| <?php |
| session_start(); |
| ?> |
| <!--#set var="title" value="Feedback" --> |
| <?php |
| virtual("/incl/header.incl"); |
| ?> |
| <h1>Send Us Some Feedback</h1> |
| <p>Use the fields below to submit your feedback. If you require a response, |
| please include your name and email address.</p> |
| <form action="/FBThanks.php" method="post" name="Feedback" |
| id="Feedback"> |
| <table> |
| <tr> |
| <td> |
| <p><em>First Name:</em> |
| <input name="FirstName" type="text" id="FirstName" size="30"/> </p> |
| <p><em>Last Name:</em> |
| <input name="LastName" type="text" id="LastName" size="30"/> </p> |
| <p><em>Email: </em><input name="Email" type="text" id="Email" size="70"/> |
| </p> |
| <p><em>Topic:</em> |
| <select name="Topic" id="Topic"> |
| <option value="Ask A Question" selected="selected">Ask A Question</option> |
| <option value="Submit FAQ Question">Submit FAQ Question</option> |
| <option value="Comment On HLVM">Comment On HLVM</option> |
| <option value="HLVM Architecture">HLVM Architecture</option> |
| <option value="Using HLVM">Using HLVM</option> |
| <option value="Documentation">Documentation</option> |
| <option value="Web Site">Web Site</option> |
| <option value="Other Issue">Other Issue</option> |
| </select> |
| </p> |
| <p><em>Question or Comment:</em><br/> |
| <textarea name="Comment" cols="60" rows="10" id="Comment"></textarea> |
| <br/><br/> |
| <img src="/security-image.php?width=144" width="144" height="30" |
| alt="Security Image" /><br/> |
| <br/><label for="secode"><em>Enter Security Code:</em></label> |
| <input type="text" name="secode" id="secode" size="40" value="Enter Code In Image Here" /> |
| <input type="submit" name="Submit" value="Submit"/> |
| </p> |
| </td> |
| </tr> |
| </table> |
| </form> |
| <?php |
| virtual("/incl/footer.incl"); |
| ?> |