{call_header}
{assign var="actionReturn" value=$obj->actionReturn}
{literal}
<style>
    label.error{
        color: red;
    }
      .success_msg{
        border: 1px solid;
        margin: 10px 0px;
        padding:15px 10px 15px 50px;
        background-repeat: no-repeat;
        background-position: 10px center;
        color: #4F8A10;
        background-color: #DFF2BF;
    }
</style>
<script type="text/javascript" src="{/literal}{$smarty.const.CONST_SITE_ADDRESS}{literal}js/jquery.validate.min.js"></script>



 <script> 
$(document).ready(function(){
        $('.Blocked').change( function() {
    var isChecked = this.checked;
    if(isChecked) {
         $("input").attr('disabled','disabled');
         $('#address').attr('disabled','disabled');
         $('#salutation').attr('disabled','disabled');
         $(".Blocked").removeAttr('disabled');
         $("#submitfeedback").removeAttr('disabled');
         $("#answer").removeAttr('disabled');
         $(".refrsh_cptcha").removeAttr('disabled');
         //$('#name').attr('readonly','readonly');
         $('#name').val('Anonymous');
         $("#anonymous").removeAttr('disabled');
         $('#anonymous').val('1');
         $('#message').attr("placeholder", "Type Message here Anonymously");
         
    } else {
      $("input").removeAttr('disabled');
      $('#address').removeAttr('disabled');
       $('#salutation').removeAttr('disabled');
       $('#name').val('');
       $('#message').attr("placeholder", "Message").placeholder();
    }

   });
});
  

$(function() {
  
  // alert('hai');  
  
    $("#registrationform").validate({
    
        rules: {
            name  : "required",
            password  : "required",
      confirm_password :   "required",
	  
      address    :  "required",
      designation : "required",
      company     :  "required",
      message     :  "required",
            email: {
                required: true,
                email: true
                  },
              answer:{
                    required: true,
                    remote : {
            url: "check_captcha.php",
            type: "POST",            
          } 
                }
            },
        
        messages: {
            name: "Please enter your full name",
            password: "Please enter your password",
      confirm_password:"Please confirm your password",
      address   :"Please enter your Address ",
      designation   :"Please enter your designation ",
      company   :"Please enter your organization/company name ",
      message   :"Please enter your message",
            email: "Please enter a valid email address",
                    answer:{
                            required: "Please Enter The Captcha Code",
                            remote: "Please enter Valid Captcha",
                        }

            }
    });

  });
  </script>
  {/literal}

<section class="content_area clearfix">
  <form method='post' id='registrationform'>
    <h2>Feedback</h2>
           {if ($obj->popPageError() != "")}
    <div class="success_msg">Enquiry/Feedback send!! Please check your Spam email also for our replies.</div>
    {/if}
        <div class="contact_sec clearfix">
        <div class="social_media">
          <ul>
          <li class="facebook"><a href="{$actionReturn.data1}" title="Click to go Facebook page" target="_blank">Facebook</a></li>
          <li class="twitter"><a href="{$actionReturn.data2}" title="Click to go Twitter page" target="_blank">Twitter</a></li>
          <li class="mail"><a href="mailto:{$actionReturn.data3}?Subject=Hello%20again" target="_blank" title="Click to send Email">Email</a></li>
          </ul>
        </div>
        <p>Please use the form below to send us your enquiry or comments.</p>
        <p><input type="checkbox" class="Blocked" /> Submit Anonymously</p>
        <div class="input_boxs">
      <select class="salutation" name="salutation" id="salutation">
  <option value="Mr">Mr</option>
  <option value="Mrs">Mrs</option>
  <option value="Ms">Ms</option>
  </select>
  <input class="name" name="name" id="name" type="text"  placeholder="Name*" valtype="emptyCheck-Please enter name" />
            <input type="text" placeholder="Email*" name="email" id="email" />
            <input type="text" placeholder="Phone"  name="contact_no" id="contact_no" />
            
            <input name="company" id="company" type="text" placeholder="Company*"  />
            <input name="designation" id="designation" placeholder="Designation*"  type="text" />
            
        </div>
        <div class="text_box">
        <textarea name="address" id="address"  placeholder="Address*" rows="2" cols="35"></textarea>
          <textarea placeholder="Question/Message*" name="message" id="message"></textarea>
<!--captcha-->
          <div class="captcha"><img class="cap_img" src="{$smarty.const.CONST_SITE_ADDRESS}captcha.php" name="captcha_img" id="captcha_img" />
        <br/>
        <input class="captcha_txt_feld" style="width:150px; text-align:center;" type="text" id="answer" name="answer" placeholder="Enter captcha here*" />
        
        <input class="refrsh_cptcha"  type="button" onclick="document.getElementById('captcha_img').src='{$smarty.const.CONST_SITE_ADDRESS}captcha.php?img=' + Math.random(); return false" value="Refresh Captcha" /></div>
<!-- captcha ends -->
        </div>
        
    <input name="anonymous" id="anonymous" type="hidden"  value="" />
        
        <input type="submit" id="submitfeedback" class="rsrvtn_btn2 flt_rght" value="Send" name="actionvar" title="Click to send your feedback">
        </div>
</form>
      </section>

</div>
{call_footer}