PAL.C.T MINI SHELL
<div class='news_tittle'>
<h4> Hubungi Kami </h4>
</div>
<div class="col-md-12">
<form role="form" method="POST" class="form-horizontal" action="aksi-hubungi-kami.html" enctype='multipart/form-data'>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Nama</label>
<div class="col-sm-8">
<input name="nama" type="text" placeholder="Nama Anda" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Email</label>
<div class="col-sm-8">
<input name="email" type="email" id="exampleInputEmail1" placeholder="Email" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Ponsel</label>
<div class="col-sm-8">
<input name="phone" type="text" placeholder="No.Ponsel" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Topik</label>
<div class="col-sm-8">
<select name='topik' class="form-control">
<option value='Inquiry / PreSaless'> Inquiry / PreSales </option>
<option value='Produk Info / Detail Produk'> Produk Info / Detail Produk </option>
<option value='Komplain / Waranty'> Komplain / Waranty </option>
<option value='Others'> Others </option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Subjek</label>
<div class="col-sm-8">
<input name="subjek" type="number" placeholder="Subjek" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Komentar / Pesan</label>
<div class="col-sm-8">
<textarea class="form-control" name="isi_testimoni" cols="40"></textarea>
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Kode Barang</label>
<div class="col-sm-8">
<input name="kode" type="text" placeholder="Kode barang" class="form-control">
</div>
</div>
<div class="form-group">
<div class="col-sm-offset-3 col-sm-9">
<button class="btn btn-primary" type="submit">Submit</button>
<br><br><i>Note : Form yang bertanda <span class='red'>*</span> harus di isi.</i>
</div>
</div>
</form>
</div>
<br><br>
<div class='news_tittle'>
<h4> Request Produk </h4>
</div>
<div class='row'>
<form role="form" method="POST" class="form-horizontal" action="aksi-request-produk.html" enctype='multipart/form-data'>
<div class="col-md-6">
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Nama</label>
<div class="col-sm-8">
<input name="nama" type="text" placeholder="Nama Anda" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Email</label>
<div class="col-sm-8">
<input name="email" type="email" placeholder="Email" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Ponsel</label>
<div class="col-sm-8">
<input name="phone" type="text" placeholder="No.Ponsel" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" ><span class='red'>*</span>Subjek</label>
<div class="col-sm-8">
<input name="subjek" type="number" placeholder="No.Ponsel" class="form-control">
</div>
</div>
</div>
<div class='col-md-6'>
<div class="form-group">
<label class="col-sm-3 control-label" >Brand</label>
<div class="col-sm-8">
<input name="brand" type="text" placeholder="Nama Brand" class="form-control" value='kaercher' disable>
<input name="brand" type="hidden" placeholder="Nama Brand" class="form-control" value='kaercher'>
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Model / Tipe</label>
<div class="col-sm-8">
<input name="model" type="text" id="exampleInputEmail1" placeholder="Model / Tipe Produk" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Kota</label>
<div class="col-sm-8">
<input name="kota" type="text" placeholder="Kota" class="form-control">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Foto</label>
<div class="col-sm-8">
<input name="fupload" type="file">
</div>
</div>
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" >Deskripsi / SpesifikasiProduk</label>
<div class="col-sm-9">
<textarea class="form-control" name="deskripsi" cols="40"></textarea>
</div>
</div>
<div class="form-group">
<div class="col-sm-offset-2 col-sm-10"><br>
<button class="btn btn-primary" type="submit">Submit</button>
<br>
<br><i>Note : Form yang bertanda <span class='red'>*</span> harus di isi.</i>
</div>
</div>
</form>
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