Blest Organics (1849) -- Blest Organics OptIn (378)

contact - Blest Organics Contact Form

FormID: 995 AccountID: 378

RESPONSIVE config-contact.php file: <?php $arHandlebarView["template"] = "form-whatever"; if ($useThanks!=true) { $arHandlebarView["headerText"] = 'Contact Us'; $arHandlebarView["descriptionText"] = $reqmessage.'<p>We would like the opportunity to provide you with more information. Please fill in the simple form below, select the <strong>Submit</strong> button, and we will get back to you shortly.</p>'; $arHandlebarForm["hiddenSection"][] = array("name"=>"FormID","value"=>"0000000995"); $arHandlebarForm["hiddenSection"][] = array("name"=>"AID","value"=>"0000000378"); $arHandlebarForm["hiddenSection"][] = array("name"=>"ref","value"=>$_REQUEST['ref']); $arHandlebarForm["hiddenSection"][] = array("name"=>"ET","value"=>$_REQUEST['ET']); $arHandlebarForm["hiddenSection"][] = array("name"=>"FT","value"=>$_REQUEST['FT']); if ($_REQUEST['PID']<>"") $_REQUEST['Num']=$_REQUEST['PID']; if ($_REQUEST['Num']<>"") $arHandlebarForm["hiddenSection"][] = array("name"=>"PID","value"=>$_REQUEST['Num']); $arContactSection["FirstName"] = array("type"=>"input","required"=>1,"label"=>" First Name:","name"=>"FirstName","id"=>"FirstName","maxlength"=>24,"value"=>$_REQUEST["FirstName"]); $arContactSection["LastName"] = array("type"=>"input","required"=>0,"label"=>" Last Name:","name"=>"LastName","id"=>"LastName","maxlength"=>32,"value"=>$_REQUEST["LastName"]); $arContactSection["Email"] = array("type"=>"input","required"=>1,"label"=>" Email:","name"=>"Email","id"=>"Email","maxlength"=>64,"value"=>$_REQUEST["Email"]); $arContactSection["Phone"] = array("type"=>"input","required"=>0,"label"=>" Phone:","name"=>"Phone","id"=>"Phone","maxlength"=>16,"value"=>$_REQUEST["Phone"]); $arContactSection["Address1"] = array("type"=>"input","required"=>0,"label"=>" Address1:","name"=>"Address1","id"=>"Address1","maxlength"=>48,"value"=>$_REQUEST["Address1"]); $arContactSection["Address2"] = array("type"=>"input","required"=>0,"label"=>" Address2:","name"=>"Address2","id"=>"Address2","maxlength"=>48,"value"=>$_REQUEST["Address2"]); $arContactSection["City"] = array("type"=>"input","required"=>0,"label"=>" City:","name"=>"City","id"=>"City","maxlength"=>24,"value"=>$_REQUEST["City"]); $arContactSection["State"] = array("type"=>"select","required"=>0,"label"=>" State:","name"=>"State","id"=>"State","data"=>array( array("value"=>"","label"=>"State/Province"),array("value"=>"AL","label"=>"Alabama","selected"=>(($URL_State=="AL")?1:0)),array("value"=>"AK","label"=>"Alaska","selected"=>(($URL_State=="AK")?1:0)),array("value"=>"AZ","label"=>"Arizona","selected"=>(($URL_State=="AZ")?1:0)),array("value"=>"AR","label"=>"Arkansas","selected"=>(($URL_State=="AR")?1:0)),array("value"=>"CA","label"=>"California","selected"=>(($URL_State=="CA")?1:0)),array("value"=>"CO","label"=>"Colorado","selected"=>(($URL_State=="CO")?1:0)),array("value"=>"CT","label"=>"Connecticut","selected"=>(($URL_State=="CT")?1:0)),array("value"=>"DE","label"=>"Delaware","selected"=>(($URL_State=="DE")?1:0)),array("value"=>"DC","label"=>"Dist. of 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Island","selected"=>(($URL_State=="VI")?1:0)),array("value"=>"AB","label"=>"Alberta","selected"=>(($URL_State=="AB")?1:0)),array("value"=>"BC","label"=>"British Columbia","selected"=>(($URL_State=="BC")?1:0)),array("value"=>"MB","label"=>"Manitoba","selected"=>(($URL_State=="MB")?1:0)),array("value"=>"NB","label"=>"New Brunswick","selected"=>(($URL_State=="NB")?1:0)),array("value"=>"NF","label"=>"Newfoundland","selected"=>(($URL_State=="NF")?1:0)),array("value"=>"NT","label"=>"NW Territories","selected"=>(($URL_State=="NT")?1:0)),array("value"=>"NS","label"=>"Nova Scotia","selected"=>(($URL_State=="NS")?1:0)),array("value"=>"ON","label"=>"Ontario","selected"=>(($URL_State=="ON")?1:0)),array("value"=>"PE","label"=>"Prince