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Feb 3rd, 2016
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  1. <script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
  2. <script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.11088" type="text/javascript"></script>
  3. <script type="text/javascript"> JotForm.init(function(){ setTimeout(function() { $('input_4').hint('ex: myname@example.com'); }, 20); JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"]; JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"]; JotForm.calendarOther = {"today":"Today"}; JotForm.setCalendar("8", false, false); JotForm.formatDate({date:(new Date()), dateField:$("id_"+8)}); JotForm.displayLocalTime("hour_8", "min_8", "ampm_8"); JotForm.description('input_8', 'Select a desired travel date.'); JotForm.clearFieldOnHide="disable"; JotForm.onSubmissionError="jumpToSubmit"; });
  4. </script>
  5. <link href="https://cdn.jotfor.ms/static/formCss.css?3.3.11088" rel="stylesheet" type="text/css" />
  6. <link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/nova.css?3.3.11088" />
  7. <link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.11088" />
  8. <style type="text/css"> .form-label-left{ width:50px !important; } .form-line{ padding-top:12px; padding-bottom:12px; } .form-label-right{ width:50px !important; } .form-all{ width:437px; color:#69430F !important; font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif; font-size:14px; } .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{ color: #69430F; } </style> <style type="text/css" id="form-designer-style"> /* Injected CSS Code */
  9. #form-custom { padding:90px 0 0 25px; } .contact-form-tbl{ border:0;}
  10. .contact-form-tbl td input{ background-color:#630; border:#000000 1px solid;} .txt-box { height:30px; width:150px; font-size:14px; padding:5px;} .ph3-txt-box { height:30px; width:30px; font-size:14px; padding:5px;} .ph4-txt-box { height:30px; width:30px; font-size:14px; padding:5px;} .txt-area-box { height:60px; width:150px; font-size:14px; padding:5px; } /* Injected CSS Code */
  11. </style> <form class="jotform-form" action="https://submit.jotform.us/submit/21864740183152/" method="post" name="form_21864740183152" id="21864740183152" accept-charset="utf-8"> <input type="hidden" name="formID" value="21864740183152" /> <div class="form-all"> <ul class="form-section page-section"> <li class="form-line" data-type="control_image" id="id_9"> <div id="cid_9" class="form-input-wide"> <img alt="" class="form-image" border="0" src="http://sixstardesign.com/client/rising-tide/images/lbl-name.png" height="18" width="55" /> </div> </li> <li class="form-line form-line-column form-col-1 form-line-column-clear" data-type="control_fullname" id="id_3"> <label class="form-label form-label-left" id="label_3" for="input_3"> Name </label> <div id="cid_3" class="form-input jf-required"> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" type="text" size="10" name="q3_name[first]" id="first_3" /> <label class="form-sub-label" for="first_3" id="sublabel_first" style="min-height: 13px;"> First Name </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" type="text" size="15" name="q3_name[last]" id="last_3" /> <label class="form-sub-label" for="last_3" id="sublabel_last" style="min-height: 13px;"> Last Name </label> </span> </div> </li> <li class="form-line form-line-column form-col-1 form-line-column-clear" data-type="control_email" id="id_4"> <label class="form-label form-label-left" id="label_4" for="input_4"> E-mail </label> <div id="cid_4" class="form-input jf-required"> <input type="email" class=" form-textbox validate[Email]" id="input_4" name="q4_email4" size="30" value="" /> </div> </li> <li class="form-line form-line-column form-col-1 form-line-column-clear" data-type="control_phone" id="id_5"> <label class="form-label form-label-left" id="label_5" for="input_5"> Phone </label> <div id="cid_5" class="form-input jf-required"> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" type="tel" name="q5_phone[area]" id="input_5_area" size="3"> <span