KVSun-Forms/Obituary.html at master · KVSun/KVSun-Forms · GitHub

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<!DOCTYPE html>
<html>
	<head>
		<title>Submit Obituary</title>
		<meta charset="utf-8" />
		<link rel="stylesheet" href="stylesheets/styles/import.css" media="all" />
		<script src="scripts/custom.js" async></script>
	</head>
	<body>
		<nav id="nav"></nav>
		<form name="obituary" method="POST" enctype="multipart/form-data" class="tabbed">
			<fieldset id="obituary_text">
				<legend>Obituary</legend>
				<textarea name="obituary[text]" cols="80" rows="25" autofocus required></textarea>
				<br />
				<a href="#obituary_deceased" role="button">Next</a>
			</fieldset>
			<fieldset id="obituary_deceased">
				<legend>Deceased</legend>
				<label for="obituary_deceased_name">Name</label>
				<input type="text" name="obituary[deceased][name]" id="obituary_deceased_name" placeholder="John Smith" pattern="[A-z\. ]+" required />
				<br />
				<label for="obituary_deceased_birthDate">Date of Death:</label>
				<input type="date" name="obituary[deceased][birthDate]" id="obituary_deceased_birthDate" placeholder="YYYY-MM-DD" />
				<br />
				<label for="obituary_deceased_deathDate">Date of Death:</label>
				<input type="date" name="obituary[deceased][deathDate]" id="obituary_deceased_deathDate" placeholder="YYYY-MM-DD" />
				<br />
				<label for="obituary_deceased_usePhoto"><em>Add a photo for $5?</em></label>
				<input type="checkbox" name="obituary[deceased][usePhoto]" data-visibility-target="#obit_photo" />
				<br />
				<div id="obit_photo" hidden>
					<label for="obituary_deceased_photo">Photo:</label>
					<input type="file" name="obituary[deceased][photo]" id="obituary_deceased_photo" accept="image/*" placeholder="Upload image" />
				</div>
				<a href="#obituary_text" role="button">Prev</a>
				<a href="#obituary_contact" role="button">Next</a>
			</fieldset>
			<fieldset id="obituary_contact">
				<legend>Contact and Billing</legend>
				<label for="obituary_contact_name">Name:</label>
				<input type="text" name="obituary[contact][name]" id="obituary_contact_name" placeholder="John Smith" pattern="[A-z\. ]+" required />
				<br />
				<label for="obituary_contact_tel">Phone:</label>
				<input type="tel" name="obituary[contact][tel]" id="obituary_contact_tel" placeholder="17603791234" required />
				<br />
				<label for="obituary_contact_email">E-Mail Address:</label>
				<input type="email" name="obituary[contact][email]" id="obituary_contact_email" placeholder="user@example.com" required />
				<hr />
				<a href="#obituary_deceased" role="button">Previous</a>
				<br />
				<button type="submit">Submit</button>
				<button type="reset">Reset</button>
			</fieldset>
		</form>
	</body>
</html>