mirror of
https://github.com/atlanticbiomedical/portal-legacy.git
synced 2025-07-02 01:47:28 -04:00
197 lines
8.0 KiB
PHP
197 lines
8.0 KiB
PHP
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
|
|
<head>
|
||
|
|
|
||
|
|
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
|
|
<meta name="title" content="Atlantic Biomedical" />
|
||
|
|
<meta name="robots" content="index, follow" />
|
||
|
|
<meta name="description" content="Atlantic Biomedical" />
|
||
|
|
<meta name="keywords" content="Atlantic Biomedical, medical, equipment, repair" />
|
||
|
|
<meta name="language" content="en" />
|
||
|
|
|
||
|
|
<title>Atlantic Biomedical</title>
|
||
|
|
|
||
|
|
<link rel="shortcut icon" href="/favicon.ico" />
|
||
|
|
|
||
|
|
<script type="text/javascript" src="/sf/prototype/js/prototype.js"></script>
|
||
|
|
|
||
|
|
<script type="text/javascript" src="/sf/calendar/calendar.js"></script>
|
||
|
|
<script type="text/javascript" src="/sf/calendar/lang/calendar-en.js"></script>
|
||
|
|
<script type="text/javascript" src="/sf/calendar/calendar-setup.js"></script>
|
||
|
|
<link href="style.css" rel="stylesheet" type="text/css" />
|
||
|
|
<script type="text/javascript" src="autotab.js"></script>
|
||
|
|
<script src="scriptaculous/lib/prototype.js" type="text/javascript"></script>
|
||
|
|
<script src="scriptaculous/src/effects.js" type="text/javascript"></script>
|
||
|
|
<script type="text/javascript" src="validation.js"></script>
|
||
|
|
<link rel="stylesheet" type="text/css" media="screen" href="/css/main.css" />
|
||
|
|
<link rel="stylesheet" type="text/css" media="screen" href="/css/client.css" />
|
||
|
|
<link rel="stylesheet" type="text/css" media="screen" href="/css/user.css" />
|
||
|
|
<link rel="stylesheet" type="text/css" media="screen" href="/css/theme.css" />
|
||
|
|
<link rel="stylesheet" type="text/css" media="screen" href="/sf/calendar/skins/aqua/theme.css" />
|
||
|
|
</head>
|
||
|
|
<body>
|
||
|
|
|
||
|
|
<div class="header">
|
||
|
|
<div class="logo_wrapper">
|
||
|
|
|
||
|
|
<div class="logo">
|
||
|
|
<img src="/images/logo.png" alt="Logo" /> </div>
|
||
|
|
</div>
|
||
|
|
<div class="menu">
|
||
|
|
<div class="menuCommands">
|
||
|
|
<a href="/index.php/scheduler">Scheduler</a> |
|
||
|
|
|
||
|
|
<a href="/index.php/workOrder">Workorders</a> |
|
||
|
|
<a href="/index.php/maps">Maps</a> |
|
||
|
|
<a href="/index.php/clientManager">Clients</a> |
|
||
|
|
<a href="/index.php/userManager">Users</a> |
|
||
|
|
<a href="http://<?php echo $_SERVER['HTTP_HOST']; ?>/messages/index.php">Messages</a> |
|
||
|
|
|
||
|
|
<a href="http://www.accella.net/bugs/index.php">Support</a> |
|
||
|
|
<a href="/index.php/security/logout">Logout</a> </div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
|
||
|
|
<div id="main">
|
||
|
|
<center>
|
||
|
|
<br/>
|
||
|
|
<form method="post" action="formmail.php" id="test">
|
||
|
|
<fieldset>
|
||
|
|
|
||
|
|
<label for="for">For </label>
|
||
|
|
<select name="for" class="half">
|
||
|
|
<option value="arwolcott@gmail.com">Allison Wolcott</option>
|
||
|
|
<option value="caendres1@gmail.com">Carl Endres</option>
|
||
|
|
<option value="caendres@gmail.com" selected="selected">Chris Endres</option>
|
||
|
|
<option value="kcwashburn1@gmail.com">Kate Washburn</option>
|
||
|
|
</select>
|
||
|
|
|
||
|
|
<div class="form-row">
|
||
|
|
<label for="name" class="name">Name </label>
|
||
|
|
<input type="text" name="name" id="name" class="validate-name half" />
|
||
|
|
<div class="form-row-ff"></div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="form-row">
|
||
|
|
<label for="company">Company </label>
|
||
|
|
<input type="text" name="company" class="validate-company" />
|
||
|
|
<div class="form-row-ff"></div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="form-row"><span id="bug">
|
||
|
|
<label for="phone">Phone </label>
|
||
|
|
<input type="text" name="phone" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="validate-phone phone" />
|
||
|
|
<input type="text" name="phone-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="validate-phone phone" />
|
||
|
|
<input type="text" name="phone-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="validate-phone phone3" />
|
||
|
|
<label for="ext" class="ext">ext. </label>
|
||
|
|
<input type="text" name="ext" size="4" class="phone" />
|
||
|
|
<label for="time_to_call" class="time">Time To Call</label>
|
||
|
|
<input type="text" name="time_to_call" class="phone" /></span>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<span style="display:inline-block"><label for="mobile">Mobile </label>
