phyllis-fantasies/sitesrc/contact-static.html

---
title: Contact Us
layout: bctop
---

<div class="row">
  <div class="col-xs-12">
    <h1 class="fancy-script">Contact Phyllis' Fantasies</h1>
  </div>
</div>
<div class="row">
  <div class="col-sm-8">
    <img src="images/phyllis-contact.jpg" alt="" width="700" height="430" border="0"/>
  </div>
  <div class="col-sm-4">
    <p><big>Questions? Comments? Concerns? Special requests? Drop us a line!</big></p>
  </div>
</div>
<div class="row">&nbsp;</div>

<div class="row">
  <div class="col-sm-1">&nbsp;</div>
  <div class="col-sm-10 col-xs-12">
    <form class="form-horizontal" method="post" action="contact_mail.php">
      <div class="form-group">
	<label for="name" class="col-sm-3 control-label">Name</label>
	<div class="col-sm-9">
	  <input type="text" class="form-control" id="name" placeholder="Name">
	</div>
      </div>
      <div class="form-group">
	<label for="from" class="col-sm-3 control-label">E-mail address</label>
	<div class="col-sm-9">
	  <input type="text" class="form-control" id="from" placeholder="E-mail address">
	</div>
      </div>
      <div class="form-group">
	<label for="subject" class="col-sm-3 control-label">Subject</label>
	<div class="col-sm-9">
	  <input type="text" class="form-control" id="subject" placeholder="Subject">
	</div>
      </div>
      <div class="form-group">
	<label for="verif_box" class="col-sm-3 control-label">Security code</label>
	<div class="col-sm-1">
	  <p class="form-control-static">
	    <img src="verification_image.php?0000" width="50" height="24" border="0">
	  </p>
	</div>
	<div class="col-sm-8">
	  <input type="text" class="form-control" id="verif_box" size="20" maxlength="20"
		 placeholder="Type the number at left into this box">
	</div>
      </div>
      <div class="form-group">
	<label for="message" class="col-sm-3 control-label">Message</label>
	<div class="col-sm-9">
	  <textarea id="message" class="form-control" rows="8"></textarea>
	</div>
      </div>
      <div class="form-group">
	<div class="col-sm-9 col-sm-offset-3">
	  <button type="submit" class="btn btn-default">Send Message</button>
	</div>
      </div>
    </form>
  </div>
  <div class="col-sm-1">&nbsp;</div>
</div>