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<form action="" method="post" name="emailContact" onsubmit="WAValidateRQ(document.emailContact.Contact_Name,'- Please enter your name',document.emailContact.Contact_Name,0,false,'text');WAValidateEM(document.emailContact.Email_address,document.emailContact.Email_address.value,'- Please enter your email address',document.emailContact.Email_address,0,true);WAValidateRQ(document.emailContact.Comments,'- Please provide a comment so that we know how best to assist you',document.emailContact.Comments,0,true,'textarea');WAValidateRQ(document.emailContact.Security_code,'- Please enter the text as it appears in the image above',document.emailContact.Security_code,0,false,'text');WAValidateRQ(document.emailContact.Security_question,'- Please answer the question to ensure a human is filling out this form.',document.emailContact.Security_question,0,false,'text');WAAlertErrors('The following errors were found','Correct invalid entries to continue',true,false);return document.MM_returnValue">
<div style="width:100%">
<label for="Contact_Name" >Your name:</label>
<br />
<input name="Contact_Name" type="text" id="Contact_Name" class="inputValue" value="<?php echo(ValidatedField("contact","Contact_Name")) ?>" />
<input name="addblock" type="text" id="addblock" style="display:none" value="" />
<br />
<?php
if (ValidatedField("contact","contact")) {
if ((strpos((",".ValidatedField("contact","contact").","), "," . "1" . ",") !== false || "1" == "")) {
if (!(false)) {
?>
<p class="emailFormError">* Please provide your name.</p>
<?php //WAFV_Conditional contact.php contact(1:)
}
}
}?>
<br />
<label for="Email_address" >E-mail address:</label>
<br />
<input name="Email_address" type="text" class="inputValue" id="Email_address" value="<?php echo(ValidatedField("contact","Email_address")) ?>" />
<input name="seconddblock" id="seconddblock" type="text" style="display:none" value="">
<br />
<?php
if (ValidatedField("contact","contact")) {
if ((strpos((",".ValidatedField("contact","contact").","), "," . "2" . ",") !== false || "2" == "")) {
if (!(false)) {
?>
<p class="emailFormError">* Please provide your email addess so we can get back in touch with you.</p>
<?php //WAFV_Conditional contact.php contact(2:)
}
}
}?>
<br />
<label for="Comments" >Comments:</label>
<br />
<textarea name="Comments" id="Comments" class="inputText" ><?php echo(ValidatedField("contact","Comments")) ?></textarea>
<br />
<?php
if (ValidatedField("contact","contact")) {
if ((strpos((",".ValidatedField("contact","contact").","), "," . "3" . ",") !== false || "3" == "")) {
if (!(false)) {
?>
<p class="emailFormError">* Please let us know how we can assist you.</p>
<br />
<?php //WAFV_Conditional contact.php contact(3:)
}
}
}?>
<br />
<input name="addblock2" type="text" id="addblock2" style="display:none" value="" />
<br />
<label for="Security_code" >type this Security code in the box below:</label>
<br />
<img src="WA_ValidationToolkit/WAVT_CaptchaSecurityImages.php?noisecolor=<?php echo $WAGLOBAL_Captcha_Noise; ?>&bgcolor=<?php echo $WAGLOBAL_Captcha_BG; ?>" alt="security code" /> <span class="style1"> NOT case sensitive.</span> <br />
<input name="Security_code" type="text" id="Security_code" class="inputValue" maxlength="40" />
<br />
<?php
if (ValidatedField("contact","contact")) {
if ((strpos((",".ValidatedField("contact","contact").","), "," . "4" . ",") !== false || "4" == "")) {
if (!(false)) {
?>
<p class="emailFormError">* Your security code entry did not match the image.</p>
<?php //WAFV_Conditional contact.php contact(4:)
}
}
}?>
<br />
<label for="Security_code" ><br />
<label for="Security_question" >Please answer:</label>
<?php require_once("WA_ValidationToolkit/WAVT_CaptchaSecurityQuestion.php"); ?></label>
<br />
<input name="Security_question" type="text" id="Security_question" class="inputValue" maxlength="40" />
<br />
<?php
if (ValidatedField("contact","contact")) {
if ((strpos((",".ValidatedField("contact","contact").","), "," . "5" . ",") !== false || "5" == "")) {
if (!(false)) {
?>
<p class="emailFormError">* Your answer was not correct.</p>
<?php //WAFV_Conditional contact.php contact(4:)
}
}
}?>
<br />
<input type="submit" value="Submit" class="inputButton"/>
</div>
</form>