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Viewing File: /home/u403625155/domains/connecttogetherwith.com/public_html/charityworld/web/reservation.php

<?php 

require "../../mail.php";

?>





<!--Author: W3layouts
Author URL: http://w3layouts.com
License: Creative Commons Attribution 3.0 Unported
License URL: http://creativecommons.org/licenses/by/3.0/
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<!DOCTYPE HTML>
<html>
<head>
<title>App</title>
<!-- Custom Theme files -->
<link href="css/style.css" rel="stylesheet" type="text/css" media="all"/>
<!-- Custom Theme files -->
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
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<meta name="keywords" content="Ensaluto Form Responsive,Login form web template, Sign up Web Templates, Flat Web Templates, Login signup Responsive web template, Smartphone Compatible web template, free webdesigns for Nokia, Samsung, LG, SonyErricsson, Motorola web design" />
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<script src="js/jquery.min.js"></script>
<script src="https://unpkg.com/sweetalert/dist/sweetalert.min.js"></script>
</head>

<style type="text/css">

	.app{
		padding: 20px;
	}
	.app input{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
	}
	select[name='location']{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
		width: 72%;
		outline: none;
		padding: 10px;
	}
	.date{
		background-color: #f2f2f2;
		border-top: 1px solid #fff;
		outline: none;
		padding: 7px;
	}
	.app h1{
		padding: 10px;
		font-weight: bolder;
		font-size: 24px;
	}
	label{
		text-align: right;
	}
	::placeholder{
		font-size: 13px;
	}
	input[type='checkbox']{
		transform: scale(1.5);
		margin: 10px;
	}

	input[type='radio']{
		transform: scale(1.5);
		margin: 10px;
	}
	button{
		margin-top: 15px;
		padding: 10px 25px;
		background-color: black;
		color: white;
		border: none;
		border-radius: 4px;
		cursor: pointer;
	}


	@media screen and (max-width: 1024px) {
		.app{
			width: 60%;
		}

	}


	@media screen and (max-width: 600px) {
		.app{
			width: 85%;
		}

	}


</style>

<body>
<!--sign up form start here-->
<div class="app">
	
	<h1>Private Reservations</h1>
	<p style="color: white;font-size: 12px;">Book a private reservation to spend some time together.</p><br>

	<form method="POST">

		<label><b>User Details:</b> </label><br>
		<input type="text" name="fname" placeholder="First Name">
		
		<input type="text" name="lname" placeholder="Last Name">
		
		<input type="text" name="email" placeholder="Email">

		<input type="text" name="phone" placeholder="Phone"><br>

		<label><b>Address Details: </b></label><br>
		<input type="text" name="address" placeholder="Address">

		<input type="text" name="street_address" placeholder="Street Address">
		
		<input type="text" name="city" placeholder="City">
		
		<input type="text" name="state" placeholder="State/Province/Region">
		
		<input type="text" name="country" placeholder="Country"><br>

		<label><b>Ideal Loaction: </b></label><br>
		<select name="location">
			<option value="Private Restaurant">Private Restaurant</option>
			<option value="Hotel">Hotel</option>
			<option value="Spa">Spa</option>
			<option value="Other">Other</option>
		</select><br><br>

		<input type="text" name="event_location" placeholder="Event Location"><br>

		<label><br>Reason for Meeting: </label><br>
		<input type="text" name="reason" placeholder=""><br>

		<label><b>Date:</b></label><br>
		<select name="days" class="date">
		  <option value="1">Days</option>
		  <option value="1">1</option>
		  <option value="2">2</option>
		  <option value="3">3</option>
		  <option value="4">4</option>
		  <option value="5">5</option>
		  <option value="6">6</option>
		  <option value="7">7</option>
		  <option value="8">8</option>
		  <option value="9">9</option>
		  <option value="10">10</option>
		  <option value="11">11</option>
		  <option value="12">12</option>
		  <option value="13">13</option>
		  <option value="14">14</option>
		  <option value="15">15</option>
		  <option value="16">16</option>
		  <option value="17">17</option>
		  <option value="18">18</option>
		  <option value="19">19</option>
		  <option value="20">20</option>
		  <option value="21">21</option>
		  <option value="22">22</option>
		  <option value="23">23</option>
		  <option value="24">24</option>
		  <option value="25">25</option>
		  <option value="26">26</option>
		  <option value="27">27</option>
		  <option value="28">28</option>
		  <option value="29">29</option>
		  <option value="30">30</option>
		  <option value="31">31</option>
		</select>

