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Jan 20th, 2019
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  1. <form action="/Task/Form/ProcessForm.cfm" id="contact_form_HL" method="post" name="Contact_Light" onsubmit="return validate()">
  2.  
  3. <label>
  4. <span>Select The Location<span style="color:#FF0000">*</span></span>
  5. <select class="select-input-patient" name="location">
  6. <option value="Alabama - Scottsboro">Alabama - Scottsboro</option>
  7. <option value="Georgia - Cumming">Georgia - Cumming</option>
  8. <option value="Georgia - Dalton">Georgia - Dalton</option>
  9. </select>
  10. </label>
  11. </form>
  12.  
  13. <input class="submit" name="SUBMIT" type="submit" value="SUBMIT" />
  14. <input name="email_subject" type="hidden" value="Contact Form" />
  15. <input name="email_form" type="hidden" value="Contact@contact.com" />
  16. <input name="email_to" type="hidden" value="Contact@contact.com" />
  17. <input name="email_bcc" type="hidden" value="foo@foo.com" />
  18. <input name="returnURL" type="hidden" value="/thankyou/" />
  19.  
  20. <form action="/Task/Form/ProcessForm.cfm" id="contact_form_HL" method="post" name="Contact_Light" onsubmit="return validate()">
  21.  
  22. <label>
  23. <span>Select The Location<span style="color:#FF0000">*</span></span>
  24. <select class="select-input-patient" name="email_to">
  25. <option value="foo@scottsboro.com">Alabama - Scottsboro</option>
  26. <option value="foo@cumming.com">Georgia - Cumming</option>
  27. <option value="foo@dalton.com">Georgia - Dalton</option>
  28. </select>
  29. </label>
  30.  
  31. <input class="submit" name="SUBMIT" type="submit" value="SUBMIT" />
  32. <input name="email_subject" type="hidden" value="Contact Form" />
  33. <input name="email_form" type="hidden" value="Contact@contact.com" />
  34. <input name="email_bcc" type="hidden" value="foo@foo.com" />
  35. <input name="returnURL" type="hidden" value="/thankyou/" />
  36. </form>
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