Your IP : 216.73.216.34
<?php
include("function.php");
$aa='be-an-agent-distributor.html';
$aaa=$lang['words'][270];
$purl=$aa;
$pageh1=$aaa;
$topbg='contact-us';
$pagebreadcrumb=$lang['words'][222].', '.$lang['words'][223];
$pkeyw=$lang['words'][225];
$feedbacktit=$lang['words'][270];
$pagekeyword=$lang['words'][222].', '.$aaa;
$pagekeyword2=$lang['words'][222].', '.$lang['words'][225];
$pagekeyword3=$company['12'];
include("lang_beanagent.php");
include("head.php");
?>
<div class="section m-0" style="background: url('https://<?=$imgweb?>/img/4.jpg') no-repeat bottom center; background-size: auto;">
<div class="container">
<div class="row justify-content-center align-items-center">
<div class="col-md-6">
<div class="card shadow-sm">
<div class="card-body mb-0 pb-0">
<h2 class="mb-1"><?=$lang['words'][270]?></h2>
<p class="mb-3">
<?=$lang_beanagent['words'][1]?>.
<br/>
<?=$lang_beanagent['words'][2]?>
<br/>
<?=$lang_beanagent['words'][3]?>:
</p>
<div class="mb-0 pb-0">
<form name="InquiryForm" class='rd-mailform' onSubmit="return validateInquiryForm(this);" action="dow-brochure.php" method=post encType=multipart/form-data>
<input type="hidden" name="dowpdf" id="dowpdf" value="<?=$dow[0]?>"/>
<input type="hidden" name="service" value="1" id="service" />
<input type="hidden" name="s" id="s" />
<input type="hidden" name="feedbackurl" id="feedbackurl" value="<?=$purl?>"/>
<input type="hidden" name="subject" id="subject" value="<?=$feedbacktit?>"/>
<input type="hidden" name="fax" id="fax" value="/"/>
<input type="hidden" name="replyDays" id="replyDays" value="/"/> <input type="hidden" name="website" id="website" value="/"/>
<INPUT type=hidden value="<?=preg_replace('/(http:\/\/)|(https:\/\/)/i', '', $company[7])?>" name=fromSite>
<INPUT type=hidden name=HI_vc_key>
<input type="hidden" name="form-type" value="contact"/>
<div class="row">
<div class="form-group col-md-12">
<label>Industries you specialize?</label>
<input type="checkbox" name="Inquireon[]" id="Inquireon[]" value="<?=$lang['words'][255]?>">
<?=$lang['words'][255]?>
<input type="checkbox" name="Inquireon[]" id="Inquireon[]" value="<?=$lang['words'][256]?>" style="margin-left:10px;">
<?=$lang['words'][256]?>
<input type="checkbox" name="Inquireon[]" id="Inquireon[]" value="<?=$lang['words'][257]?>" style="margin-left:10px;">
<?=$lang['words'][257]?>
</div>
</div>
<fieldset>
<div class="row mb-0 pb-0">
<div class="form-group col-md-6 mb-0 pb-0">
<label> <input type="text"
name="name"
placeholder="* Your Name"
/></label>
</div>
<div class="form-group col-md-6 mb-0 pb-0">
<label> <input type="text"
name="email"
placeholder="* E-mail"
/></label>
</div>
<div class="form-group col-md-12 mb-0 pb-0">
<label> <input type="text"
name="company"
placeholder="* Company Name"
/></label>
</div>
<div class="form-group col-md-4 mb-0 pb-0">
<label> <input type="text"
name="tel"
placeholder="* Phone"
/>
</label></div>
<div class="form-group col-md-4 mb-0 pb-0">
<label> <input type="text"
name="address"
placeholder="* Zip/Postal Code"
/>
</label></div>
<div class="form-group col-md-4 mb-0 pb-0">
<label> <input type="text"
name="country"
placeholder="* Country"
/>
</label></div>
</div>
<label class="textarea" data-add-placeholder="">
<TEXTAREA onMouseUp="textLimitCheck(this, messageCount,3000)" onMouseDown="textLimitCheck(this, messageCount,3000)" onKeyDown="textLimitCheck(this, messageCount,3000)" onKeyUp="textLimitCheck(this, messageCount,3000)" style="HEIGHT: 150px" name="content" placeholder="* Message: (20 Characters Minimum)" work-break:all data-constraints='@Required @Length(min=20,max=999999)'></TEXTAREA>
<INPUT id=messageCount style="WIDTH: 80px" readOnly name=messageCount >
</label>
<div class="vcode">
<INPUT maxLength=4 style="WIDTH: 80px; float: left;" name=HI_vc_value class="HI_vc_value" ><img src="auth_image.php" class="en-img">
</div>
<div class="mfControls text-left text-lg-left">
<INPUT class="button button-3d button-rounded button-red" type=submit value=<?=$lang['words'][58]?> name=submit>
</div>
</fieldset>
</form>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="heading-block border-bottom-0 bottommargin-sm">
<div class="badge rounded-pill badge-default"><?=$lang_download['words'][2]?></div>
<h3 class="nott ls0"><?=$lang_beanagent['words'][4]?>!</h3>
</div>
<p>
<?=$lang_beanagent['words'][5]?>.
</p>
</div>
</div>
</div>
</div>
<? include('foot.php');
if ($_SESSION['MemberName']!=""){
$content = ob_get_contents();
$fp = 'be-an-agent-distributor.html';
$fp = fopen($fp, "w");
fwrite($fp, $content);
fclose($fp);
ob_end_clean();
}
echo "<script language=\"javascript\">window.open('./contact.php?ttt=$_GET[ttt]','_self');</script>";
?>