<?php require_once(dirname(__FILE__).'/koneksi.php'); require_once(dirname(__FILE__).'/common/header.php'); ?> <br/> <form class="well form-horizontal" action="cek_comment.php" method="post" id="contact_form"> <fieldset> <legend>Berikan kritik dan saran anda pada kolom dibawah ini</legend> <div class="form-group"> <label class="col-md-4 control-label">Nama</label> <div class="col-md-4 inputGroupContainer"> <div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span> <input name="name" required placeholder="Isi Nama Anda" class="form-control" type="text"> </div> </div> </div> <div class="form-group"> <label class="col-md-4 control-label">Hp </label> <div class="col-md-4 inputGroupContainer"> <div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span> <input name="phone" required placeholder="Nomor Handphone" class="form-control" type="text"> </div> </div> </div> <div class="form-group"> <label class="col-md-4 control-label">E-Mail</label> <div class="col-md-4 inputGroupContainer"> <div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span> <input name="email" required placeholder="E-Mail" class="form-control" type="text"> </div> </div> </div> <div class="form-group col-md-8" style="margin-top: 20px;margin-left: 15px;"> <label for="comment" required >Kritik Dan Saran:</label></div> <textarea class="form-control" rows="5" id="comment" name="comment" placeholder="Masukkan Ulasan Anda"></textarea><br> <button type="submit" onclick="window.alert('Terimakasih Telah Memberikan Kritik dan Saran!');" class="btn btn-primary" name="kirim"> Kirim <span class="glyphicon glyphicon-send"></span></button> </fieldset> </form> <?php require_once(dirname(__FILE__).'/common/footer.php'); ?>