php/contact.html at master · josefophe/php · GitHub

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<!DOCTYPE html>
<html lang="en">

<head>
  <meta charset="UTF-8">
  <meta name="viewport" content="width=device-width, initial-scale=1.0">
  <title>Contact Form</title>
</head>

<body>
  <div align="left">

    <h3>Contact Me</h3>

    <form action="submitform.php" method="POST">
      <p>
        <label for="first_name">First Name</label><br />
        <input type="text" name="first_name" placeholder="Enter Your First Name" /><br />
      </p>

      <p>
        <label for="last_name">Last Name</label><br />
        <input type="text" name="last_name" placeholder="Enter Your Last Name" /><br />
      </p>

      <p>
        <label for="email">Email</label><br />
        <input type="email" name="email" placeholder="Enter Your Email" required />
      </p>

      <p>
        <label for="department">Department</label><br />

        <select name="department">
          <option>Select Department</option>
          <option>HR</option>
          <option>Marketing</option>
          <option>Board </option>
          <option>Kitchen</option>
        </select>
      </p>
      <p>
        <label for="gender">Gender</label><br />
        <input type="radio" name="gender" /> Female
        <input type="radio" name="gender" /> Male
      </p>

      <p>
        <label for="email">Your Message</label><br />
        <textarea name="message"></textarea>
      </p>

      <p>

        <input type="checkbox" name="terms" required /> By Checking this box you agree to our terms and conditions

      </p>

      <button type="submit">Send Message</button>

    </form>

  </div>
</body>

</html>