notify php

<?php include "header.php"; ?>
<div class="row">
    <div class="col-md-12">
        <div class="widget">
            <div class="widget-content-white glossed">
                <div class="padded">
                    <form action="notify_act.php" method="post" role="form">
                        <div class="widget-controls pull-right">
                            <a href="#" class="widget-link-remove"><i class="icon-minus-sign"></i></a>
                            <a href="#" class="widget-link-remove"><i class="icon-remove-sign"></i></a>
                        </div>
                        <h3 class="form-title form-title-first"><i class="icon-file"></i> Input Notify</h3>
                        <div class="row">
                            <div class="col-md-12">
                                <div class="form-group">
                                    <label>Notifier (Nick Name)</label>
                                    <input type="text" class="form-control" placeholder="Nick Name" name="hacker">
                                </div>
                                <div class="form-group">
                                    <label>Team</label>
                                    <input type="text" class="form-control" placeholder="Team Name" name="team">
                                </div>
                                <div class="form-group">
                                    <label>Domain</label>
                                    <input type="text" class="form-control" placeholder="http://example.com" name="url">
                                </div>
                                <!--<div class="form-group">
                                  <label>Proof of Concept</label>
                                  <select class="form-control">
                                    <option value="">--------SELECT--------</option>
                                <option
        value="1" >known vulnerability (i.e. unpatched system)</option>
                                    <option
        value="2" >undisclosed (new) vulnerability</option>
                                    <option
        value="3" >configuration / admin. mistake</option>
                                    <option
        value="4" >brute force attack</option>
                                    <option
        value="5" >social engineering</option>
                                    <option
        value="6" >Web Server intrusion</option>
                                    <option
        value="7" >Web Server external module intrusion</option>
                                    <option
        value="8" >Mail Server intrusion</option>
                                    <option
        value="9" >FTP Server intrusion</option>
                                    <option
        value="10" >SSH Server intrusion</option>
                                    <option
        value="11" >Telnet Server intrusion</option>
                                    <option
        value="12" >RPC Server intrusion</option>
                                    <option
        value="13" >Shares misconfiguration</option>
                                    <option
        value="14" >Other Server intrusion</option>
                                    <option
        value="15" >SQL Injection</option>
                                    <option
        value="16" >URL Poisoning</option>
                                    <option
        value="17" >File Inclusion</option>
                                    <option
        value="18" >Other Web Application bug</option>
                                    <option
        value="19" >Remote administrative panel access through bruteforcing</option>
                                    <option
        value="20" >Remote administrative panel access through password guessing</option>
                                    <option
        value="21" >Remote administrative panel access through social engineering</option>
                                    <option
        value="22" >Attack against the administrator/user (password stealing/sniffing)</option>
                                    <option
        value="23" >Access credentials through Man In the Middle attack</option>
                                    <option
        value="24" >Remote service password guessing</option>
                                    <option
        value="25" >Remote service password bruteforce</option>
                                    <option
        value="26" >Rerouting after attacking the Firewall</option>
                                    <option
        value="27" >Rerouting after attacking the Router</option>
                                    <option
        value="28" >DNS attack through social engineering</option>
                                    <option
        value="29" >DNS attack through cache poisoning</option>
                                    <option
        value="30" >Not available</option>
                                    <option
        value="31" >Cross-Site Scripting</option>
                                  </select>
                                </div>-->
                            </div>
                        </div>
                        <input type="hidden" name="key" value="kucing"/>
                        <input type="hidden" name="secret" value="tai"/>
                        <button class="btn btn-primary">Submit Site</button>
                        <button class="btn btn-default">Cancel</button>
                    </form>
                </div>
                <div class="col-md-6">
                </div>
            </div>
        </div>
    </div>
</div>

<?php include "footer.php"; ?>