class="phone-separate"> &nbsp;- </span> <label class="form-sub-label" for="input_5_area" id="sublabel_area" style="min-height: 13px;"> Area Code </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" type="tel" name="q5_phone[phone]" id="input_5_phone" size="8"> <label class="form-sub-label" for="input_5_phone" id="sublabel_phone" style="min-height: 13px;"> Phone Number </label> </span> </div> </li> <li class="form-line form-line-column form-col-1 form-line-column-clear" data-type="control_textarea" id="id_6"> <label class="form-label form-label-top" id="label_6" for="input_6"> Interested In </label> <div id="cid_6" class="form-input-wide jf-required"> <textarea id="input_6" class="form-textarea" name="q6_interestedIn" cols="40" rows="6"></textarea> </div> </li> <li class="form-line form-line-column form-col-2 allowTime" data-type="control_datetime" id="id_8"> <label class="form-label form-label-top" id="label_8" for="input_8"> Charter Date </label> <div id="cid_8" class="form-input-wide jf-required"> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" id="month_8" name="q8_charterDate[month]" type="tel" size="2" maxlength="2" value="02" /> <span class="date-separate"> &nbsp;- </span> <label class="form-sub-label" for="month_8" id="sublabel_month" style="min-height: 13px;"> Month </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <input class="currentDate form-textbox" id="day_8" name="q8_charterDate[day]" type="tel" size="2" maxlength="2" value="03" /> <span class="date-separate"> &nbsp;- </span> <label class="form-sub-label" for="day_8" id="sublabel_day" style="min-height: 13px;"> Day </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <input class="form-textbox" id="year_8" name="q8_charterDate[year]" type="tel" size="4" maxlength="4" value="2016" /> <label class="form-sub-label" for="year_8" id="sublabel_year" style="min-height: 13px;"> Year </label> </span> <span style='white-space: nowrap; display: inline-block;' class='allowTime-container'> <span class="form-sub-label-container" style="vertical-align: top"> <div id="at_8"> at </div> <label class="form-sub-label" for="at_8" style="min-height: 13px;"> </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <select class="currentTime time-dropdown form-dropdown" id="hour_8" name="q8_charterDate[hour]"> <option> </option> <option value="1"> 1 </option> <option value="2"> 2 </option> <option value="3"> 3 </option> <option value="4"> 4 </option> <option value="5"> 5 </option> <option value="6"> 6 </option> <option value="7"> 7 </option> <option value="8"> 8 </option> <option selected="selected" value="9"> 9 </option> <option value="10"> 10 </option> <option value="11"> 11 </option> <option value="12"> 12 </option> </select> <span class="date-separate"> &nbsp;: </span> <label class="form-sub-label" for="hour_8" id="sublabel_hour" style="min-height: 13px;"> Hour </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <select class="time-dropdown form-dropdown" id="min_8" name="q8_charterDate[min]"> <option> </option> <option selected="selected" value="00"> 00 </option> <option value="10"> 10 </option> <option value="20"> 20 </option> <option value="30"> 30 </option> <option value="40"> 40 </option> <option value="50"> 50 </option> </select> <label class="form-sub-label" for="min_8" id="sublabel_minutes" style="min-height: 13px;"> Minutes </label> </span> <span class="form-sub-label-container" style="vertical-align: top"> <select class="time-dropdown form-dropdown" id="ampm_8" name="q8_charterDate[ampm]"> <option selected="selected" value="AM"> AM </option> <option value="PM"> PM </option> </select> <label class="form-sub-label" for="ampm_8" style="min-height: 13px;"> </label> </span> </span> <span class="form-sub-label-container" style="vertical-align: top"> <img class="showAutoCalendar" alt="Pick a Date" id="input_8_pick" src="https://cdn.jotfor.ms/images/calendar.png" align="absmiddle" /> <label class="form-sub-label" for="input_8_pick" style="min-height: 13px;"> </label> </span> </div> </li> <li