Thank you for a clean cut website that isn't all bells and whistles and just clear, clearly navigable content. I'm already enjoying the benefits of your quick email responses and appreciate the expedience!

Blessings!

The Diaper Hyena
http: www.thediaperhyena.com

Companies that offer support as good as yours are a rarity. Thank you for this position you have taken.

Andy Kerr
westcliffemarketing.com

Home > Kmita Mail PHP form to email > Demo > Call back Form

Kmita Mail v.3 : Call Back Form Demo

Kmita Mail can be easily used for collecting information for registration for some event or registration of Internet Username and Password. The data submitted in the form can be stored in an MySQL database (PHP only) which can be integrated with various other application like Member login .

First Name
Last Name
Email Address
Country
Day Phone Number
Night Phone Number
Prefferred time of calling		to in hrs
		Enter the characters shown in the above image [0-9, A-F]:

Registration Form HTML

<form action="http://alldemos.kmitascripts.com/kmitam/submit.php" method="post" > <div align="justify"><span class="text">Kmita Mail can be easily used for collecting information for registration for some event or registration of Internet Username and Password. The data submitted in the form can be stored in an MySQL database (PHP only) which can be integrated with various other application like Member login . </span><br /> <br /> </div> <table width="95%" height="255" border="0" align="center" cellpadding="1" cellspacing="3"> <tr> <td height="25" class="text_justify_no_side_border"><div align="right"> <input type="hidden" name="formname" value="callback0.php" /> First Name</div></td> <td width="12" height="25" class="text_justify_no_side_border"> </td> <td width="400" height="25" class="text_justify_no_side_border"><input name="rn_Name" type="text" id="rn_Name" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right"> Last Name</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="rn_Last_Name" type="text" id="rn_Last_Name" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Email Address </div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="re_Email" type="text" id="re_Email" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Country</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><font size="2"> <select name="km_Country" class="normalform" id="km_Country"> <option value="India">India</option> <option value="USA" selected="selected">USA</option> <option value="Canada">Canada</option> <option value="France">France</option> <option value="UK">UK</option> <option value="Germany">Germany</option> <option value="Mexico">Mexico</option> <option value="Belgium">Belgium</option> <option value="Other">Other</option> </select> </font></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Day Phone Number</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="nn_Day_Telephone" type="text" id="nn_Day_Telephone" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Night Phone Number</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="nn_Night_Telephone" type="text" id="nn_Night_Telephone" /></td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><div align="right">Prefferred time of calling</div></td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="br_1_24_Preferred_time_from" type="text" id="br_1_24_Preferred_time_from" size="10" maxlength="15" /> to <input name="br_1_24_Preferred_time_to" type="text" id="br_1_24_Preferred_time_to" size="10" maxlength="15" /> in hrs </td> </tr> <tr> <td height="25" class="text_justify_no_side_border"><img src="http://alldemos.kmitascripts.com/kmitam/image.php" width="150" height="80" /> </td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" valign="top" class="text_justify_no_side_border"><p>Enter the characters shown in the above image [0-9, A-F]:<br /> <br /> <input name="secnum" type="text" id="secnum" /> </p> </td> </tr> <tr> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"> </td> <td height="25" class="text_justify_no_side_border"><input name="submit" type="submit" /></td> </tr> </table> <p> </p> </form>

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