Skip to content

Commit

Permalink
Update contact.html
Browse files Browse the repository at this point in the history
  • Loading branch information
therealsupermax authored Nov 10, 2024
1 parent 9a0e2a5 commit a917123
Showing 1 changed file with 6 additions and 7 deletions.
13 changes: 6 additions & 7 deletions contact.html
Original file line number Diff line number Diff line change
Expand Up @@ -13,27 +13,27 @@ <h1>Contact Information</h1>
<form id="contact-form" action="https://formsubmit.co/supermax333@proton.me" method="POST">
<div class="form-group">
<label for="first-name">First Name</label>
<input type="text" id="first-name" required>
<input type="text" id="first-name" name="first-name" required>
</div>
<div class="form-group">
<label for="last-name">Last Name</label>
<input type="text" id="last-name" required>
<input type="text" id="last-name" name="last-name" required>
</div>
<div class="form-group">
<label for="phone">Phone Number</label>
<input type="text" id="phone" required>
<input type="text" id="phone" name="phone" required>
</div>
<div class="form-group">
<label for="email">Email</label>
<input type="email" id="email" required>
<input type="email" id="email" name="email" required>
</div>
<div class="form-group">
<label for="address">Mailing Address</label>
<input type="text" id="address" required>
<input type="text" id="address" name="address" required>
</div>
<div class="form-group">
<label for="insurance">Insurance Company</label>
<input type="text" id="insurance" required>
<input type="text" id="insurance" name="insurance" required>
</div>
<button type="submit">Submit</button>
</form>
Expand All @@ -42,4 +42,3 @@ <h1>Contact Information</h1>
<script src="contact.js"></script>
</body>
</html>

0 comments on commit a917123

Please sign in to comment.