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- <div id="report_form">
- <form name="contactForm" id='contact_form' method="post" action='email.php' enctype="multipart/form-data">
- <h3>Basic Information</h3>
- <img height=200 width=200 src="upload/default.jpg">
- <input type="file" name="file" id="file"><br>
- <table>
- <tr>
- <td colspan='3'>NAME OF SUBJECT
- </tr>
- <tr>
- <td>Lastname:
- <td><input type='text' name='lname' id='lname'>
- <td><div id='lname_error' class='error'><img src='images/error.png'>Please enter valid lastname.</div>
- <div id='lname_null' class='error'><img src='images/error.png'>Please enter your Lastname.</div>
- </tr>
- <tr>
- <td>Firstname:
- <td><input type='text' name='fname' id='fname'>
- <td><div id='fname_error' class='error'><img src='images/error.png'>Please enter valid firstname.</div>
- <div id='fname_null' class='error'><img src='images/error.png'>Please enter your Firstname.</div>
- </tr>
- <tr>
- <td>M.I.:
- <td><input type='text' name='mname' id='mname'>
- <td><div id='mname_error' class='error'><img src='images/error.png'>Please enter valid M.I.</div>
- <div id='mname_null' class='error'><img src='images/error.png'>Please enter your M.I.</div>
- </tr>
- <tr>
- <td>Alias:
- <td><input type='text' name='alias' id='alias'>
- <td><div id='alias_error' class='error'><img src='images/error.png'>Please enter valid Alias.</div>
- <div id='alias_null' class='error'><img src='images/error.png'>Please enter your Alias.</div>
- </tr>
- <tr>
- <td>Place where last seen:
- <td><textarea rows="3" cols="30" name="place" id='place'></textarea>
- <td><div id='place_error' class='error'><img src='images/error.png'>Please enter valid place.</div>
- <div id='place_null' class='error'><img src='images/error.png'>Please enter your place.</div>
- </tr>
- <tr>
- <td>Address:
- <td><textarea rows="3" cols="30" name="address" id='address'></textarea>
- <td><div id='address_error' class='error'><img src='images/error.png'>Please enter valid address.</div>
- <div id='address_null' class='error'><img src='images/error.png'>Please enter your address.</div>
- </tr>
- <tr>
- <td>Gender:
- <td><select name="gender" id='gender'>
- <option value="male">Male</option>
- <option value="female">Female</option>
- </select>
- <td><div id='gender_error' class='error'><img src='images/error.png'>Please enter valid address.</div>
- <div id='gender_null' class='error'><img src='images/error.png'>Please enter your address.</div>
- </tr>
- <tr>
- <td>Nationality:
- <td><input type='text' name='nationality' id='nationality'>
- <td><div id='nationality_error' class='error'><img src='images/error.png'>Please enter valid nationality.</div>
- <div id='nationality_null' class='error'><img src='images/error.png'>Please enter your nationality.</div>
- </tr>
- <tr>
- <td>Age:
- <td><input type='text' name='age' id='age'>
- <td><div id='age_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='age_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Complexion:
- <td><input type='text' name='complexion' id='complexion'>
- <td><div id='complexion_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='complexion_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Height:
- <td><input type='text' name='height' id='height'>
- <td><div id='height_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='height_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Weight:
- <td><input type='text' name='weight' id='weight'>
- <td><div id='weight_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='weight_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Build:
- <td><input type='text' name='build' id='build'>
- <td><div id='build_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='build_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Hair color:
- <td><input type='text' name='haircolor' id='haircolor'>
- <td><div id='haircolor_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='haircolor_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Pecularities:
- <td><input type='text' name='pecularities' id='pecularities'>
- <td><div id='pecularities_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='pecularities_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td>Other identification data:
- <td><input type='text' name='other' id='other'>
- <td><div id='other_error' class='error'><img src='images/error.png'>Please enter valid age.</div>
- <div id='other_null' class='error'><img src='images/error.png'>Please enter your age.</div>
- </tr>
- <tr>
- <td colspan='3'>COMPLAINANT/INFORMANT
- </tr>
- <tr>
- <td>Lastname:
- <td><input type='text' name='clname' id='clname'>
- <td><div id='clname_error' class='error'><img src='images/error.png'>Please enter valid lastname.</div>
- <div id='clname_null' class='error'><img src='images/error.png'>Please enter your Lastname.</div>
- </tr>
- <tr>
- <td>Firstname:
- <td><input type='text' name='cfname' id='cfname'>
- <td><div id='cfname_error' class='error'><img src='images/error.png'>Please enter valid firstname.</div>
- <div id='cfname_null' class='error'><img src='images/error.png'>Please enter your Firstname.</div>
- </tr>
- <tr>
- <td>M.I.:
- <td><input type='text' name='cmname' id='cmname'>
- <td><div id='cmname_error' class='error'><img src='images/error.png'>Please enter valid M.I.</div>
- <div id='cmname_null' class='error'><img src='images/error.png'>Please enter your M.I.</div>
- </tr>
- <tr>
- <td>Address:
- <td><textarea rows="3" cols="30" name="caddress" id='caddress'></textarea>
- <td><div id='caddress_error' class='error'><img src='images/error.png'>Please enter valid address.</div>
- <div id='caddress_null' class='error'><img src='images/error.png'>Please enter your address.</div>
- </tr>
- <tr>
- <td>E-mail Address:
- <td><input type='text' name='email' id='email'>
- <td><div id='email_error' class='error'><img src='images/error.png'>Please enter your valid E-mail ID.</div>
- </tr>
- </table>
- <p> Email Subject:
- <div id='subject_error' class='error'><img src='images/error.png'>Please enter the subject.</div>
- <div>
- <input type='text' name='subject' id='subject'>
- </div>
- </p>
- <p> Your Message:
- <div id='message_error' class='error'><img src='images/error.png'>Please enter your message.</div>
- <div>
- <textarea name='message' id='message'></textarea>
- </div>
- </p>
- <div id='mail_success' class='success'><img src='images/success.png'>Your message has been sent successfully.</div>
- <div id='mail_fail' class='error'><img src='images/error.png'> Sorry, error occured this time sending your message.</div>
- <p id='submit'>
- <input type='submit' id='send_message' value='Submit Form'>
- </p>
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