| Code: |
| <form method="post" action="http://www.indianpanorama.in/cgi-bin/FormMail.pl" >
<input type="hidden" name="recipient" value="3" /> <input type="hidden" name="subject" value="InPan Site Online Enquiry" /> <input type="hidden" name="redirect" value="http://www.indianpanorama.in/thankyou.html" /> <table width="100%" border="0" cellspacing="5" cellpadding="0" class="ipbody12pt"> <tr> <td class="ipbody12pt" width="22%"> <div align="right" class="ipbody"><b>Your name</b></div> </td> <td width="28%"> <input type="text" name="Name" class="ipbody"> </td> <td width="24%"> <div align="right" class="ipbody"><b>Your email address</b></div> </td> <td width="26%"> <input type="text" name="email" class="ipbody"> </td> </tr> <tr> <td class="ipbody12pt" width="22%"> <div align="right" class="ipbody">City</div> </td> <td width="28%"> <input type="text" name="City" class="ipbody"> </td> <td width="24%"> <div align="right" class="ipbody"><b>Country</b></div> </td> <td width="26%"> <input type="text" name="Country" class="ipbody"> </td> </tr> <tr> <td class="ipbody12pt" width="22%"> <div align="right" class="ipbody">Phone with country/area code</div> </td> <td width="28%"> <input type="text" name="Phone number" class="ipbody"> </td> <td width="24%"> <div align="right" class="ipbody">Month & year of travel</div> </td> <td width="26%"> <input type="text" name="Travelling when?" class="ipbody"> </td> </tr> <tr> <td class="ipbody12pt" width="22%"> <div align="right" class="ipbody">Number of persons</div> </td> <td width="28%"> <input type="text" name="Number of persons" class="ipbody"> </td> <td width="24%" class="ipbody"> <div align="right">Duration of visit</div> </td> <td width="26%"> <input type="text" name="Duration of visit" class="ipbody"> </td> </tr> <tr> <td width="22%"> <div align="right" class="ipbody">Standard of hotels</div> </td> <td width="28%"> <input type="text" name="Standard of hotels" class="ipbody"> </td> <td width="24%" class="ipbody"> <div align="right">Budget per day (approx)</div> </td> <td width="26%"> <input type="text" name="Daily budget" class="ipbody"> </td> </tr> <tr> <td width="22%"> </td> <td width="28%"> </td> <td width="24%"> </td> <td width="26%"> </td> </tr> <tr> <td width="22%" class="ipbody" valign="top"> <p align="left"><b>Your interests<br> </b> Please indicate your areas of interest by ticking as many boxes as you wish.</p> </td> <td width="28%" valign="top" class="ipbody"> <p> <input type="checkbox" name="Houseboats" value="Yes"> Houseboat cruises<br> <input type="checkbox" name="Wildlife" value="Yes"> Wildlife & nature<br> <input type="checkbox" name="Trekking" value="Yes"> Trekking<br> <input type="checkbox" name="Art & culture" value="Yes"> Art & culture<br> <input type="checkbox" name="Architecture & History" value="Yes"> Architecture & History<br> <input type="checkbox" name="Beaches" value="Yes"> Beaches<br> <input type="checkbox" name="Ayurveda" value="Yes"> Ayurveda<br> <input type="checkbox" name="Music & dance" value="Yes"> Music & dance<br> <input type="checkbox" name="Cuisine" value="Yes"> Cuisine<br> <input type="checkbox" name="Homestays" value="Yes"> Homestays<br> <input type="checkbox" name="Markets" value="Yes"> Markets & bazaars<br> <input type="checkbox" name="Camel treks" value="Yes"> Camel trekking<br> <input type="checkbox" name="Villages" value="Yes"> Village visits<br> <input type="checkbox" name="Spirituality" value="Yes"> Spirituality<br> <input type="checkbox" name="Yoga" value="Yes"> Yoga and meditation</p> <p> Other interests:<br> <input type="text" name="Other interests" size="30" value="Other interests ..." class="ipbody"> </p> <p> </p> </td> <td width="24%" valign="top"> <p class="ipbody" align="left"><b>Your Indian travel dreams</b><br> Describe (if you wish) your dream holiday in India. Tell us what you hope to see, do and experience.</p> </td> <td width="26%" valign="top"> <textarea name="Indian Travel Dreams" cols="25" rows="25" class="ipbody">Travel dreams ...</textarea> </td> </tr> <tr> <td width="22%" class="ipbody" valign="top"> <div align="right"></div> </td> <td colspan="2" valign="top"> <div align="left" class="ipbody"> </div> <div align="left"> <span class="ipbody"><b> </b></span></div> </td> <td width="26%" valign="bottom"><span class="ipbody"><b> </b> </span> </td> </tr> </table> <table width="100%" border="0" cellspacing="5" cellpadding="0"> <tr> <td width="35%"> <div align="right"><span class="ipbody"><b>Click to send </b></span> <b><span class="ipbody"> <input type="submit" name="Submit" value="Submit" onClick="MM_validateForm('name','','R');MM_validateForm('email','','RisEmail');MM_validateForm('country','','R');return document.MM_returnValue"> </span></b> </div> </td> <td width="5%"> </td> <td width="60%"><span class="ipbody"> <b> <input type="reset" name="Reset" value="Reset"> Clear the form and start again </b></span></td> </tr> </table> <p> </p> </form> |
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