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Ryan Westfall
2025-03-24 20:41:08 -05:00
parent 6cb735491b
commit 766789b953
9 changed files with 258 additions and 29 deletions
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97
refundom/webpage/templates/webpage/contact.html
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@@ -13,24 +13,105 @@
<!-- Contact Form -->
<div class="col-md-6">
<div class="contact-form">
<form>
<form action="{% url 'contact' %}" method="POST">
{% csrf_token %}
<div class="form-group">
<label for="name">Full Name</label>
<input type="text" class="form-control" id="name" placeholder="Enter your full name" required>
<input type="text" class="form-control" id="name" name="name" placeholder="Enter your full name" required>
</div>
<div class="form-group">
<label for="email">Email Address</label>
<input type="email" class="form-control" id="email" placeholder="Enter your email" required>
<input type="email" class="form-control" id="email" name="email" placeholder="Enter your email" required>
</div>
<div class="form-group">
<label for="phone">Phone Number</label>
<input type="tel" class="form-control" id="phone" placeholder="Enter your phone number">
<label for="phone_number">Phone Number</label>
<input type="tel" class="form-control" id="phone_number" name="phone_number" placeholder="Enter your phone number" required>
</div>
<!-- Address Fields -->
<div class="form-group">
<label for="street">Street Address</label>
<input type="text" class="form-control" id="street" name="street" placeholder="123 Main St" required>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="city">City</label>
<input type="text" class="form-control" id="city" name="city" placeholder="City" required>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label for="state">State</label>
<select class="form-control" id="state" name="state" required>
<option value="" disabled selected>Select</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<!-- Add all other states as needed -->
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label for="zip">ZIP Code</label>
<input type="text" class="form-control" id="zip" name="zip" placeholder="12345" required>
</div>
</div>
</div>
<div class="form-group">
<label for="message">Message</label>
<textarea class="form-control" id="message" rows="5" placeholder="How can we help you?" required></textarea>
{% if capchaForm %}
{{ capchaForm }}
{% endif %}
</div>
<button type="submit" class="btn btn-primary btn-block">Submit</button>
<button type="submit" value="Send" class="btn btn-primary btn-block">Submit</button>
</form>
</div>
</div>