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40 lines
1.8 KiB
40 lines
1.8 KiB
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<form id="contact-form" method="post" action="<?php echo $BASE_URL;?>/blocks/contactFormSubmit.php">
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<div class="row py-4">
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<div class="col-10 col-sm-6 mx-auto">
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<span class="font-12">Destinatario</span>
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<select class="input" name="dest">
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<option value="info@ordinefarmacistisalerno.it">Informazioni</option>
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<option value="presidenza@ordinefarmacistisalerno.it">Presidenza</option>
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<option value="vicepresidenza@ordinefarmacistisalerno.it">Vice Presidenza</option>
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<option value="segreteria@ordinefarmacistisalerno.it">Segreteria</option>
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<option value="tesoreria@ordinefarmacistisalerno.it">Tesoreria</option>
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<option value="consiglio@ordinefarmacistisalerno.it">Consiglio</option>
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</select>
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</div>
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<div class="col-sm-4 d-none d-sm-block"></div>
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<div class="col-10 mx-auto">
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<span class="font-12">Nome mittente</span>
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<input type="text" name="name">
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</div>
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<div class="col-10 mx-auto">
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<span class="font-12">Email mittente</span>
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<input type="text" name="email">
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</div>
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<div class="col-10 mx-auto">
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<span class="font-12">Oggetto</span>
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<input type="text" name="subject">
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</div>
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<div class="col-10 mx-auto">
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<span class="font-12">Messaggio</span>
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<textarea cols="40" rows="6" name="message"></textarea>
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</div>
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<div class="col-10 mx-auto">
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<div class="g-recaptcha" data-sitekey="6Le7kkUUAAAAAK-lsvoefiaBsH1TycWnHipCC8VF"></div>
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</div>
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<div class="col-10 mx-auto text-right">
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<button type="submit">Invia messaggio</button>
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</div>
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</div>
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</form>
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