<form id="contact-form" method="post" action="contact_processing.php" class="form-horizontal"> <div class="control-group row"> <label class="control-label col-md-3" for="contact-name">نام</label> <div class="controls col-md-9"> <input id="contact-name" name="contact-name" type="text" placeholder="" class="input-xlarge form-control" required=""> </div> </div> <div class="control-group row"> <label class="control-label col-md-3" for="contact-email">ایمیل</label> <div class="controls col-md-9"> <input id="contact-email" name="contact-email" type="text" placeholder="تست.تست@تست.تست" class="input-xlarge form-control" required=""> </div> </div> <div class="control-group row"> <label class="control-label col-md-3" for="contact-topic">موضوع</label> <div class="controls col-md-9"> <select id="contact-topic" name="contact-topic" class="input-xlarge form-control"> <option>بخش پنجم</option> <option selected="selected">بخش چهارم</option> <option>بخش سوم</option> <option>بخش دوم</option> <option>بخش اول</option> </select> </div> </div> <div class="control-group row"> <label class="control-label col-md-3" for="contact-message">پیام</label> <div class="controls col-md-9"> <textarea id="contact-message" name="contact-message" class=" form-control" rows="5">ما مشتاق به شنیدن از شما هستیم !</textarea> </div> </div> <div class="control-group row"> <label class="control-label col-md-3">کد امنیتی</label> <div class="controls col-md-9"> <input type="text" name="captcha_code" class="form-control" size="10" maxlength="6" /> <a href="#" onclick="document.getElementById('captcha').src = '/securimage/securimage_show.php?' + Math.random(); return false"> <img id="captcha" src="/securimage/securimage_show.php" alt="CAPTCHA Image" /> </a> </div> </div> <div class="control-group text-right"> <input type="hidden" name="submitted" id="submitted" value="true" /> <button type="submit" class="btn btn-default" name="submitted"><i class="fa fa-paper-plane-o"></i> ارسال</button> </div> </form>