<br/>
<p><?=$intro?></p>

<br/>

<form class="form-horizontal" action="/contact/submit" method="post">
<input type="hidden" name="formname" value="<?php echo $title; ?>" />
<input type="hidden" name="ctype" value="<?php echo $ctype; ?>" />

<fieldset>


<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single required" for="fname">Contact First Name</label>
  <div class="col-sm-7">
    <input id="fname" name="fname" type="text" placeholder="" class="form-control" required="required" value="<?=$post['fname']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single required" for="lname">Contact Last Name</label>
  <div class="col-sm-7">
    <input id="lname" name="lname" type="text" placeholder="" class="form-control" required="required" value="<?=$post['lname']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="company">Company Name</label>
  <div class="col-sm-7">
    <input id="company" name="company" type="text" placeholder="" class="form-control" value="<?=$post['company']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="title">Title</label>
  <div class="col-sm-7">
    <input id="title" name="title" type="text" placeholder="" class="form-control" value="<?=$post['title']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single required" for="email">Email Address</label>
  <div class="col-sm-7">
    <input id="email" name="email" type="email" placeholder="" class="form-control" required="required" value="<?=$post['email']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="address1">Address 1</label>
  <div class="col-sm-7">
    <input id="address1" name="address1" type="text" placeholder="" class="form-control" value="<?=$post['add1']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="address2">Address 2</label>
  <div class="col-sm-7">
    <input id="address2" name="address2" type="text" placeholder="" class="form-control" value="<?=$post['add2']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="city">City</label>
  <div class="col-sm-7">
    <input id="city" name="city" type="text" placeholder="" class="form-control" value="<?=$post['city']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="state">State</label>
  <div class="col-sm-7">
    <input id="state" name="state" type="text" placeholder="" class="form-control" value="<?=$post['state']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="zip">Postal Code</label>
  <div class="col-sm-7">
    <input id="zip" name="zip" type="text" placeholder="" class="form-control" value="<?=$post['zip']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="phone">Phone Number</label>
  <div class="col-sm-7">
    <input id="phone" name="phone" type="tel" placeholder="" class="form-control" value="<?=$post['phone']?>">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group pooh">
  <label class="col-sm-4 control-label single" for="pooh">Your Comments</label>
  <div class="col-sm-7">
    <input id="yourcomments" name="yourcomments" type="text" placeholder="" class="form-control" value="">
  </div>
</div>

<?php if ($ctype == 'temp_request'): ?>
<!-- Multiple Checkboxes -->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="likeinfo">I would like more information about:</label>
  <div class="col-sm-7">
    <div class="checkbox"><label for="likeinfo-0">
      <input type="checkbox" name="likeinfo[]" id="likeinfo-0" value="Risk Assessment/Integrated Asset Protection">
      Risk Assessment/Integrated Asset Protection
    </label></div>
    <div class="checkbox"><label for="likeinfo-1">
      <input type="checkbox" name="likeinfo[]" id="likeinfo-1" value="Criminal Background Check">
      Criminal Background Check
    </label></div>
    <div class="checkbox"><label for="likeinfo-2">
      <input type="checkbox" name="likeinfo[]" id="likeinfo-2" value="Incident Reporting Software Security Officers">
      Incident Reporting Software Security Officers
    </label></div>
    <div class="checkbox"><label for="likeinfo-3">
      <input type="checkbox" name="likeinfo[]" id="likeinfo-3" value="Nuclear Security Capabilities">
      Nuclear Security Capabilities
    </label></div>
  </div>
</div>

<!-- Multiple Radios -->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="usesecurity">Do you use a security officer service?</label>
  <div class="col-sm-7">
    <div class="radio"><label for="usesecurity-0">
      <input type="radio" name="usesecurity" id="usesecurity-0" value="Yes" checked="checked"> Yes
    </label></div>
    <div class="radio"><label for="usesecurity-1">
      <input type="radio" name="usesecurity" id="usesecurity-1" value="No"> No
    </label></div>
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label" for="hrsperweek">How many hours per week? (approx)</label>
  <div class="col-sm-7">
    <input id="hrsperweek" name="hrsperweek" type="text" placeholder="" class="form-control" value="<?=$post['hrsperweek']?>">
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label" for="currentprovider">Who is your current security provider?</label>
  <div class="col-sm-7">
    <input id="currentprovider" name="currentprovider" type="text" placeholder="" class="form-control" value="<?=$post['currentprovider']?>">
    
  </div>
</div>

<!-- Multiple Radios -->
<div class="form-group">
  <label class="col-sm-4 control-label single" for="satisfied">Are you satisfied with the level of service from your current provider?</label>
  <div class="col-sm-7">
    <div class="radio"><label for="satisfied-0">
      <input type="radio" name="satisfied" id="satisfied-0" value="Yes" checked="checked"> Yes
    </label></div>
    <div class="radio"><label for="satisfied-1">
      <input type="radio" name="satisfied" id="satisfied-1" value="No"> No
    </label></div>
  </div>
</div>

<!-- Textarea -->
<div class="form-group">
  <label class="col-sm-4 control-label" for="satisfiedwhy">Why or why not?</label>
  <div class="col-sm-7">                     
    <textarea class="form-control" rows="4" id="satisfiedwhy" name="satisfiedwhy"><?=$post['satisfiedwhy']?></textarea>
  </div>
</div>

<!-- Multiple Radios -->
<div class="form-group">
  <label class="col-sm-4 control-label" for="usebidding">Do you use a bidding procedure when selecting a security services vendor?</label>
  <div class="col-sm-7">
    <div class="radio"><label for="usebidding-0">
      <input type="radio" name="usebidding" id="usebidding-0" value="Yes" checked="checked"> Yes
    </label></div>
    <div class="radio"><label for="usebidding-1">
      <input type="radio" name="usebidding" id="usebidding-1" value="No"> No
    </label></div>
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-sm-4 control-label" for="contractexpire">When is the current contract up for review?</label>
  <div class="col-sm-7">
    <input id="contractexpire" name="contractexpire" type="text" placeholder="" class="form-control" value="<?=$post['contractexpire']?>">
    
  </div>
</div>
<?php endif; ?>


<!-- Textarea -->
<div class="form-group">
  <label class="col-sm-4 control-label required" for="message">Message</label>
  <div class="col-sm-7">                     
    <textarea class="form-control" rows="4" id="message" name="message" required="required"><?=$post['message']?></textarea>
  </div>
</div>

<!-- Button -->
<div class="form-group">
  <label class="col-sm-4 control-label" for="msgsubmit"></label>
  <div class="col-sm-7">
    <button id="msgsubmit" name="msgsubmit" class="btn btn-primary">Submit Form</button>
  </div>
</div>

</fieldset>
</form>