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- <form action="/Task/Form/ProcessForm.cfm" id="contact_form_HL" method="post" name="Contact_Light" onsubmit="return validate()">
- <label>
- <span>Select The Location<span style="color:#FF0000">*</span></span>
- <select class="select-input-patient" name="location">
- <option value="Alabama - Scottsboro">Alabama - Scottsboro</option>
- <option value="Georgia - Cumming">Georgia - Cumming</option>
- <option value="Georgia - Dalton">Georgia - Dalton</option>
- </select>
- </label>
- </form>
- <input class="submit" name="SUBMIT" type="submit" value="SUBMIT" />
- <input name="email_subject" type="hidden" value="Contact Form" />
- <input name="email_form" type="hidden" value="Contact@contact.com" />
- <input name="email_to" type="hidden" value="Contact@contact.com" />
- <input name="email_bcc" type="hidden" value="foo@foo.com" />
- <input name="returnURL" type="hidden" value="/thankyou/" />
- <form action="/Task/Form/ProcessForm.cfm" id="contact_form_HL" method="post" name="Contact_Light" onsubmit="return validate()">
- <label>
- <span>Select The Location<span style="color:#FF0000">*</span></span>
- <select class="select-input-patient" name="email_to">
- <option value="foo@scottsboro.com">Alabama - Scottsboro</option>
- <option value="foo@cumming.com">Georgia - Cumming</option>
- <option value="foo@dalton.com">Georgia - Dalton</option>
- </select>
- </label>
- <input class="submit" name="SUBMIT" type="submit" value="SUBMIT" />
- <input name="email_subject" type="hidden" value="Contact Form" />
- <input name="email_form" type="hidden" value="Contact@contact.com" />
- <input name="email_bcc" type="hidden" value="foo@foo.com" />
- <input name="returnURL" type="hidden" value="/thankyou/" />
- </form>
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