		<select name="month" class="date">
		  <option value="">Month</option>
		  <option value="1">1</option>
		  <option value="2">2</option>
		  <option value="3">3</option>
		  <option value="4">4</option>
		  <option value="5">5</option>
		  <option value="6">6</option>
		  <option value="7">7</option>
		  <option value="8">8</option>
		  <option value="9">9</option>
		  <option value="10">10</option>
		  <option value="11">11</option>
		  <option value="12">12</option>
		</select>

		<select name="year" class="date">
		  <option value="">Year</option>
		  <option value="1920">1920</option>
		  <option value="1921">1921</option>
		  <option value="1922">1922</option>
		  <option value="1923">1923</option>
		  <option value="1924">1924</option>
		  <option value="1925">1925</option>
		  <option value="1926">1926</option>
		  <option value="1927">1927</option>
		  <option value="1928">1928</option>
		  <option value="1929">1929</option>
		  <option value="1930">1930</option>
		  <option value="1931">1931</option>
		  <option value="1932">1932</option>
		  <option value="1933">1933</option>
		  <option value="1934">1934</option>
		  <option value="1935">1935</option>
		  <option value="1936">1936</option>
		  <option value="1937">1937</option>
		  <option value="1938">1938</option>
		  <option value="1939">1939</option>
		  <option value="1940">1940</option>
		  <option value="1941">1941</option>
		  <option value="1942">1942</option>
		  <option value="1943">1943</option>
		  <option value="1944">1944</option>
		  <option value="1945">1945</option>
		  <option value="1946">1946</option>
		  <option value="1947">1947</option>
		  <option value="1948">1948</option>
		  <option value="1949">1949</option>
		  <option value="1950">1950</option>
		  <option value="1951">1951</option>
		  <option value="1952">1952</option>
		  <option value="1953">1953</option>
		  <option value="1954">1954</option>
		  <option value="1955">1955</option>
		  <option value="1956">1956</option>
		  <option value="1957">1957</option>
		  <option value="1958">1958</option>
		  <option value="1959">1959</option>
		  <option value="1960">1960</option>
		  <option value="1961">1961</option>
		  <option value="1962">1962</option>
		  <option value="1963">1963</option>
		  <option value="1964">1964</option>
		  <option value="1965">1965</option>
		  <option value="1966">1966</option>
		  <option value="1967">1967</option>
		  <option value="1968">1968</option>
		  <option value="1969">1969</option>
		  <option value="1970">1970</option>
		  <option value="1971">1971</option>
		<option value="1972">1972</option>
		<option value="1973">1973</option>
		<option value="1974">1974</option>
		<option value="1975">1975</option>
		<option value="1976">1976</option>
		<option value="1977">1977</option>
		<option value="1978">1978</option>
		<option value="1979">1979</option>
		<option value="1980">1980</option>
		<option value="1981">1981</option>
		<option value="1982">1982</option>
		<option value="1983">1983</option>
		<option value="1984">1984</option>
		<option value="1985">1985</option>
		<option value="1986">1986</option>
		<option value="1987">1987</option>
		<option value="1988">1988</option>
		<option value="1989">1989</option>
		<option value="1990">1990</option>
		<option value="1991">1991</option>
		<option value="1992">1992</option>
		<option value="1993">1993</option>
		<option value="1994">1994</option>
		<option value="1995">1995</option>
		<option value="1996">1996</option>
		<option value="1997">1997</option>
		<option value="1998">1998</option>
		<option value="1999">1999</option>
		<option value="2000">2000</option>
		<option value="2001">2001</option>
		<option value="2002">2002</option>
		<option value="2003">2003</option>
		<option value="2004">2004</option>
		<option value="2005">2005</option>
		<option value="2006">2006</option>
		<option value="2007">2007</option>
		<option value="2008">2008</option>
		<option value="2009">2009</option>
		<option value="2010">2010</option>
		<option value="2011">2011</option>
		<option value="2012">2012</option>
		<option value="2013">2013</option>
		<option value="2014">2014</option>
		<option value="2015">2015</option>
		<option value="2016">2016</option>
		<option value="2017">2017</option>
		<option value="2018">2018</option>
		<option value="2019">2019</option>
		<option value="2020">2020</option>
		<option value="2021">2021</option>
		<option value="2022">2022</option>
		<option value="2023">2023</option>
		<option value="2024">2024</option>
		<option value="2025">2025</option>
		<option value="2026">2026</option>
		</select><br><br>

