<form action="http://alldemos.kmitascripts.com/kmitam/submit.php" method="post" > <span class="text">Contact form is the most widely used form using Kmita Mail. You can validate the field inputs, show errors in each field, send autoresponder, add this data to MySQL database and lot more.</span><br /> <br /> <table cellspacing="0" cellpadding="2"> <tr> <td height="25" colspan="2" class="text_justify_no_side_border">Fields with <font color="#FF0000">*</font> are required.</td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right"><span class="inside_text"><font color="#FF0000">*</font></span> Name</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="Name" name="Name" /> <input type="hidden" name="formname" value="contact" /></td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text">Company</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="Company" name="Company" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"> <div align="right"><font color="#FF0000">* </font>Email Address </div> </div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="re_Email" name="re_Email" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text">Address</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><textarea id="Address" name="Address"></textarea> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"> <font color="#FF0000">*</font> City</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="city" name="city" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"><font color="#FF0000">*</font> State</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="state" name="state" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"><font color="#FF0000">*</font> Country</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><select name="Country" id="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> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text">Zip Code </div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="Zip_code" name="Zip_code" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"> <font color="#FF0000">*</font> Telephone</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input id="Telephone" name="Telephone" /> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text">Did you contact us earlier? </div></td> <td height="25" valign="top" class="text_justify_no_side_border"><input name="Contact_Us_Earlier" type="radio" value="Yes" /> Yes <input name="Contact_Us_Earlier" type="radio" value="No" checked="checked" /> No</td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text">Kmita Product you are interested in </div></td> <td height="25" valign="top" class="text_justify_no_side_border"><p> <span class="inside_text"> <input name="Products[]" type="checkbox" id="Products" value="Kmita Mail" /> Kmita Mail <br /> <input name="Products[]" type="checkbox" id="Products" value="Kmita Tell Friend" /> Kmita Tell Friend<br /> <input name="Products[]" type="checkbox" id="Products" value="Kmita Catalogue" /> Kmita Catalogue<br /> <input name="Products[]" type="checkbox" id="Products" value="Kmita Randomizer" /> Kmita Randomizer <br /> <input name="Products[]" type="checkbox" id="Products" value="Kmita FAQ" /> Kmita FAQ <input name="km_Products" type="hidden" id="km_Products" value="no product selected" /> <br /> </span></p></td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right" class="inside_text"><font color="#FF0000">*</font> Query</div></td> <td height="25" valign="top" class="text_justify_no_side_border"><textarea id="Query" name="Query" rows="5"></textarea> </td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border"><div align="right"><img src="http://alldemos.kmitascripts.com/kmitaadmin/kmitam/image.php" width="150" height="80" /> </div></td> <td height="25" valign="top" class="text_justify_no_side_border">Enter the characters shown in the above image [0-9, A-F]: <input name="secnum" type="text" id="secnum" /></td> </tr> <tr> <td height="25" valign="top" class="text_justify_no_side_border">&nbsp;</td> <td height="25" valign="top" class="text_justify_no_side_border"><span class="inside_text"> <input type="submit" name="Submit" value="Submit" /> </span></td> </tr> </table> <!--// Security Image Code --> </form>