<?php include('layout/header.php')?>

<!-- HERO SECTION -->
	<div class="hero">
		<div class="container">
			<div class="row justify-content-between">
				<div class="col-lg-5">
					<div class="intro-excerpt">
								<h1>Enquiry</h1>
							</div>
						</div>
					<div class="col-lg-7">
				</div>
			</div>
		</div>
	</div>

<!-- ENQUIRY FORM -->
<div class="container my-5" id="enquiry-form">

    <h4 class="mb-4">
        » Please complete the enquiry form below so that we may send you detailed technical information
    </h4>

    <form method="post" action="">

        <!-- PERSONAL INFORMATION -->
        <h5 class="mt-4 mb-3">Personal Information</h5>

        <div class="row">
            <div class="col-md-6 mb-3">
                <label>Company Name</label>
                <input type="text" name="company_name" class="form-control">
            </div>

            <div class="col-md-6 mb-3">
                <label>Contact Person Name <span class="text-danger">*</span></label>
                <input type="text" name="contact_person" class="form-control" required>
            </div>

            <div class="col-md-12 mb-3">
                <label>Address</label>
                <textarea name="address" class="form-control" rows="2"></textarea>
            </div>

            <div class="col-md-4 mb-3">
                <label>City <span class="text-danger">*</span></label>
                <input type="text" name="city" class="form-control" required>
            </div>

            <div class="col-md-4 mb-3">
                <label>State / Country</label>
                <input type="text" name="state_country" class="form-control">
            </div>

            <div class="col-md-4 mb-3">
                <label>Zip Code</label>
                <input type="text" name="zip_code" class="form-control">
            </div>

            <div class="col-md-6 mb-3">
                <label>Telephone No. <span class="text-danger">*</span></label>
                <input type="text" name="telephone" class="form-control" required>
            </div>

            <div class="col-md-6 mb-3">
                <label>Fax No.</label>
                <input type="text" name="fax" class="form-control">
            </div>

            <div class="col-md-6 mb-3">
                <label>Email Address <span class="text-danger">*</span></label>
                <input type="email" name="email" class="form-control" required>
            </div>
        </div>

        <!-- TECHNICAL INFORMATION -->
        <h5 class="mt-4 mb-3">Request Additional Technical Information</h5>

        <div class="mb-3">
            <label class="fw-bold">1) My interest is in:</label>
            <div class="form-check">
                <input class="form-check-input" type="checkbox" name="interest[]" value="PMDC Motors">
                <label class="form-check-label">PMDC Motors</label>
            </div>
            <div class="form-check">
                <input class="form-check-input" type="checkbox" name="interest[]" value="Geared Motors">
                <label class="form-check-label">Geared Motors</label>
            </div>
            <div class="form-check">
                <input class="form-check-input" type="checkbox" name="interest[]" value="DC Drives">
                <label class="form-check-label">DC Drives</label>
            </div>
        </div>

        <div class="mb-3">
            <label class="fw-bold">2) My requirements are:</label>
            <div class="row mt-2">
                <div class="col-md-4 mb-2">
                    <label>Horsepower (HP)</label>
                    <input type="text" name="horsepower" class="form-control">
                </div>

                <div class="col-md-4 mb-2">
                    <label>Full Load Speed (RPM)</label>
                    <input type="text" name="speed" class="form-control">
                </div>

                <div class="col-md-4 mb-2">
                    <label>Torque (Kgcm)</label>
                    <input type="text" name="torque" class="form-control">
                </div>
            </div>
        </div>

        <div class="mb-3">
            <label>Gearbox Type</label>
            <select name="gearbox_type" class="form-select">
                <option value="">Select Gearbox Type</option>
                <option value="Parallel Shaft">Parallel Shaft</option>
            </select>
        </div>

        <div class="mb-4">
            <label class="fw-bold">3) Detailed technical or application question</label>
            <textarea name="technical_question" class="form-control" rows="4"
                placeholder="Please describe your application or technical requirement in detail"></textarea>
        </div>

        <button type="submit" name="submit" class="btn btn-primary px-5">
            Submit Enquiry
        </button>

    </form>
</div>

<?php include('layout/footer.php')?>
