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Directory (0750) :  /home2/ppcad7no/joshidiagnosticcentre.com/../pccaterers.in/

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Current File : /home2/ppcad7no/joshidiagnosticcentre.com/../pccaterers.in/enquiry.php
<?php include("site-header.php");?>
<?php include("send-enquiry-code-product.php");?> 
		<!-- slider area start -->
		 <div class="breadcumb-area black-opacity bg-img-3" style="background:url(<?=$site_url."/uploaded_files/".db_scalar("select header_flash_image_name from tbl_header_flash WHERE header_flash_type='Inner'")?>) no-repeat center; background-size:cover;">
            <div class="container">
                <div class="row">
                    <div class="col-xs-12">
                        <div class="breadcumb-wrap">
                            <h2> <?=ucwords(strtolower($pgHeading));?></h2>
                        </div>
                    </div>
                </div>
            </div>
            <div class="breadcumb-menu">
                <div class="container">
                    <div class="row">
                        <div class="col-xs-12">
                            <ul>
                                <li><a href="<?=$site_url?>/index.html">Home</a></li>
                                <li>/</li>
                                <li> <?=ucwords(strtolower($pgHeading));?></li>
                            </ul>
                        </div>
                    </div>
                </div>
            </div>
        </div>

		<!-- about-area start -->
        
        
        <div class="contact-area ptb-100">
            <div class="container">
                <div class="row">
                    <div class="col-md-8">
                        <div class="contact-wrap form-style">
                           
 <div class="col-md-12 text-center <?=$clrerr?>" ><?=display_sess_msg()?></div>  
    						<form method="post" action="" name="enqFrm" onSubmit="return EnqValidation();" enctype="multipart/form-data">
            <div class="row clearfix"> 
              
              <!--Form Group-->
              <div class="form-group col-md-6 col-sm-6 col-xs-12">
                <input class="form-control" type="text" placeholder="Your Name" maxlength="70" value="" name="enquiry_nam" id="enquiry_nam">
              </div>
              
              <!--Form Group-->
              <div class="form-group col-md-6 col-sm-6 col-xs-12">
                <input class="form-control" type="text" placeholder="Mobile" maxlength="15" value="" name="enquiry_mobil" id="enquiry_mobil">
              </div>
              
              <!--Form Group-->
              <div class="form-group col-md-12 col-sm-12 col-xs-12">
                <input class="form-control" type="email" placeholder="Email Address" maxlength="200" value="" name="enquiry_emai" id="enquiry_emai">
              </div>
              
               <div class="form-group col-md-12 col-sm-12 col-xs-12">
<input class="form-control" type="text" placeholder="Enter Subject" maxlength="200" value="<?php if($_REQUEST['prd']!=""){ echo $_REQUEST['prd'];}?>" name="enquiry_sub" id="enquiry_sub">
              </div>
              
              <!--Form Group--> 
              
              <!--Form Group-->
              <div class="form-group col-md-12 col-sm-12 col-xs-12">
                <textarea class="form-control" rows="3" cols="20" placeholder="Your Message" name="enquiry_detai" id="enquiry_detai"></textarea>
              </div>
              
              <!--Form Group-->
              
              <div class="form-group col-md-12 col-sm-12 col-xs-12">
                <input id="security_cod" name="captcha" class="form-control"  type="text" placeholder="Enter Security Code" maxlength="4" style="width:85%">
                <img src="<?=$site_url?>/amitabhcaptcha.php" class="pull-right"   width="60" height="32"
                 style="margin-top:-51px" alt="Captcha" id="cap" /> </div>
              
              <!--Form Group-->
             
             <div class="col-md-12 col-sm-12 col-xs-12">
<button id="submit" class="cont-submit btn-contact btn-style" name="EnqSubmit">SEND MESSAGE</button>
</div>              
          
          
          
             
            </div>
          </form>
                        </div>
                    </div>
                    <div class="col-md-4 hidden-xs enqs">
                     <img src="assets/images/enqu.png" class="img-responsive">
                        
                    </div>
                    
                </div>
            </div>
        </div>
<?php include("site-footer.php");?>

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