Code: Select all
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Contact Form</title>
<script>
function RefreshCaptcha()
{
var div1 = document.getElementById("sec");
div1.innerHTML = "<img name='security_image' src='captcha.php?width=100&height=40&characters=5' alt='security code' />";
}
</script>
</head>
<body>
<form action="sendmail.php" method="post" name="form1" id="form1">
<table width="333" height="149" border="0" cellpadding="2" cellspacing="2">
<tr>
<td colspan="3" align="center" valign="middle">Contact Form </td>
</tr>
<tr>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
</tr>
<tr>
<td width="91" align="left" valign="middle">First Name </td>
<td width="8" align="left" valign="middle"> </td>
<td width="214" align="left" valign="middle"><input name="firstname" type="text" id="firstname" maxlength="60" /></td>
</tr>
<tr>
<td align="left" valign="middle">Last Name </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="lastname" type="text" id="lastname" maxlength="60" /></td>
</tr>
<tr>
<td align="left" valign="middle">Address</td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="address" type="text" id="address" maxlength="60" /></td>
</tr>
<tr>
<td align="left" valign="middle">Phone</td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="phone" type="text" id="phone" maxlength="60" /></td>
</tr>
<tr>
<td align="left" valign="middle">e-mail</td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="email" type="text" id="email" maxlength="60" /></td>
</tr>
<tr>
<td align="left" valign="top">Message</td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><textarea name="message" cols="32" rows="12" id="message"></textarea></td>
</tr>
<tr>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
</tr>
<tr>
<td align="left" valign="middle">Security Code </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
</tr>
<tr>
<td align="left" valign="middle"><div id='sec'><img name="security_image" src="captcha.php?width=100&height=40&characters=5" alt="security code" /></div></td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="garbage" type="text" id="garbage" style="display:none;" />
<input name="security_code" type="text" id="security_code" maxlength="60" />
[<span style='cursor:pointer;' title='Please type the letters and/or numbers you see in the image on the left'>?</span>] [<a href="javascript:RefreshCaptcha()">Reload</a>] </td>
</tr>
<tr>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
</tr>
<tr>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"> </td>
<td align="left" valign="middle"><input name="Send" type="submit" id="Send" value="Send" /> <input name="Clear" type="reset" id="Clear" value="Clear" /></td>
</tr>
</table>
</form>
</body>
</html>