mirror of
https://github.com/atlanticbiomedical/portal-legacy.git
synced 2025-07-02 01:47:28 -04:00
134 lines
5.5 KiB
HTML
134 lines
5.5 KiB
HTML
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
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<html xmlns="http://www.w3.org/1999/xhtml">
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<head>
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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
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<title>Untitled Document</title>
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<link href="style.css" rel="stylesheet" type="text/css" />
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<script type="text/javascript" src="autotab.js"></script>
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<script src="scriptaculous/lib/prototype.js" type="text/javascript"></script>
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<script src="scriptaculous/src/effects.js" type="text/javascript"></script>
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<script type="text/javascript" src="validation.js"></script>
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</head>
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<body>
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<form method="post" action="formmail.php" id="test">
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<fieldset>
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<label for="for">For </label>
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<select name="for" class="half">
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<option value="arwolcott@gmail.com">Allison Wolcott</option>
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<option value="caendres1@gmail.com">Carl Endres</option>
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<option value="caendres@gmail.com">Chris Endres</option>
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<option value="kcwashburn1@gmail.com">Kate Washburn</option>
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</select>
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<div class="form-row">
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<label for="name" class="name">Name </label>
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<input type="text" name="name" id="name" class="validate-name half" />
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<div class="form-row-ff"></div>
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</div>
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<div class="form-row">
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<label for="company">Company </label>
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<input type="text" name="company" class="validate-company" />
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<div class="form-row-ff"></div>
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</div>
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<div class="form-row"><span id="bug">
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<label for="phone">Phone </label>
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<input type="text" name="phone" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="validate-phone phone" />
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<input type="text" name="phone-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="validate-phone phone" />
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<input type="text" name="phone-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="validate-phone phone3" />
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<label for="ext" class="ext">ext. </label>
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<input type="text" name="ext" size="4" class="phone" />
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<label for="time_to_call" class="time">Time To Call</label>
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<input type="text" name="time_to_call" class="phone" /></span>
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</div>
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<span style="display:inline-block"><label for="mobile">Mobile </label>
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<input type="text" name="mobile" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
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<input type="text" name="mobile-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
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<input type="text" name="mobile-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="phone3" />
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<label for="time_to_call_mobile" class="time2">Time To Call</label>
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<input type="text" name="time_to_call_mobile" class="phone" /></span>
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<span style="display:inline-block"><label for="fax">Fax </label>
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<input type="text" name="fax" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
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<input type="text" name="fax-2" onKeyUp="return autoTab(this, 3, event);" maxlength="3" size="3" class="phone" />
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<input type="text" name="fax-3" onKeyUp="return autoTab(this, 4, event);" maxlength="4" size="4" class="phone3" /></span>
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<span style="display:inline-block"><div id="checkboxes">
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<label for="telephoned" class="row1_label">Telephoned </label>
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<input type="checkbox" name="telephoned" />
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<label for="came_to_see_you" class="row2_label">Came To See You </label>
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<input type="checkbox" name="came_to_see_you" />
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<label for="wants_to_see_you" class="row3_label">Wants To See You </label>
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<input type="checkbox" name="wants_to_see_you" />
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<label for="returned_your_call" class="row1_label">Returned Your Call </label>
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<input type="checkbox" name="returned_your_call" />
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<label for="please_call" class="row2_label">Please Call </label>
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<input type="checkbox" name="please_call" />
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<label for="will_call_again" class="row3_label">Will Call Again </label>
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<input type="checkbox" name="will_call_again" />
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<label for="rush" class="row1_label">Rush </label>
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<input type="checkbox" name="rush" />
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<label for="special_attention" class="row2_label">Special Attention </label>
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<input type="checkbox" name="special_attention" />
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</div></span>
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<div class="form-row">
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<label for="callers_message" id="message">Message </label>
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<textarea name="callers_message" cols="10" rows="10" class="validate-message"></textarea>
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<div class="form-row-ff"></div>
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</div>
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<input type="submit" value="Submit Message" class="button" />
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<div class="form-row">
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<label for="signed" id="signed">Signed </label>
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<select name="signed" class="validate-sign">
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<option></option>
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<option value="Allison">Allison</option>
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<option value="Chris">Chris</option>
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<option value="Kate">Kate</option>
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</select>
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<div class="form-row-ff"></div>
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</div>
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</fieldset>
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</form>
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<script type="text/javascript">
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var valid = new Validation('test', {immediate : true});
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Validation.addAllThese([
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['validate-name', 'A name is required.', function(v){
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return !Validation.get('IsEmpty').test(v);
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}],
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['validate-company', 'A company is required.', function(v){
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return !Validation.get('IsEmpty').test(v);
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}],
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['validate-phone', 'A phone number is required.', function(v){
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return !Validation.get('IsEmpty').test(v);
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}],
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['validate-message', 'A message is required.', function(v){
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return !Validation.get('IsEmpty').test(v);
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}],
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['validate-sign', 'Please sign this message.', function(v){
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return !Validation.get('IsEmpty').test(v);
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}]
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]);
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</script>
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</body>
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</html>
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