1. <?php error_reporting(0); ?>
  2. <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
  3. <html xmlns="http://www.w3.org/1999/xhtml">
  4. <head>
  5. <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
  6. <title>Untitled Document</title>
  7. <style type="text/css">
  8.  
  9. /* Form styles */
  10. div.form-container { margin: 10px; padding: 5px; background-color: #ebebeb; border: #ebebeb 1px solid;font: 80%/1.5 Arial,Helvetica,sans-serif; color: #626d75; }
  11. /*p.legend { margin-bottom: 1em; }
  12. p.legend em { color: #C00; font-style: normal; }*/
  13.  
  14. div.errors { margin: 0 0 10px 0; padding: 5px 10px; border: #FC6 1px solid; background-color: #FFC; }
  15. div.errors p { margin: 0; }
  16. div.errors p em { color: #C00; font-style: normal; font-weight: bold; }
  17.  
  18. div.form-container form p { margin: 0; }
  19. div.form-container form p.note { margin-left: 170px; font-size: 90%; color: #333; }
  20. div.form-container form fieldset { margin: 5px 0; padding: 5px; border: #aee758 1px solid; }
  21. div.form-container form legend { font-weight: bold; color: #626d75; }
  22. div.form-container form fieldset div { padding: 0.25em 0; }
  23. div.form-container label { margin-right: 10px; padding-right: 10px; width: 100px; display: block; float: left; text-align: right; position: relative; }
  24. div.form-container label.error, 
  25. div.form-container span.error { color: #C00; }
  26. div.form-container label em {position: absolute;right: 1px;font-size: 120%;font-style: normal;color: #C00;top: 0px;}
  27. div.form-container input.error { border-color: #C00; background-color: #FEF; }
  28. div.form-container input:focus,
  29. div.form-container input.error:focus, 
  30. div.form-container textarea:focus {	background-color: #FFC; border-color: #FC6; }
  31. div.form-container div.controlset label, 
  32. div.form-container div.controlset input { display: inline; float: none; }
  33. div.form-container div.controlset label.controlset { display: block; float: left; }
  34. div.form-container div.controlset div { margin-left: 170px; }
  35. div.form-container div.buttonrow { margin-left: 180px; }
  36. /*EO FORM*/
  37. </style>
  38. </head>
  39.  
  40. <body>
  41. <div class="form-container">
  42. 	<form action="mailer.php" method="post">
  43. 	<p class="legend"><strong>Note:</strong> Required  (<em>*</em>)</p>
  44.  
  45. 	<fieldset>
  46. 		<legend>User Details</legend>
  47. 	  <div><label for="fname">Name / Surname <em>*</em></label> 
  48. 	  			 <input type="text" name="name" value="<? echo $name; ?>" size="30" /></div>
  49. 	  <div><label for="email">Email Address <em>*</em></label> 
  50. 			  <p><input  type="text" name="email" value="<? echo $email; ?>" size="30" />
  51. 			</p>
  52. 			  <p align="center"><small>We will never sell or disclose your email address to anyone.</small></p></div>
  53. 	</fieldset>
  54.  
  55. 	<fieldset>
  56. 		<legend>Profile</legend>
  57. 	  <div><label for="subject">Subject </label> 
  58. 	            <input  type="text" name="subject" value="<? echo $subject; ?>" size="30" /></div>
  59. 	  <div><label for="desc">Message <em>*</em></label>
  60. 				<textarea  name="message" cols="25" rows="4"></textarea></div>
  61.  
  62.  
  63. 			<p align="center"><small>Please enter the value below</small></p>	
  64. <div><label for="subject">Security <em>*</em></label><input type="text" name="number" value="<? echo $number; ?>" /> 
  65. <img src="security.php" /></div>
  66.  
  67.  
  68. 	</fieldset>
  69.  
  70.  
  71. 	<div class="buttonrow">
  72. 		        <input type="submit" value="Send" name="submit" class="button" />
  73.                 <input type="reset" value="Reset" class="button" />
  74. 	</div>
  75.     </form>
  76. </div><!-- /form-container -->
  77.  
  78. </body>
  79. </html>