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<html> <head> <title>Contact us</title> <link href="style.css" type="text/css" rel="stylesheet"> <script src="js/jquery.min.js"></script> <script src="js/captcha.js"></script> </head> <body> <div class="container"> <form id="contact" action="javascript:void(0)" method="post" onsubmit="submit_form()"> <h3>Contact Form</h3> <h4>Contact us for any query</h4> <fieldset> <input placeholder="Your name" type="text" tabindex="1" autofocus> </fieldset> <fieldset> <input placeholder="Your Email Address" type="text" tabindex="2"> </fieldset> <fieldset> <input placeholder="Your Phone Number (optional)" type="text" tabindex="3"> </fieldset> <fieldset> <input placeholder="Your Web Site (optional)" type="text" tabindex="4"> </fieldset> <fieldset> <textarea placeholder="Type your message here...." tabindex="5"></textarea> </fieldset> <fieldset> <img src="captcha.php?rand=<?php echo rand(); ?>" id="captchaimg" height="50" width="350"> </fieldset> <fieldset> <input placeholder="Captcha" type="text" tabindex="2" id="captcha_code"> <span class="err captcha-err"></span> </fieldset> <fieldset> Can't read the above code? <a class="ccc" href="javascript:void(0);" onClick="refresh_captcha();">Refresh</a> </fieldset> <fieldset> <button name="submit" type="submit" id="contact-submit">Submit</button> </fieldset> </form> </div> </body> </html>
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