| Server IP : 127.0.0.2 / Your IP : 52.14.157.158 Web Server : Apache/2.4.18 (Ubuntu) System : User : www-data ( ) PHP Version : 7.0.33-0ubuntu0.16.04.16 Disable Function : disk_free_space,disk_total_space,diskfreespace,dl,exec,fpaththru,getmyuid,getmypid,highlight_file,ignore_user_abord,leak,listen,link,opcache_get_configuration,opcache_get_status,passthru,pcntl_alarm,pcntl_fork,pcntl_waitpid,pcntl_wait,pcntl_wifexited,pcntl_wifstopped,pcntl_wifsignaled,pcntl_wexitstatus,pcntl_wtermsig,pcntl_wstopsig,pcntl_signal,pcntl_signal_dispatch,pcntl_get_last_error,pcntl_strerror,pcntl_sigprocmask,pcntl_sigwaitinfo,pcntl_sigtimedwait,pcntl_exec,pcntl_getpriority,pcntl_setpriority,php_uname,phpinfo,posix_ctermid,posix_getcwd,posix_getegid,posix_geteuid,posix_getgid,posix_getgrgid,posix_getgrnam,posix_getgroups,posix_getlogin,posix_getpgid,posix_getpgrp,posix_getpid,posix,_getppid,posix_getpwnam,posix_getpwuid,posix_getrlimit,posix_getsid,posix_getuid,posix_isatty,posix_kill,posix_mkfifo,posix_setegid,posix_seteuid,posix_setgid,posix_setpgid,posix_setsid,posix_setuid,posix_times,posix_ttyname,posix_uname,pclose,popen,proc_open,proc_close,proc_get_status,proc_nice,proc_terminate,shell_exec,source,show_source,system,virtual MySQL : OFF | cURL : ON | WGET : ON | Perl : ON | Python : ON | Sudo : ON | Pkexec : ON Directory : /var/www/html/resources/views/pages/Requestformpage/ |
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@extends('template.default')
@section('content')
<div class="header-breadcrumbs">
<div class="container">
<div class="row">
<div class="col-lg-12 col-md-12 col-sm-12 sol-xs-12">
<div class="breadcrumbs-title text-center">
<h2>Contact Us</h2>
<div class="subheader-pages">
<ul>
<li><a href="{{route('home')}}" style="color:#fff;">Home</a></li>
<li><a href="{{route('publicSessions')}}" style="color:#fff;">Public Sessions</a></li>
<li>Consulting Services</li>
</ul>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- Contact Us-area start hear -->
<div class="contactus-area">
<div class="container">
<div class="row">
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="form-title text-center">
<h3>Request for Proposal for Consulting Services</h3>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="contractus-form">
<form action="{{route('Thankyou')}}" method="post" id="consultingServiceRequest">
{{ csrf_field() }}
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>Name</label>
<input type="text" name="name" >
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>Title</label>
<input type="text" name="title" >
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>Organization</label>
<input type="text" name="organizations" >
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>EmailID</label>
<input type="email" name="emailid" >
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>Address</label>
<input type="text" name="address" >
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 row">
<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
<label>City</label>
<input type="text" name="city" >
</div>
<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
<label>State</label>
<input type="text" name="state" >
</div>
<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
<label>Zip</label>
<input type="text" name="zip" >
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 ">
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 row">
<label>Phone</label>
<input type="text" name="phone">
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 ">
<label>Fax</label>
<input type="text" name="fax" >
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<div class="form-group">
<label class="required"><em>*</em>Preferred contact method</label>
<div class="input-box">
<select title="Preferred contact method" class="nice-select validate-select required-entry" style="" name="contact">
<option>Email</option>
<option>Phone</option>
<option>Fax</option>
<option>Mail</option>
</select>
</div>
</div>
</div>
<!-- <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<label>Name</label>
<input type="text" name="name" >
</div>
-->
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label class="required"><em>*</em>select request</label>
</div>
<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12">
<!-- <input type="radio" class="radio">
<div class="col-lg-3 col-md-3 col-sm-12 col-xs-12">
Consulting
</div> -->
<ul>
<li>Consulting</li>
<li>Expert Witness</li>
</ul>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<h3> Questions About the Project</h3>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label>Please briefly describe project:</label>
<textarea name="describe" id="summarize" ></textarea >
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label>What services are you seeking?</label>
<textarea name="service" id="workingside" ></textarea>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label>What is your timing?</label>
<textarea name="timing" id="jurisdiction" ></textarea>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label>Where will the project take place?</label>
<textarea name="project" id="notes" ></textarea>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<label>Other comments about the project?</label>
<textarea name="comment" id="notes" ></textarea>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="g-recaptcha padding" data-sitekey="6LewNTwUAAAAABJUCnCUPItkHMZnokl-w697xWzB"></div>
</div>
</div>
</div>
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<button class="btn-hr">Submit Request</button>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- 40.contactus-area end hear -->
@endsection
@push('styles')
<style>
.form-error{color:red !important; font-weight: lighter;}
.color{color:red;}
</style>
<link href="{{{URL::asset('public/css/home.css')}}}" rel="stylesheet">
<link href="{{{URL::asset('public/css/category-management.css')}}}" rel="stylesheet" type="text/css" />
@endpush
@push('scripts')
<script type="text/javascript" src="{{{URL::asset('public/js/jquery-1.7.1.min.js')}}}"></script>
<script>
$(function() {
$('#consultingServiceRequest').validate({
errorClass: "form-error",
rules: {
name:
{
required:true,
},
title:
{
required:true,
},
organizations:
{
required:true,
},
address:
{
required:true,
},
city:
{
required:true,
},
state:
{
required:true,
},
emailid:
{
required:true,
},
phone:
{
required:true,
number:true
},
fax:
{
required:true,
},
zip:
{
required:true,
},
contact:
{
required:true,
},
describe:
{
required:true,
},
service:
{
required:true,
},
timing:
{
required:true,
},
project:
{
required:true,
},
comment:
{
required:true,
},
},
messages: {
name: "Please enter name",
organizations: "*Please enter organization name",
address: "*Please enter address",
city: "*Please enter City",
state: "*Please enter State",
fax: "*Please enter Fax",
zip: "*Please enter zip",
title: "*Please enter Title",
contact: "*Please select contact method",
describe: "*Please provide comment",
service: "*Please provide comment",
timing: "*Please provide comment",
project: "*Please provide comment",
comment: "*Please provide comment",
email: {
required:"*Please enter the email ID"
},
phone:{
required:"*Please enter the phone number",
number:"*Please enter a valid phone number"
},
},
submitHandler: function(form) {
form.submit();
}
});
});
</script>
@endpush