-
Notifications
You must be signed in to change notification settings - Fork 1
/
become-a-dealer.php
106 lines (103 loc) · 6.79 KB
/
become-a-dealer.php
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
<?php require_once dirname(__FILE__) . "/inc/config.php"; ?>
<?php // Page data
$pageTitle = "Contact Us";
$pageTitleTag = $siteName . " Outback Feeders " . $pageTitle;
$pageDescription = $siteName . "Contact Outback Feeders " . $pageTitle;
$pageKeywords = $pageTitle . " Contact Outback Feeders " . $siteKeywords;
$extraCss = array("forms");
?>
<?php require_once dirname(__FILE__) . "/inc/header.php"; ?>
<main class="ob-main flex-container cushycms-text">
<h1>Become a Dealer</h1>
<a href="outback-dealers.php">Find a dealer</a>
<div class="form gform-dealer">
<h2>Apply to Become a Dealer Today</h2>
<div class="gform_wrapper" id="gform_wrapper_4">
<form method="post" enctype="multipart/form-data" id="gform_1" action="//outbackfeeders.com/obf/mail/mail.php">
<input type="hidden" name="recipients" value="myaddress" />
<input type="hidden" name="good_url" value="/" />
<input type="hidden" name="subject" value="Outback Become a Dealer Form" />
<input type="hidden" name="csvfile" value="mail-dealer.csv" />
<input type="hidden" name="logfile" value="mail-dealer.log" />
<input type="hidden" name="derive_fields" value="ipaddr = REMOTE_ADDR,
browser = HTTP_USER_AGENT,
referrer = HTTP_REFERER,
DateTime = %'Date of form submission was: '% . %date% + %time%" />
<input type="hidden" name="csvcolumns"
value="DateTime:cs,ipaddr:cs,email:c,
realname:c,companyname:c,phone:cs,location:c,
product:r,browser:c,referrer:c,message:r" />
<input type="hidden" name="required"
value="email:Your email address,
realname:Your name,
companyname:Your company name,
phone:Your phone number,
location:Your primary location,
product:The reason you're interested in our product" />
<div class="gform_body">
<ul id="gform_fields_4" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_4_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="realname">Name<span class="gfield_required">*</span></label>
<div class="ginput_container ginput_container_text">
<input name="realname" id="realname" type="text" value="" class="medium" tabindex="1" placeholder="Name" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_4_5" class="gfield dealer-field-right field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="companyname">Company Name<span class="gfield_required">*</span></label>
<div class="ginput_container ginput_container_text">
<input name="companyname" id="companyname" type="text" value="" class="medium" tabindex="1" placeholder="Company Name" aria-required="true" aria-invalid="false">
</div>
</li>
</li>
<li id="field_4_3" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="phone">Phone<span class="gfield_required">*</span></label>
<div class="ginput_container ginput_container_text">
<input name="phone" id="phone" type="text" value="" class="medium" tabindex="3" placeholder="Phone" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_4_8" class="gfield dealer-field-right gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="email">Email<span class="gfield_required">*</span></label>
<div class="ginput_container ginput_container_email">
<input name="email" id="email" type="text" value="" class="medium" tabindex="4" placeholder="Email" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_4_6" class="gfield field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="location">Location</label>
<div class="ginput_container ginput_container_text">
<input name="location" id="location" type="text" value="" class="medium" tabindex="5" placeholder="Location" aria-invalid="false">
</div>
</li>
<li id="field_4_4" class="gfield dealer-field-right gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="product">Products You Are Interested In<span class="gfield_required">*</span></label>
<div class="ginput_container ginput_container_select">
<select name="product" id="product" class="medium gfield_select" tabindex="6" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">Products You Are Interested In</option>
<option value="Corn Feeders">Corn Feeders</option>
<option value="Protein Feeders">Protein Feeders</option>
<option value="Specialty Products">Specialty Products</option>
</select>
</div>
</li>
<li id="field_4_7" class="gfield message-text field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="message">Comments</label>
<div class="ginput_container ginput_container_textarea">
<textarea name="message" id="message" class="textarea medium" tabindex="7" placeholder="Comments" aria-invalid="false" rows="10" cols="50"></textarea>
</div>
</li>
<li id="field_4_8" class="gfield image-verify field_sublabel_below field_description_below gfield_visibility_visible">
<label class="gfield_label" for="comments">Comments</label>
<div class="ginput_container imgverify">
<img src="http://outbackfeeders.com/obf/mail/verifyimg.php" alt="Image verification" name="vimg" />
<input type="text" size="12" name="imgverify" placeholder="Enter image text" />
</div>
</li>
</ul>
</div>
<div class="gform_footer top_label">
<input type="submit" id="gform_submit_button_4" class="gform_button button" value="SEND YOUR INFO" tabindex="8" />
</div>
</form>
</div>
</div>
</main>
<?php require_once dirname(__FILE__) . "/inc/footer.php"; ?>