80 lines
2.3 KiB
HTML
80 lines
2.3 KiB
HTML
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---
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title: Contact Us
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layout: default
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---
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<!-- Breadcrumb navigation -->
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<div class="row">
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<div class="col-xs-12">
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<ol class="breadcrumb">
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<li><a href="index.html">Home</a></li>
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<li class="active">Contact Us</li>
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</ol>
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</div>
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</div>
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<div class="row">
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<div class="col-xs-12">
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<h1 class="fancy-script">Contact Phyllis' Fantasies</h1>
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</div>
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</div>
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<div class="row">
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<div class="col-sm-8">
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<img src="images/phyllis-contact.jpg" alt="" width="700" height="430" border="0"/>
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</div>
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<div class="col-sm-4">
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<p><big>Questions? Comments? Concerns? Special requests? Drop us a line!</big></p>
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</div>
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</div>
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<div class="row"> </div>
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<div class="row">
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<div class="col-sm-1"> </div>
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<div class="col-sm-10 col-xs-12">
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<form class="form-horizontal" method="post" action="contact_mail.php">
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<div class="form-group">
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<label for="name" class="col-sm-3 control-label">Name</label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="name" placeholder="Name">
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</div>
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</div>
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<div class="form-group">
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<label for="from" class="col-sm-3 control-label">E-mail address</label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="from" placeholder="E-mail address">
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</div>
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</div>
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<div class="form-group">
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<label for="subject" class="col-sm-3 control-label">Subject</label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="subject" placeholder="Subject">
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</div>
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</div>
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<div class="form-group">
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<label for="verif_box" class="col-sm-3 control-label">Security code</label>
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<div class="col-sm-1">
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<p class="form-control-static">
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<img src="verification_image.php?0000" width="50" height="24" border="0">
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</p>
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</div>
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<div class="col-sm-8">
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<input type="text" class="form-control" id="verif_box" size="20" maxlength="20"
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placeholder="Type the number at left into this box">
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</div>
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</div>
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<div class="form-group">
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<label for="message" class="col-sm-3 control-label">Message</label>
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<div class="col-sm-9">
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<textarea id="message" class="form-control" rows="8"></textarea>
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</div>
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</div>
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<div class="form-group">
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<div class="col-sm-9 col-sm-offset-3">
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<button type="submit" class="btn btn-default">Send Message</button>
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</div>
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</div>
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</form>
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</div>
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<div class="col-sm-1"> </div>
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</div>
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