Kmita Mail v.3 : Support Form Demo
Support Form HTML
<form action="http://alldemos.kmitascripts.com/kmitam/submit.php" method="post" >
<div align="justify"><span class="text">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="307" border="0" align="center" cellpadding="2" cellspacing="0">
<tr>
<td width="145" height="25" class="text_justify_no_side_border"><div align="right"> 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">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">Department</div></td>
<td height="25" class="text_justify_no_side_border"> </td>
<td height="25" class="text_justify_no_side_border"><select name="formname" id="formname">
<option value="sales0.php">Sales</option>
<option value="tech_support0.php" selected="selected">Technical</option>
<option value="affiliates0.php">Affiliates</option>
</select></td>
</tr>
<tr>
<td height="103" valign="top" class="text_justify_no_side_border"><div align="right">Query</div></td>
<td height="103" class="text_justify_no_side_border"> </td>
<td height="103" class="text_justify_no_side_border"><textarea name="rn_Query" cols="40" rows="5" id="rn_Query"></textarea></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">Enter the characters shown in the image [0-9, A-F]:
<input name="secnum" type="text" id="secnum" /></p>
</td>
</tr>
<tr>
<td width="145" height="25" class="text_justify_no_side_border"><div align="right">
<input name="formname" type="hidden" id="formname" value="tech_support0.php" />
</div></td>
<td height="25" class="text_justify_no_side_border"> </td>
<td height="25" class="text_justify_no_side_border"><div align="left">
<input name="submit" type="submit" />
</div></td>
</tr>
</table>
</form>
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