Mini Shell
Mini Shell
| Direktori : /home/serb/www/ |
| Current File : /home/serb/www/fake-report.php |
<? session_start();
include("lib/globals.php");
include("lib/common.php");
include("lib/functions.php");
?>
<? include "includes/header_top.php";?>
<script language="javascript">
function validate()
{
if(document.cntus.userName.value=="")
{
alert("Enter your Name");
document.cntus.userName.focus();
return false;
}
if((document.cntus.emailAddrs.value.indexOf('@',0)<1)||(document.cntus.emailAddrs.value.indexOf('.',0)<1))
{
alert("Enter any valid email address");
document.cntus.emailAddrs.focus();
return false;
}
if(document.cntus.phNumber.value=="")
{
alert("Enter your Phone Number");
document.cntus.phNumber.focus();
return false;
}
if(document.cntus.urQuery.value=="")
{
alert("Enter your Query");
document.cntus.urQuery.focus();
return false;
}
if(document.cntus.security_code.value=="")
{
alert("Enter Security Code");
document.cntus.security_code.focus();
return false;
}
/*if(document.f1.check.checked!=true)
{
alert("You need to check your age.");
return false;
}*/
}
</script>
<body>
<? include "includes/header.php";?>
<div class="main_bg">
<div style="height:32px; width:1000px;">
</div>
<div style="width:1000px; margin:0 auto;">
<div class="statedetails">
<div class="stdtls_header">
Fake Report
</div>
<div class="stdtls_midder">
<div style=" width:990px; margin:0 auto;">
<form action="fakereport-process.php" method="post" name="cntus" style="margin: 0px; padding: 0px;" onSubmit="return validate();">
<input name="submit_form" value="1" type="hidden">
<table class="join_table2" border="0" cellpadding="0" cellspacing="0">
<tr>
<td colspan="3">
<? if($_GET['msg']==1){ ?>
<p class="passwordmsg">Thank you for sending information.</p>
<? } ?>
</td>
</tr>
<tr>
<td class="jointext222">Your Name :</td>
<td><input name="userName" id="username" class="main_input" type="text"></td>
<td></td>
</tr>
<tr>
<td class="jointext222">Your Email :</td>
<td><input name="emailAddrs" id="email" class="main_input" type="text"> </td>
<td></td>
</tr>
<!-- <tr>
<td class="jointext222">Contact Phone Number :</td>
<td><input name="phNumber" id="phnumber" class="main_input" type="text"></td>
<td></td>
</tr> -->
<tr>
<td class="jointext222">Describe Fake Report :</td>
<td><textarea name="urQuery" id="querry" class="main_input" style="width:220px; height:150px;"></textarea>
<td></td>
</tr>
<tr>
<td class="jointext222">Security Code :</td>
<td>
<table>
<tbody><tr>
<td width="312" valign="top">
<span>
Type the characters you see in the picture below. </span>
<div>
<img src="CaptchaSecurityImages.php?width=100&height=40&characters=5" />
</div>
<input id="security_code" name="security_code" class="main_input" type="text" />
<!--<input type="text" name="vercode" />--><!--<input name="captcha" type="text"> --><br/>
<span>
Letters are not case-sensitive </span> </td>
</tr>
<tr>
<td></td>
<td> </td>
</tr>
</tbody>
</table> </td>
<td></td>
</tr>
<tr>
<td></td>
<td>
<input src="images/submit.png" type="image" style="margin-left:20px;"/>
<input type="hidden" name="estid" value="<?=$_GET['estid']?>"
</td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
</tr>
</table>
</form>
</div>
</div>
<div class="stdtls_footer"></div>
</div>
</div>
</div>
<? include "includes/footer.php";?>