		<label><b>Time: </b></label><br>
		<input type="text" name="hour" placeholder="HH" style="width: 11%;"> <b>:</b>
		<input type="text" name="minute" placeholder="MM" style="width: 11%;">

		<select name="meridian" style="padding: 13px;outline: none;">
			<option value="AM">AM</option>
			<option value="PM">PM</option>
		</select><br>

		<label><b>Packages: </b></label><br>
		<input type="radio" name="package" value="2 Hours Reservation"><span style="font-size: 17px;">2 Hours Reservation</span>
		<input type="radio" name="package" value="5 Hours Reservation"><span style="font-size: 17px;">5 Hours Reservation</span>
		<input type="radio" name="package" value="All Day Reservation"><span style="font-size: 16px;">All Day Reservation</span><br><br>

		<label><b>Gender: </b></label><br>
		<span>Male</span><input type="radio" name="gender" value="male">
		<span>Female</span><input type="radio" name="gender" value="female">

		<p style="color: white;font-size: 12px;">NOTE: Your Payment has to be made in other for your application to be approved. Payment Validates Application.</p><br>

		<label><b>Consent*</b></label><br>
		<span>I Agree</span><input type="radio" name="choice" value="agree">
		<span>I Disagree</span><input type="radio" name="choice" value="disagree"><br>

		<button name="send">Submit</button>

	</form>







<?php

if($_POST){
	$fname=$_POST['fname'];
	$lname=$_POST['lname'];
	$email=$_POST['email'];
	$phone=$_POST['phone'];
	$address=$_POST['address'];
	$street_address=$_POST['street_address'];
	$city=$_POST['city'];
	$state=$_POST['state'];
	$country=$_POST['country'];
	$location=$_POST['location'];
	$event_location=$_POST['event_location'];
	$reason=$_POST['reason'];
	$days=$_POST['days'];
	$month=$_POST['month'];
	$year=$_POST['year'];
	$hour=$_POST['hour'];
	$minute=$_POST['minute'];
	$meridian=$_POST['meridian'];
	$package=$_POST['package'];
	$gender=$_POST['gender'];
	$choice=$_POST['choice'];
	
	$subject="New Permit Request";

$message = "<p>
	Name: $fname " . " " . $lname . " <br/>
	Email of Client: $email <br/>
	Phone Number: $phone <br/>
	Address: $address <br/>
	Street Address: $street_address <br/>
	City: $city <br/>
	State: $state <br/>
	Country: $country <br/>
	location: $location <br/>
	event location: $event_location <br/>
	reason: $reason <br/>
	Time: $days/$month/$year: $hour:$minute $meridian <br/>
	Package: $package <br/>
	Gender: $gender <br/>
	Choice: $choice <br/>
</p>";
	
	sendmail("support@connecttogetherwith.com","$subject","$message");
	
	echo"
	<script>
	swal('Great','We have received your request We Will Respond As Soon As Possible','success')
	</script>
	";
}

?>










<script src="https://unpkg.com/sweetalert/dist/sweetalert.min.js"></script>


</div>
<!--sign up form end here-->
</body>
</html>
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