class="form-line" data-type="control_text" id="id_10"> <div id="cid_10" class="form-input-wide"> <div id="text_10" class="form-html"> <table class="contact-form-tbl" border="0" cellspacing="0" cellpadding="8" width="250"> <tbody> <tr> <td align="right"> <img src="http://sixstardesign.com/client/rising-tide/images/lbl-name.png" alt="" width="55" height="18" /> </td> <td> <label for="textfield" /> <input id="textfield" class="txt-box" name="textfield" type="text" /> </td> </tr> <tr> <td align="right"> <img src="http://sixstardesign.com/client/rising-tide/images/lbl-email.png" alt="" width="55" height="18" /> </td> <td> <input id="input_1_1" class="txt-box" name="name" type="text" /> </td> </tr> <tr> <td align="right"> <img src="http://sixstardesign.com/client/rising-tide/images/lbl-phone.png" alt="" width="62" height="19" /> </td> <td> <input id="phone1" class="ph3-txt-box" maxlength="3" name="textfield3" size="3" type="text" /> <input id="textfield4" class="ph3-txt-box" maxlength="3" name="textfield4" size="3" type="text" /> <input id="textfield5" class="ph4-txt-box" maxlength="4" name="textfield5" size="4" type="text" /> </td> </tr> <tr> <td> <img src="http://sixstardesign.com/client/rising-tide/images/lbl-interest.png" alt="" width="139" height="18" /> </td> <td> <label for="textarea" /> <textarea id="textarea" class="txt-area-box" cols="30" rows="5" name="textarea" /> </td> </tr> <tr> <td> <img src="http://sixstardesign.com/client/rising-tide/images/lbl-charter.png" alt="" width="144" height="19" /> </td> <td> <input id="textfield6" class="txt-box" name="textfield6" type="text" /> </td> </tr> </tbody> </table> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_2"> <div id="cid_2" class="form-input-wide"> <div style="margin-left:56px" class="form-buttons-wrapper"> <button id="input_2" type="submit" class="form-submit-button form-submit-button-img"> <img src="http://sixstardesign.com/client/rising-tide/images/submit-butn.png" alt="Submit" /> </button> </div> </div> </li> <li style="display:none"> Should be Empty: <input type="text" name="website" value="" /> </li> </ul> </div> <input type="hidden" id="simple_spc" name="simple_spc" value="21864740183152" /> <script type="text/javascript"> document.getElementById("si" + "mple" + "_spc").value = "21864740183152-21864740183152"; </script>
  12. </form>
  13. <script type="text/javascript">JotForm.ownerView=true;</script><div id="form-toolbar" style="position:fixed; background:lightyellow; border-bottom:1px solid #ccc; top:0px; left:0px; width:100%; font-family:verdana; opacity:0.5; text-align:right;padding-bottom:8px;"><button id="fill-form" style="margin-top:12px;margin-left: 12px;float:left; background:#FC7C01; color: white; outline:none; line-height: 16px; font-weight: bold; padding: 6px 12px; border: none;box-shadow: 0px 0px 4px black;">Fill Form</button> <div style='padding:5px;padding-right:15px; float:right;'> </div><span id="close-bar" style="font-weight: bold; float: right; display: block; margin-top: 12px; margin-left: 8px; cursor: pointer;">x</span><a id="clone-form" target="_blank" href="http://support.jotform.com/admn/cloneform.php?formID=21864740183152" style="font-size:12px; margin-top:12px;margin-left: 12px;float:right; background:#FC7C01; color: white; line-height: 16px; text-decoration:none; padding: 6px 12px; border: none;box-shadow: 0px 0px 4px black;">Clone Form</a><a id="open-admin" target="_blank" href="https://support.jotform.com/admn?keyword=21864740183152"style="font-size:12px; margin-top:12px;margin-left: 12px;float:right; background:#FC7C01; color: white; line-height: 16px; text-decoration:none; padding: 6px 12px; border: none;box-shadow: 0px 0px 4px black;">Admin</a></div><script type="text/javascript">$("fill-form").observe("click", function(e){var s = document.createElement("script");s.src = "/js/form-tester.js?3.3.11088";document.body.appendChild(s);});$("close-bar").observe("click", function(e){$("form-toolbar").remove();});</script>
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