HTML CODE
<div id="booking">
<div class="container">
<div class="section-title text-center">
<h3>Please provide us with the following information</h3>
</div>
<div class="col-md-8 col-md-offset-2">
<form name="sentMessage" id="contactForm" novalidate>
<div class="row">
<div class="col-md-6">
<div class="form-group">
Please select preferred survey day/time from the following: <br>
<input type="radio" name="time" value="Mon-morning-9am-12pm"> Monday morning 9am-12pm
<br>
<input type="radio" name="time" value="Mon-afternoon-1pm-4pm"> Monday afternoon 1pm-4pm
<br>
<input type="radio" name="time" value="Wed-morning-9am-12pm"> Wednesday morning 9am-12pm
<br>
<input type="radio" name="time" value="Wed-afternoon-1pm-4pm"> Wednesday afternoon 1pm-4pm
<p class="help-block text-danger"></p>
</div>
</div>
<br>
<div class="col-md-6">
<div class="form-group">
<input type="text" id="name" class="form-control" placeholder="Name" required="required">
<p class="help-block text-danger"></p>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="email" id="email" class="form-control" placeholder="Email" required="required">
<p class="help-block text-danger"></p>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<input type="text" id="number" class="form-control" placeholder="Number to best reach you on: mobile, work" required="required">
<p class="help-block text-danger"></p>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="text" id="date" class="form-control" placeholder="Potential Moving Date" required="required">
<p class="help-block text-danger"></p>
</div>
</div>
<div id="success"></div>
<button type="submit" class="btn btn-custom btn-lg">Send Message</button>
</form>
</div>
</div>
</div>
PHP Code
<?php
// Check for empty fields
if (empty($_POST['time']) ||
empty($_POST['name']) ||
empty($_POST['email']) ||
empty($_POST['number']) ||
empty($_POST['date']) ||
!filter_var($_POST['email'],FILTER_VALIDATE_EMAIL))
{
echo "No arguments Provided!";
return false;
}
$time = $_POST['time'];
$name = $_POST['name'];
$email_address = $_POST['email'];
$number = $_POST['number'];
$date = $_POST['date'];
// Create the email and send the message
$to = 'me@example.co.uk'; // Add your email address inbetween the '' replacing yourname@yourdomain.com - This is where the form will send a message to.
$email_subject = "Website Contact Form: $name";
$email_body = "You have received a new message from your website contact form: Arrange a Survey.\n\n"."Here are the details:\n\nTime: $time \n\nName: $name \n\nEmail: $email_address \n\nNumber: $number \n\nDate:\n$date";
$headers = "From: noreply@yourdomain.com\n"; // This is the email address the generated message will be from. We recommend using something like noreply@yourdomain.com.
$headers .= "Reply-To: $email_address";
mail($to,$email_subject,$email_body,$headers);
return true;
?>
Javascript Code
$(function() {
$("input,textarea").jqBootstrapValidation({
preventSubmit: true,
submitError: function($form, event, errors) {
// additional error messages or events
},
submitSuccess: function($form, event) {
event.preventDefault(); // prevent default submit behaviour
// get values from FORM
var time = $("input#time").val();
var name = $("input#name").val();
var email = $("input#email").val();
var number = $("input#number").val();
var date = $("input#date").val();
var firstName = name; // For Success/Failure Message
// Check for white space in name for Success/Fail message
if (firstName.indexOf(' ') >= 0) {
firstName = name.split(' ').slice(0, -1).join(' ');
}
$.ajax({
url: "././mail/survey.php",
type: "POST",
data: {
time: time,
name: name,
email: email,
number: number,
date: date
},
cache: false,
success: function() {
// Success message
$('#success').html("<div class='alert alert-success'>");
$('#success > .alert-success').html("<button type='button' class='close' data-dismiss='alert' aria-hidden='true'>×")
.append("</button>");
$('#success > .alert-success')
.append("<strong>Your message has been sent. </strong>");
$('#success > .alert-success')
.append('</div>');
//clear all fields
$('#contactForm').trigger("reset");
},
error: function() {
// Fail message
$('#success').html("<div class='alert alert-danger'>");
$('#success > .alert-danger').html("<button type='button' class='close' data-dismiss='alert' aria-hidden='true'>×")
.append("</button>");
$('#success > .alert-danger').append("<strong>Sorry " + firstName + ", it seems that my mail server is not responding. Please try again later!");
$('#success > .alert-danger').append('</div>');
//clear all fields
$('#contactForm').trigger("reset");
},
})
},
filter: function() {
return $(this).is(":visible");
},
});
$("a[data-toggle=\"tab\"]").click(function(e) {
e.preventDefault();
$(this).tab("show");
});
});
/*When clicking on Full hide fail/success boxes */
$('#name').focus(function() {
$('#success').html('');
});