[HOME]

Path : /home/hermanostamargo/www/home/

Upload :

Current File : /home/hermanostamargo/www/home/form.php

  <!-- Modal -->
  <? include("form_config.php");?>
  <div class="modal fade" id="formModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
    <div class="modal-dialog" role="document">
      <div class="modal-content">
        <div class="modal-header">
          <h5 class="modal-title" id="exampleModalLabel"><?=$titulo;?></h5>
          <button type="button" class="close" data-dismiss="modal" aria-label="Close">
            <span aria-hidden="true">&times;</span>
          </button>
        </div>
        <div class="modal-body">
          <p><em><?= $contactaWeb;?> <?= $textoInfoPromoTxt2; ?> <strong><a href="tel:<?=$row_dir["tel"]?>"><?=$row_dir["tel"]?></a></strong></em></p>
          <form id="formulario" name="formulario" class="form-horizontal" action="#formModal" method="post" enctype="multipart/form-data">
            <div class="form-group row">
              <label for="nombre" class="col-md-2 col-form-label"><?= $fnombre?></label>
              <div class="col-md-10">
                <input name="nombre" type="text" class="form-control" id="nombre" value="<?=$_POST['nombre']?>" required tabindex="1">
              </div>
            </div>

            <div class="form-group row">
              <label for="tel" class="col-md-2 col-form-label"><?= $ftel?></label>
              <div class="col-md-10">
                <input name="telefono" type="tel" class="form-control" id="telefono" value="<?=$_POST['telefono']?>" tabindex="2">
              </div>
            </div>

            <div class="form-group row">
              <label for="email" class="col-md-2 col-form-label"><?= $femail?></label>
              <div class="col-md-10">
                <input name="email" type="email" class="form-control" id="email" value="<?=$_POST['email']?>" required tabindex="2">
              </div>
            </div>

            <div class="form-group row">
            <label for="mensaje" class="col-md-2 col-form-label"><?= $fmensaje?></label>
              <div class="col-md-10">
                <textarea name="mensaje" id="detalles" class="form-control tinymce" rows="8" tabindex="4" required><?=$_POST['mensaje']?></textarea>
              </div>
            </div>

            <div class="form-check">
              <label class="privacidad form-check-label">
                <input type="checkbox" name="privacidad" class="form-check-input" value="1" required>
                <?=$fprivacidad;?>
              </label>
            </div>

            <div class="privacidad-content">
              <p class="text-center"><strong><?=$rowlegal["titulo"]?></strong></p>
              <?=$rowlegal["descripcion"]?>
            </div>


            <div class="form-group row">
              <div class="col-sm-12">
                <input type="submit" name="submit" class="btn btn-primary btn-lg btn-block" value="<?= $enviar?>" tabindex="5">
              </div>
            </div>
          </form>



        </div>
        <div class="modal-footer">
          <button type="button" class="btn btn-secondary" data-dismiss="modal">Cerrar</button>
        </div>
      </div>
    </div>
  </div>