="validate[optional]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="left">
<font face="Verdana" size="2" color="#000000"><b>How Did You Find Us?</b></font>
</td>
<td style="">
<select id="element_14" name="element_14" class="validate[optional]">
<option value="-- Please Select --" selected="selected">
-- Please Select --
</option>
<option value="Google">
Google
</option>
<option value="Yahoo">
Yahoo
</option>
<option value="MSN">
MSN
</option>
<option value="Local Newspaper">
Local Newspaper
</option>
<option value="Saw Our Vehicle">
Saw Our Vehicle
</option>
<option value="Recommendation">
Recommendation
</option>
<option value="Previous Client">
Previous Client
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr>
<td colspan="2" align="center">
<input name="element_counts" value="15" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="Submit" type="submit" />
</td>
</tr>
</table>
</form>
<div>
Redagavo pandevix· 2011 Geg. 30 13:05:45