Edward Isl","selected"=>(($URL_State=="PE")?1:0)),array("value"=>"QB","label"=>"Quebec","selected"=>(($URL_State=="QB")?1:0)),array("value"=>"SK","label"=>"Saskatchewan","selected"=>(($URL_State=="SK")?1:0)),array("value"=>"YT","label"=>"Yukon Territory","selected"=>(($URL_State=="YT")?1:0)) ) ); $arContactSection["Zip"] = array("type"=>"input","required"=>0,"label"=>" Zip:","name"=>"Zip","id"=>"Zip","maxlength"=>10,"value"=>$_REQUEST["Zip"]); $arContactSection["Country"] = array("type"=>"select","required"=>0,"label"=>" Country:","name"=>"Country","id"=>"Country","data"=>array( array("value"=>"","label"=>"Country"),array("value"=>"United States of America","label"=>"United States of America","selected"=>(($URL_Country=="United States of America")?1:0)),array("value"=>"Canada","label"=>"Canada","selected"=>(($URL_Country=="Canada")?1:0)),array("value"=>"United Kingdom","label"=>"United Kingdom","selected"=>(($URL_Country=="United Kingdom")?1:0)),array("value"=>"Afghanistan","label"=>"Afghanistan","selected"=>(($URL_Country=="Afghanistan")?1:0)),array("value"=>"Aland Islands","label"=>"Aland Islands","selected"=>(($URL_Country=="Aland Islands")?1:0)),array("value"=>"Albania","label"=>"Albania","selected"=>(($URL_Country=="Albania")?1:0)),array("value"=>"Algeria","label"=>"Algeria","selected"=>(($URL_Country=="Algeria")?1:0)),array("value"=>"American Samoa","label"=>"American Samoa","selected"=>(($URL_Country=="American Samoa")?1:0)),array("value"=>"Andorra","label"=>"Andorra","selected"=>(($URL_Country=="Andorra")?1:0)),array("value"=>"Angola","label"=>"Angola","selected"=>(($URL_Country=="Angola")?1:0)),array("value"=>"Anguilla","label"=>"Anguilla","selected"=>(($URL_Country=="Anguilla")?1:0)),array("value"=>"Antigua and Barbuda","label"=>"Antigua and Barbuda","selected"=>(($URL_Country=="Antigua and 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$arHandlebarForm["contactSection"] = $arContactSection; $arQuestionSection["MAID:0000008155"] = array("select"=>1,"name"=>"MAID:0000008155","id"=>"MAID:0000008155","required"=>0,"label"=>"How did you hear about us?","data"=>array ( array('value'=>'0000065368','label'=>'-select one-'), array('value'=>'0000065369','label'=>'Google'), array('value'=>'0000065370','label'=>'Yahoo!'), array('value'=>'0000065371','label'=>'Bing'), array('value'=>'0000065372','label'=>'Ask.com'), array('value'=>'0000065373','label'=>'Other Internet'), array('value'=>'0000065374','label'=>'Brochure'), array('value'=>'0000065375','label'=>'Print Publication'), array('value'=>'0000065376','label'=>'Other Printed Material'), array('value'=>'0000065377','label'=>'Personal Referral'))); $arQuestionSection["TEXT:0000008201"] = array("input"=>1,"required"=>0,"label"=>"If Other, please explain further: ","name"=>"TEXT:0000008201","id"=>"TEXT:0000008201","maxlength"=>64,"value"=>$_REQUEST["TEXT:0000008201"]); $arQuestionSection["TEXT:0000008154"] = array("textarea"=>1,"required"=>0,"label"=>"Please provide additional details about your request including a way and time to contact you: ","name"=>"TEXT:0000008154","id"=>"TEXT:0000008154","value"=>$_REQUEST["TEXT:0000008154"]); $arHandlebarForm["questionSection"] = $arQuestionSection; $arHandlebarView["form"] = array("name"=>"contact_form","id"=>"contact_form","action"=>"/contact/form_contact","method"=>"post","onsubmit"=>$formOnSubmit,"submitID"=>"submitform","fields"=>$arHandlebarForm); } else { $arHandlebarView["headerText"] = 'Thank You For Your Time'; $arHandlebarView["descriptionText"] = '<P>Many thanks for contacting us. A representative will be responding to your on-line request shortly. We appreciate your business and will do our best to serve your needs!</p>'; $arHandlebarView["form"] = ''; }

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