|
||
|
|
<input type="text" name="mobile" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
|
||
|
|
<input type="text" name="mobile-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
|
||
|
|
<input type="text" name="mobile-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="phone3" />
|
||
|
|
<label for="time_to_call_mobile" class="time2">Time To Call</label>
|
||
|
|
<input type="text" name="time_to_call_mobile" class="phone" /></span>
|
||
|
|
|
||
|
|
<span style="display:inline-block"><label for="fax">Fax </label>
|
||
|
|
<input type="text" name="fax" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
|
||
|
|
<input type="text" name="fax-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
|
||
|
|
<input type="text" name="fax-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="phone3" /></span>
|
||
|
|
|
||
|
|
<span style="display:inline-block"><div id="checkboxes">
|
||
|
|
<label for="telephoned" class="row1_label">Telephoned </label>
|
||
|
|
<input type="checkbox" name="telephoned" />
|
||
|
|
|
||
|
|
<label for="came_to_see_you" class="row2_label">Came To See You </label>
|
||
|
|
<input type="checkbox" name="came_to_see_you" />
|
||
|
|
|
||
|
|
<label for="wants_to_see_you" class="row3_label">Wants To See You </label>
|
||
|
|
<input type="checkbox" name="wants_to_see_you" />
|
||
|
|
|
||
|
|
<label for="returned_your_call" class="row1_label">Returned Your Call </label>
|
||
|
|
<input type="checkbox" name="returned_your_call" />
|
||
|
|
|
||
|
|
<label for="please_call" class="row2_label">Please Call </label>
|
||
|
|
<input type="checkbox" name="please_call" />
|
||
|
|
|
||
|
|
<label for="will_call_again" class="row3_label">Will Call Again </label>
|
||
|
|
<input type="checkbox" name="will_call_again" />
|
||
|
|
|
||
|
|
<label for="rush" class="row1_label">Rush </label>
|
||
|
|
<input type="checkbox" name="rush" />
|
||
|
|
|
||
|
|
<label for="special_attention" class="row2_label">Special Attention </label>
|
||
|
|
<input type="checkbox" name="special_attention" />
|
||
|
|
</div></span>
|
||
|
|
|
||
|
|
<div class="form-row">
|
||
|
|
<label for="callers_message" id="message">Message </label>
|
||
|
|
<textarea name="callers_message" cols="10" rows="10" class="validate-message"></textarea>
|
||
|
|
<div class="form-row-ff"></div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<input type="submit" value="Submit Message" class="button" />
|
||
|
|
|
||
|
|
<div class="form-row">
|
||
|
|
<label for="signed" id="signed">Signed </label>
|
||
|
|
<select name="signed" class="validate-sign">
|
||
|
|
<option></option>
|
||
|
|
<option value="Allison||arwolcott@gmail.com">Allison</option>
|
||
|
|
<option value="Chris||caendres@gmail.com">Chris</option>
|
||
|
|
<option value="Kate||kcwashburn1@gmail.com">Kate</option>
|
||
|
|
</select>
|
||
|
|
<div class="form-row-ff"></div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
</fieldset>
|
||
|
|
</form>
|
||
|
|
<script type="text/javascript">
|
||
|
|
|
||
|
|
|
||
|
|
var valid = new Validation('test', {immediate : true});
|
||
|
|
|
||
|
|
Validation.addAllThese([
|
||
|
|
['validate-name', 'A name is required.', function(v){
|
||
|
|
return !Validation.get('IsEmpty').test(v);
|
||
|
|
}],
|
||
|
|
['validate-company', 'A company is required.', function(v){
|
||
|
|
return !Validation.get('IsEmpty').test(v);
|
||
|
|
}],
|
||
|
|
['validate-phone', 'A phone number is required.', function(v){
|
||
|
|
return !Validation.get('IsEmpty').test(v);
|
||
|
|
}],
|
||
|
|
['validate-message', 'A message is required.', function(v){
|
||
|
|
return !Validation.get('IsEmpty').test(v);
|
||
|
|
}],
|
||
|
|
['validate-sign', 'Please sign this message.', function(v){
|
||
|
|
return !Validation.get('IsEmpty').test(v);
|
||
|
|
}]
|
||
|
|
]);
|
||
|
|
|
||
|
|
</script>
|
||
|
|
</center><br/>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
|
||
|
|
<!-- </div> -->
|
||
|
|
|
||
|
|
<div class="footer">
|
||
|
|
|
||
|
|
<a href="/index.php/">Dashboard</a> |
|
||
|
|
<a href="/index.php/scheduler">Scheduler</a> |
|
||
|
|
<a href="/index.php/workOrder">Workorders</a> |
|
||
|
|
<a href="/index.php/maps">Maps</a> |
|
||
|
|
|
||
|
|
<a href="/index.php/clientManager">Clients</a> |
|
||
|
|
<a href="/index.php/userManager">Users</a> <br />
|
||
|
|
<a href="/index.php/faq">FAQs</a> |
|
||
|
|
<a href="/index.php/support">Support</a> <br />
|
||
|
|
© Copyright Atlantic Biomedical 2007
|
||
|
|
|
||
|
|
</div>
|
||
|
|
</body>
|
||
|
|
</html>
|