| 1 |
dpavlin |
1.1 |
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| 2 |
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<table width=90% align="center" cellspacing="0" border="0" cellpadding="0"> |
| 3 |
dpavlin |
1.8 |
<form method="post"> |
| 4 |
dpavlin |
1.7 |
<input type="hidden" name="from" value="{$from}"> |
| 5 |
dpavlin |
1.1 |
<tr> |
| 6 |
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<td valign=center align=left>To:</td> |
| 7 |
dpavlin |
1.4 |
<td valign=center align=left><select name=mailto> |
| 8 |
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{html_options values=$email_val output=$email_val} |
| 9 |
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</select> |
| 10 |
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</td> |
| 11 |
dpavlin |
1.1 |
</tr> |
| 12 |
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<tr> |
| 13 |
dpavlin |
1.6 |
<td valign=center align=left>{rinput name=fullname desc="Full Name"}</td> |
| 14 |
dpavlin |
1.1 |
<td valign=center align=left> |
| 15 |
dpavlin |
1.6 |
{input size=22 name=fullname} |
| 16 |
dpavlin |
1.1 |
</td> |
| 17 |
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</tr> |
| 18 |
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<tr> |
| 19 |
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<td valign=center align=left> |
| 20 |
dpavlin |
1.6 |
<div align="left">{rinput name=mailfrom desc="Email"}</div> |
| 21 |
dpavlin |
1.1 |
</td> |
| 22 |
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<td valign=center align=left> |
| 23 |
dpavlin |
1.6 |
{input size=22 name=mailfrom type=email} |
| 24 |
dpavlin |
1.1 |
</td> |
| 25 |
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</tr> |
| 26 |
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<tr> |
| 27 |
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<td valign=center align=left> |
| 28 |
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<div align="left">Country</div> |
| 29 |
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</td> |
| 30 |
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<td valign=center align=left> |
| 31 |
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<select size=1 name=country> |
| 32 |
dpavlin |
1.3 |
<option value="" selected>-- Select Your Country --</option> |
| 33 |
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{section name=c loop=$countries} |
| 34 |
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<option value="{$c/countries.iso}">{$c/countries.name}</option> |
| 35 |
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{/section} |
| 36 |
dpavlin |
1.1 |
</select> |
| 37 |
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</td> |
| 38 |
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</tr> |
| 39 |
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<tr> |
| 40 |
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<td valign=center align=left> |
| 41 |
dpavlin |
1.6 |
<div align="left">{rinput name=subject desc="Subject"}</div> |
| 42 |
dpavlin |
1.1 |
</td> |
| 43 |
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<td valign=center align=left> |
| 44 |
dpavlin |
1.6 |
{input size=22 name=subject} |
| 45 |
dpavlin |
1.1 |
</td> |
| 46 |
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</tr> |
| 47 |
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<tr> |
| 48 |
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<td valign=center align=left colspan=2> |
| 49 |
dpavlin |
1.6 |
<br>Please leave your comments below:<br> |
| 50 |
dpavlin |
1.1 |
<textarea name=comment rows=5 cols=35></textarea> |
| 51 |
dpavlin |
1.6 |
<br><br>All fields in <b>bold</b> are required |
| 52 |
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<input type=submit value=Submit name="submit"> |
| 53 |
dpavlin |
1.3 |
<input type=reset value=Reset name="reset"></form> |
| 54 |
dpavlin |
1.1 |
</td> |
| 55 |
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</tr> |
| 56 |
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</table> |
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