Mini Shell

Direktori : /home/funerariamayer/www/
Upload File :
Current File : /home/funerariamayer/www/monte-seu-plano-familiar.php

<?
$tipo = $_POST['tipo'];
?>

<section id="main-content" class="container">
      <!-- Start Page Content -->

     
      <div class="col-md-12 col-md-offset-1">
         <div class="contact-form">
            <div class="clr"></div>
            <br />
            <form name="frm_monte_seu_plano" action="monte-seu-plano-familiar-gravar" class="frmContact" method="POST">


               <h5>Plano</h5>
               <?echo $tipo;?>
               <input name="tipo" type="hidden" value="<?=$tipo;?>"><br />

               <h5>Nome</h5>
               <input name="nome" type="text" class="txbx" placeholder="Nome" /><br />

               <h5>Email</h5>
               <input name="email" type="text" class="txbx" placeholder="Email" /><br />
             
               <h5>Telefone</h5>
               <input name="telefone" type="text" class="txbx" placeholder="Telefone" /><br />

               <div class="erabox">
                  <h5>Mensagem</h5>
                  <textarea name="mensagem" class="txbx era" ></textarea>
                  <br />
                  <input type="submit" name="BTEnvia" class="sendbtn btnSend" value="SOLICITAR PLANO">
                  <div id="spanMessage"></div>
               </div>
            </form>
         </div>
         <!-- end-contact-form  -->
      </div>
      <div class="white-space"></div>
     
      <!-- END-Google Map Section -->
      <hr class="vertical-space3">
   </section> <!-- container -->

Zerion Mini Shell 1.0