%PDF-
%PDF-
Mini Shell
Mini Shell
<?php
include_once("security.php");
?>
<!DOCTYPE html>
<html>
<head>
<?php include_once("header.php"); ?>
</head>
<body>
<div class="body">
<?php include_once("top.php"); ?>
<div role="main" class="main shop">
<div class="container">
<div class="row">
<div class="col-md-12">
<hr class="tall">
</div>
</div>
<div class="row">
<div class="col-md-12">
<h2 class="mb-none"><strong>Send Enquiry</strong></h2>
<p>Your enquiry item(s) will submit to us. Kindly fill up your details below:</p>
<!--<p>Returning customer? <a href="shop-login.html">Click here to login.</a></p>-->
</div>
</div>
<div class="row">
<div class="col-md-9">
<form action="checkout-post.php" id="frmBillingAddress" method="post">
<div class="panel-group" id="accordion">
<div class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<a class="accordion-toggle" data-toggle="collapse" data-parent="#accordion" href="#collapseOne">
Contact Details
</a>
</h4>
</div>
<div id="collapseOne" class="accordion-body collapse in">
<div class="panel-body">
<div class="row">
<div class="form-group">
<div class="col-md-12">
<label>Country</label>
<select class="form-control" id="country" name="country">
<option value="">Select a country</option>
<?php
$countries = array("Afghanistan", "Albania", "Algeria", "American Samoa", "Andorra", "Angola", "Anguilla", "Antarctica", "Antigua and Barbuda", "Argentina", "Armenia", "Aruba", "Australia", "Austria", "Azerbaijan", "Bahamas", "Bahrain", "Bangladesh", "Barbados", "Belarus", "Belgium", "Belize", "Benin", "Bermuda", "Bhutan", "Bolivia", "Bosnia and Herzegowina", "Botswana", "Bouvet Island", "Brazil", "British Indian Ocean Territory", "Brunei Darussalam", "Bulgaria", "Burkina Faso", "Burundi", "Cambodia", "Cameroon", "Canada", "Cape Verde", "Cayman Islands", "Central African Republic", "Chad", "Chile", "China", "Christmas Island", "Cocos (Keeling) Islands", "Colombia", "Comoros", "Congo", "Congo, the Democratic Republic of the", "Cook Islands", "Costa Rica", "Cote d'Ivoire", "Croatia (Hrvatska)", "Cuba", "Cyprus", "Czech Republic", "Denmark", "Djibouti", "Dominica", "Dominican Republic", "East Timor", "Ecuador", "Egypt", "El Salvador", "Equatorial Guinea", "Eritrea", "Estonia", "Ethiopia", "Falkland Islands (Malvinas)", "Faroe Islands", "Fiji", "Finland", "France", "France Metropolitan", "French Guiana", "French Polynesia", "French Southern Territories", "Gabon", "Gambia", "Georgia", "Germany", "Ghana", "Gibraltar", "Greece", "Greenland", "Grenada", "Guadeloupe", "Guam", "Guatemala", "Guinea", "Guinea-Bissau", "Guyana", "Haiti", "Heard and Mc Donald Islands", "Holy See (Vatican City State)", "Honduras", "Hong Kong", "Hungary", "Iceland", "India", "Indonesia", "Iran (Islamic Republic of)", "Iraq", "Ireland", "Israel", "Italy", "Jamaica", "Japan", "Jordan", "Kazakhstan", "Kenya", "Kiribati", "Korea, Democratic People's Republic of", "Korea, Republic of", "Kuwait", "Kyrgyzstan", "Lao, People's Democratic Republic", "Latvia", "Lebanon", "Lesotho", "Liberia", "Libyan Arab Jamahiriya", "Liechtenstein", "Lithuania", "Luxembourg", "Macau", "Macedonia, The Former Yugoslav Republic of", "Madagascar", "Malawi", "Malaysia", "Maldives", "Mali", "Malta", "Marshall Islands", "Martinique", "Mauritania", "Mauritius", "Mayotte", "Mexico", "Micronesia, Federated States of", "Moldova, Republic of", "Monaco", "Mongolia", "Montserrat", "Morocco", "Mozambique", "Myanmar", "Namibia", "Nauru", "Nepal", "Netherlands", "Netherlands Antilles", "New Caledonia", "New Zealand", "Nicaragua", "Niger", "Nigeria", "Niue", "Norfolk Island", "Northern Mariana Islands", "Norway", "Oman", "Pakistan", "Palau", "Panama", "Papua New Guinea", "Paraguay", "Peru", "Philippines", "Pitcairn", "Poland", "Portugal", "Puerto Rico", "Qatar", "Reunion", "Romania", "Russian Federation", "Rwanda", "Saint Kitts and Nevis", "Saint Lucia", "Saint Vincent and the Grenadines", "Samoa", "San Marino", "Sao Tome and Principe", "Saudi Arabia", "Senegal", "Seychelles", "Sierra Leone", "Singapore", "Slovakia (Slovak Republic)", "Slovenia", "Solomon Islands", "Somalia", "South Africa", "South Georgia and the South Sandwich Islands", "Spain", "Sri Lanka", "St. Helena", "St. Pierre and Miquelon", "Sudan", "Suriname", "Svalbard and Jan Mayen Islands", "Swaziland", "Sweden", "Switzerland", "Syrian Arab Republic", "Taiwan, Province of China", "Tajikistan", "Tanzania, United Republic of", "Thailand", "Togo", "Tokelau", "Tonga", "Trinidad and Tobago", "Tunisia", "Turkey", "Turkmenistan", "Turks and Caicos Islands", "Tuvalu", "Uganda", "Ukraine", "United Arab Emirates", "United Kingdom", "United States", "United States Minor Outlying Islands", "Uruguay", "Uzbekistan", "Vanuatu", "Venezuela", "Vietnam", "Virgin Islands (British)", "Virgin Islands (U.S.)", "Wallis and Futuna Islands", "Western Sahara", "Yemen", "Yugoslavia", "Zambia", "Zimbabwe");
foreach($countries as $c){
if($c=="Malaysia"){
echo '<option value="'.$c.'" selected>'.$c.'</option>';
} else {
echo '<option value="'.$c.'">'.$c.'</option>';
}
}
?>
</select>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-6">
<label>First Name</label>
<input type="text" value="" class="form-control" id="fname" name="fname">
</div>
<div class="col-md-6">
<label>Last Name</label>
<input type="text" value="" class="form-control" id="lname" name="lname">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12">
<label>Contact Tel/Mobile:</label>
<input type="text" value="" class="form-control" id="contact" name="contact">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12">
<label>Company Name</label>
<input type="text" value="" class="form-control" id="company" name="company">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12">
<label>Address </label>
<input type="text" value="" class="form-control" id="address" name="address">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12">
<label>City </label>
<input type="text" value="" class="form-control" id="city" name="city">
</div>
</div>
</div>
<!--<div class="row">
<div class="col-md-12">
<input type="submit" value="Continue" class="btn btn-primary pull-right mb-xl" data-loading-text="Loading...">
</div>
</div>-->
</div>
</div>
</div>
</div>
<div class="actions-continue">
<input type="submit" value="Send Enquiry" name="proceed" class="btn btn-lg btn-primary mt-xl">
</div>
</form>
</div>
</div>
</div>
</div>
<?php include_once("footer.php"); ?>
</div>
<?php include_once("footer-js.php"); ?>
</body>
</html>
Zerion Mini Shell 1.0