<form action="/pl/kontakt" method="post" class="contact-form-box" enctype="multipart/form-data">
<fieldset>
<h3 class="page-subheading">Wyślij wiadomość</h3>
<div class="clearfix">
<div class="col-xs-12 col-md-3">
<div class="form-group selector1">
<label for="id_contact">Temat</label>
<div class="selector" id="uniform-id_contact" style="width: 268px;"><span style="width: 258px; user-select: none;">-- Wybierz --</span><select id="id_contact" class="form-control" name="id_contact">
<option value="0">-- Wybierz --</option>
<option value="2">Obsługa klienta</option>
</select></div>
</div>
<p id="desc_contact0" class="desc_contact"> </p>
<p id="desc_contact2" class="desc_contact contact-title unvisible">
<i class="icon-comment-alt"></i>Wszelkie pytania dotyczące produktów i zamówień
</p>
<p class="form-group">
<label for="email">Adres e-mail</label>
<input class="form-control grey validate" type="text" id="email" name="from" data-validate="isEmail" value="">
</p>
<div class="form-group selector1">
<label>Numer zamówienia</label>
<input class="form-control grey" type="text" name="id_order" id="id_order" value="">
</div>
<p class="form-group">
<label for="fileUpload">Załącz plik</label>
<input type="hidden" name="MAX_FILE_SIZE" value="134217728">
<div class="uploader" id="uniform-fileUpload"><input type="file" name="fileUpload" id="fileUpload" class="form-control"><span class="filename" style="user-select: none;">Nie wybrano pliku</span><span class="action" style="user-select: none;">Wybierz plik</span></div>
</p>
</div>
<div class="col-xs-12 col-md-9">
<div class="form-group">
<label for="message">Wiadomość</label>
<textarea class="form-control" id="message" name="message"></textarea>
</div>
</div>
</div>
<div class="submit"><div class="form-group row"><div class="offset-md-3"><div class="col-md-9"><div class="g-recaptcha" data-sitekey="6LfvdocUAAAAAKFREEpmZOVp3Jly_nLtsNtX_9__"><div style="width: 304px; height: 78px;"><div><iframe title="reCAPTCHA" src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LfvdocUAAAAAKFREEpmZOVp3Jly_nLtsNtX_9__&co=aHR0cHM6Ly9tb2xhcnIucGw6NDQz&hl=pl&v=dpzVjBAupwRfx3UzvXRnnAKb&size=normal&cb=fppqlggdad5l" width="304" height="78" role="presentation" name="a-76j4uwno87d7" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea></div><iframe style="display: none;"></iframe></div></div></div></div>
<button type="submit" name="submitMessage" id="submitMessage" class="button btn btn-default button-medium"><span>Wyślij<i class="icon-chevron-right right"></i></span></button>
</div>
</fieldset>
</form>
Darmowa dostawa od 400zł
Zadzwoń: 533 253 411 lub 42 671 02 07 |
sklep@molarr.pl
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