<div style="border: solid 1px #000000;"><form action="http://www.SnapHost.com/captcha/send.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);"> <input name="skip_WhereToSend" type="hidden" value="Email Anda" /> <input name="skip_SnapHostID" type="hidden" value="BM833MKCXEXQ" />
<input name="skip_WhereToReturn" type="hidden" value="url halaman Konfirmasi" /> <input name="skip_Subject" type="hidden" value="Contact Form" /> <input name="skip_ShowUsersIp" type="hidden" value="1" /> <input name="skip_SendCopyToUser" type="hidden" value="1" /> <script type="text/javascript"> function ValidateForm(frm) { if (frm.Nama.value == "") {alert('Nama harus di isi.');frm.Nama.focus();return false;} if (frm.Dari.value == "") {alert('Alamat email harus di isi.');frm.Dari.focus();return false;} if (frm.Dari.value.indexOf("@") < 1 || frm.Dari.value.indexOf(".") < 1) {alert('Tolong masukan alamat email yang benar.');frm.Dari.focus();return false;} if (frm.Pesan.value == "") {alert('Silahkan kirimkan komentar atau pertanyaan.');frm.Pesan.focus();return false;} if (frm.skip_CaptchaCode.value == "") {alert('Masukan kode di samping.');frm.skip_CaptchaCode.focus();return false;} return true; } function ReloadCaptchaImage(captchaImageId) { var obj = document.getElementById(captchaImageId); var src = obj.src; var date = new Date(); var pos = src.indexOf('&rad='); if (pos >= 0) { src = src.substr(0, pos); } obj.src = src + '&rad=' + date.getTime(); return false; } </script> <br /> <table border="0" cellpadding="5" cellspacing="0" style="width: 600px;"><tbody>
<input name="skip_WhereToReturn" type="hidden" value="url halaman Konfirmasi" /> <input name="skip_Subject" type="hidden" value="Contact Form" /> <input name="skip_ShowUsersIp" type="hidden" value="1" /> <input name="skip_SendCopyToUser" type="hidden" value="1" /> <script type="text/javascript"> function ValidateForm(frm) { if (frm.Nama.value == "") {alert('Nama harus di isi.');frm.Nama.focus();return false;} if (frm.Dari.value == "") {alert('Alamat email harus di isi.');frm.Dari.focus();return false;} if (frm.Dari.value.indexOf("@") < 1 || frm.Dari.value.indexOf(".") < 1) {alert('Tolong masukan alamat email yang benar.');frm.Dari.focus();return false;} if (frm.Pesan.value == "") {alert('Silahkan kirimkan komentar atau pertanyaan.');frm.Pesan.focus();return false;} if (frm.skip_CaptchaCode.value == "") {alert('Masukan kode di samping.');frm.skip_CaptchaCode.focus();return false;} return true; } function ReloadCaptchaImage(captchaImageId) { var obj = document.getElementById(captchaImageId); var src = obj.src; var date = new Date(); var pos = src.indexOf('&rad='); if (pos >= 0) { src = src.substr(0, pos); } obj.src = src + '&rad=' + date.getTime(); return false; } </script> <br /> <table border="0" cellpadding="5" cellspacing="0" style="width: 600px;"><tbody>
<tr> <td><b>Nama Produk :</b></td> <td><input maxlength="60" name="Nama" style="width: 350px;" type="text" /></td> </tr>
<tr> <td><b>Nama Anda :</b></td> <td><input maxlength="43" name="NomorTelepon" style="width: 350px;" type="text" /></td> </tr>
<tr> <td><b>Nomor HP :</b></td> <td><input maxlength="43" name="NomorTelepon" style="width: 350px;" type="text" /></td> </tr>
<tr> <td><b>Email :</b></td> <td><input maxlength="60" name="Dari" style="width: 350px;" type="text" /></td> </tr>
<tr> <td><b>Pesan :</b></td> <td><textarea cols="40" name="Pesan" rows="7" style="width: 350px;"></textarea></td> </tr> <tr> <td align="center" colspan="2"><table border="0" cellpadding="0" cellspacing="0"><tbody> <tr><td colspan="2" style="padding-bottom: 18px;"><a href="http://www.snaphost.com/" rel="nofollow" style="color: #000099; font-family: Verdana, Arial, Helvetica; font-size: 11px; text-decoration: none;" target="_blank"> Kontak form ini dilindungi dari SPAM by : <span style="text-decoration: underline;">SnapHost.com</span></a></td></tr> <tr valign="top"><td><i>Masukan kode berikut*.</i> <input maxlength="6" name="skip_CaptchaCode" style="width: 80px;" type="text" /></td><td><a href="http://www.snaphost.com/" rel="nofollow" target="_blank"><img alt="Web Form Code" src="http://www.SnapHost.com/captcha/CaptchaImage.aspx?id=BM833MKCXEXQ&ImgType=2" id="CaptchaImage" style="margin-left: 20px;" title="Anti-spam web forms" /></a></td></tr> </tbody></table> * Harus Di Isi. <input name="skip_Submit" type="submit" value="Kirim" /></td></tr> </tbody></table> </form></div>
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