CINXE.COM
Error / Suggestion Notification Form
<!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width,initial-scale=1,maximum-scale=1,user-scalable=0,minimal-ui" /> <link rel="shortcut icon" href="http://www.yenimedya.com.tr/lib/img/favicon.ico?v=8" type="image/x-icon" /> <title>Error / Suggestion Notification Form</title> <link href='http://fonts.googleapis.com/css?family=Open+Sans:300italic,400italic,600italic,700italic,700,300,600,400&subset=latin,latin-ext' rel='stylesheet' type='text/css'> <link href="static/css/bootstrap.min.css" rel="stylesheet"> <link href="static/css/bootstrap-theme.min.css" rel="stylesheet"> <link href="static/css/preset.css?v=1" rel="stylesheet"> <link href="static/css/style.css" rel="stylesheet"> <script src="static/js/jquery-2.1.3.min.js"></script> <script src="static/js/bootstrap.min.js"></script> <script type="text/javascript"> function GetWidth() { var x = 0; if (self.innerHeight) { x = self.innerWidth; } else if (document.documentElement && document.documentElement.clientHeight) { x = document.documentElement.clientWidth; } else if (document.body) { x = document.body.clientWidth; } return x; } function GetHeight() { var x = 0; if (self.innerHeight) { x = self.innerHeight; } else if (document.documentElement && document.documentElement.clientHeight) { x = document.documentElement.clientHeight; } else if (document.body) { x = document.body.clientHeight; } return x; } $(document).ready(function () { var txt = ""; txt += "Window Width: " + GetWidth() + "<br>"; txt += "Window Height: " + GetHeight() + "<br>"; txt += "Browser CodeName: " + navigator.appCodeName + "<br>"; txt += "Browser Name: " + navigator.appName + "<br>"; txt += "Browser Version: " + navigator.appVersion + "<br>"; txt += "Cookies Enabled: " + navigator.cookieEnabled + "<br>"; txt += "Browser Language: " + navigator.language + "<br>"; txt += "Browser Online: " + navigator.onLine + "<br>"; txt += "Platform: " + navigator.platform + "<br>"; txt += "User-agent header: " + navigator.userAgent + ""; $("#user-agent").val(txt); }); </script> <script type="text/javascript"> function RefreshImage(valImageId) { var objImage = document.getElementById(valImageId) if (objImage == undefined) { return; } var now = new Date(); objImage.src = objImage.src.split('?')[0] + '?x=' + now.toUTCString(); } </script> </head> <body> <div class="container"> <div class="row mar-bot-30"> <div class="col-lg-8 col-lg-offset-2 col-md-8 col-md-offset-2"> <div class="rounded-box"> <h2 class="mar-bot-30">Error / Suggestion Notification Form</h2> <div class="row"> <div class="col-lg-12 mar-bot-20"> <p class="bg-info">You can report your suggestions about our site via this form.</p> </div> </div> <div class="row"> <div class="col-lg-12 col-md-12"> <form method="post" enctype="multipart/form-data" class="form-horizontal"> <div class="form-group mar-bot-20 row"> <label for="isim" class="col-md-3 text-">Name:</label> <div class="col-md-8"><input type="text" class="form-control" id="isim" name="isim" value="" placeholder="Name Surname" required autofocus></div> </div> <div class="form-group mar-bot-20 row"> <label for="email" class="col-md-3 text-">E-mail:</label> <div class="col-md-8"><input type="email" class="form-control" id="email" name="email" value="" placeholder="name@exampleemail.com" required></div> </div> <div class="form-group mar-bot-20 row"> <label for="adres" class="col-md-3 text-">Page Address:</label> <div class="col-md-8"><input type="text" class="form-control" id="adres" name="adres" value="https://www.poemhunter.com/maya-angelou/" placeholder="http://www.errorpage.com" required></div> </div> <div class="form-group mar-bot-20 row"> <label for="baslik" class="col-md-3 text-">Subject:</label> <div class="col-md-8"><input type="text" class="form-control" id="baslik" name="baslik" value="" placeholder="Message Subject" required ></div> </div> <div class="form-group mar-bot-20 row""> <label for="aciklama" class="col-md-3 text-">Explanation:</label> <div class="col-md-8"><textarea class="form-control" id="aciklama" name="aciklama" rows="6" maxlength="500" placeholder="Specify your explanations here in detail"></textarea></div> </div> <div class="form-group mar-bot-20 row"> <label for="aciklama" class="col-md-3 text-">Picture:</label> <div class="col-md-8"><input class="" id="resim" type="file" name="resim"> <span class="text-info">(Send screenshot.)</span></div> </div> <div class="form-group mar-bot-20 row"> <label for="guvenlik_kodu" class="col-md-3 text-">Security Code</label> <div class="col-md-8"> <img src="/tickets/cptc/captcha.asp" id="imgCaptcha" /> <a href="javascript:void(0);" onclick="RefreshImage('imgCaptcha');">Change Code</a><br /><br /> <input type="text" class="form-control" name="txtCaptcha" id="txtCaptcha" value="" autocomplete="off" placeholder="Type the characters above" required/> </div> </div> <div class="form-group mar-bot-20 row"> <label for="aciklama" class="col-md-3 text-"></label> <input type="checkbox" class="sartlar" name="sartlar" required style="margin-left:15px" value="ck" > <a href="https://www.poemhunter.com/Aboutus/Privacy/" title="I have read, understood and approve the clarification text." target="_blank">I have read, understood and approve the clarification text.</a> </div> <input type="hidden" name="konu_id" value="69"> <input type="hidden" name="gonder" value="ok" /> <input type="hidden" id="user-agent" name="user-agent"> <input type="hidden" name="takip" value=""> <div class="row"> <div class="col-md-8 col-md-offset-3"> <button type="submit" class="btn btn-info btn-block btn-lg">Send</button> </div> </div> </form> </div> </div> </div> </div> </div> </div> </body> </html>