Submit To Dealer
<link href="https://cdnjs.cloudflare.com/ajax/libs/air-datepicker/2.2.3/css/datepicker.min.css" rel="stylesheet" type="text/css">
<script src="https://cdnjs.cloudflare.com/ajax/libs/air-datepicker/2.2.3/js/datepicker.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/air-datepicker/2.2.3/js/i18n/datepicker.en.js"></script>
<script type="text/javascript" src="/core/js/jquery.validate.js"></script>
<script type="text/javascript">
$(document).ready(function(){
jQuery.validator.addMethod('notEqualTo', function(value, element, param) {
return this.optional(element) || value != $(param).val();
}, 'First and last name cannot be the same.');
jQuery.validator.addMethod('zip', function(zip, element) {
return this.optional(element) || zip.match(/(^\d{5}(-\d{4})?$)$/);
}, 'Please enter a valid zip code.');
jQuery.validator.addMethod('phone', function(phone, element) {
return this.optional(element) || phone.match(/^[01]?[- .]?\(?[2-9]\d{2}\)?[- .]?\d{3}[- .]?\d{4}$/);
}, 'Please enter a valid phone number.');
$('#contact_form').validate({
rules: {
Email_Address: {
email: true
},
First_Name : {
notEqualTo: '#Last_Name'
},
Zip_Code: {
zip: true
},
Phone: {
phone: true
}
}
});
$('#contact_form').submit(function() {
if($('#contact_form').valid() === true)
{
$('#contact_form .submit').attr('disabled', 'disabled');
}
});
});
</script>
<style>
.left {
float: left;
margin: 0 20px 5px 0;
overflow: hidden;
}
.contact_form form {
width: 100%;
}
.contact_form.module, .contact_form.page_widget {
float: none;
}
</style>
<?php
if (!empty($_POST)) {
global $siteData, $siteDefineData;
require_once ENV_ROOT.'/portal/libraries/formLogger.api.php';
$logger = new formLoggerApi();
$logger->setSiteId($siteData['site.id']);
$logger->setSessionId($siteDefineData['cms_tracking_sessions']['session.id']);
$logger->setFormId('form_logger_');
$logger->setFormName('');
$logger->setcustomEmailSubject('');
$logger->setNotificationEmailAddresses('');
if ($logger->saveData($_POST)) {
echo '<h1>Thank you!</h1>';
echo '<p>We have received your information and will get back to you shortly.</p>';
echo '<style>.form-block{display:none;}</style>';
} else {
echo '<h1>It looks like something went wrong.</h1>';
}
}
?>
<div class="row form-block">
<h1 class="center">Donation</h1>
<p>Lorem ipsum dolor sit amet consectetur adipisicing elit. Sint, incidunt iusto eligendi doloremque tempora in repellendus voluptatibus nobis, corporis sapiente molestias explicabo fuga aliquam, modi illo non placeat inventore odio?</p>
<div class="contact_form page_widget">
<form action="" method="post" id="">
<div class="fname">
<label for="First_Name">First Name: <span>*</span></label>
<input type="text" name="form_logger_Contact_First_Name" maxlength="50" class="required" id="First_Name">
</div>
<div class="lname">
<label for="Last_Name">Last Name: <span>*</span></label>
<input type="text" name="form_logger_Contact_Last_Name" maxlength="50" class="required" id="Last_Name">
</div>
<div class="phone">
<label for="Phone">Phone: <span>*</span></label>
<input type="text" name="form_logger_Contact_Phone" maxlength="50" class="required phone" id="Phone">
</div>
<div class="email">
<label for="Email_Address">Email: <span>*</span></label>
<input type="text" name="form_logger_Contact_Email" maxlength="50" class="required email" id="Email_Address">
</div>
<div class="address">
<label for="Street">Street: <span>*</span></label>
<input type="text" name="form_logger_Organization_Street" maxlength="50" class="required" id="Street">
</div>
<div class="city">
<label for="City">City: <span>*</span></label>
<input type="text" name="form_logger_Organization_City" maxlength="50" class="required" value="" id="City">
</div>
<div class="state">
<label for="form_logger_Organization_State">State: <span>*</span></label>
<select name="State" class="required" id="State">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</div>
<div class="zip">
<label for="Zip">Zip Code: <span>*</span></label>
<input type="text" name="Form_logger_Organization_Zip_Code" maxlength="10" class="required zipcode" value="" id="Zip">
</div>
<div class="submit">
<input class="submit" name="send" type="submit" value="Send" id="save">
</div>
</form>
</div>
</div>
<div class="row">
<div class="panel">
Privacy Statement: Your privacy is valued! Your personal information will be kept confidential and will not be redistributed or shared with any third parties.
</div>
</div>Additional form variations can be found here