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Server : Apache/2.4.18 (Ubuntu) System : Linux canvaswebdesign 3.13.0-71-generic #114-Ubuntu SMP Tue Dec 1 02:34:22 UTC 2015 x86_64 User : oppastar ( 1041) PHP Version : 7.0.33-0ubuntu0.16.04.15 Disable Function : pcntl_alarm,pcntl_fork,pcntl_waitpid,pcntl_wait,pcntl_wifexited,pcntl_wifstopped,pcntl_wifsignaled,pcntl_wifcontinued,pcntl_wexitstatus,pcntl_wtermsig,pcntl_wstopsig,pcntl_signal,pcntl_signal_dispatch,pcntl_get_last_error,pcntl_strerror,pcntl_sigprocmask,pcntl_sigwaitinfo,pcntl_sigtimedwait,pcntl_exec,pcntl_getpriority,pcntl_setpriority, Directory : /var/www/angkasapuraretail.com/public_html/application/views/themes/2/ |
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<!--Header-->
<div class="container-fluid header-main">
<div class="container text-center">
<h2>Request For Service</h2>
<div class="link-sec">
<a href="<?= base_url();?>">Home</a> <i class="fa fa-angle-right"></i> <a href="<?= base_url('rfs');?>">Request For Service</a>
</div>
</div>
</div>
<?php if ($sent) : ?>
<script type="text/javascript">
alert('Email Sent Successfully');
// swal('','Email Sent Successfully','success');
</script>
<?php endif ?>
<!--main-->
<div class="container py-2">
<p>Silahkan memilih jenis formulir Request For Service (RFS) dibawah ini.</p>
<button class="accordion">1. Permintaan Service Perbaikan</button>
<div class="panel">
<div class="contact-info">
<h3>Request For Service</h3>
<p>Silahkan mengisi formulir Request For Service dibawah ini. Team kami akan segera menghubungi Anda.</p>
<?= form_open(); ?>
<div class="form-warp">
<div id="formRfs">
<div class="form-rfs">
<label>Nama *</label>
<input type="text" name="nama1" required="required"/>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Email *</label>
<input type="email" name="email1" style="display: block" required="required"/>
</div>
<div class="form-rfs">
<label>Handphone *</label>
<input type="text" name="hp1" style="display: block" required="required"/>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Nama Perusahaan</label>
<input type="text" name="perusahaan1" style="display: block;" />
</div>
<div class="form-rfs">
<label>No. Tel. Perusahaan</label>
<input type="text" name="telp1" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Alamat Perusahaan</label>
<textarea rows="5" name="alamat1"></textarea>
</div>
</div>
<div id="formRfs">
<div class="form-rfs">
<label>Product Yang Akan Diperbaiki</label>
<input type="text" name="produk1" style="display: block;" />
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Merk</label>
<input type="text" name="merk1" style="display: block;" />
</div>
<div class="form-rfs">
<label>Type</label>
<input type="text" name="tipe1" style="display: block;" />
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Serial</label>
<input type="text" name="serial1" style="display: block;" />
</div>
<div class="form-rfs">
<label>Tanggal Pembelian</label>
<input type="date" name="tanggal1" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Deskripsikan Kerusakan</label>
<textarea rows="5" name="deskripsi1"></textarea>
</div>
</div>
</div>
<div id="btnRfs">
<button type="submit" name="submit" value="request1">Send RFS <i class="far fa-paper-plane"></i></button>
</div>
<?= form_close(); ?>
</div>
</div>
<button class="accordion">2. Permintaan Refilling Extinguisher</button>
<div class="panel">
<div class="contact-info">
<h3>Permintaan Refilling Extinguisher</h3>
<p>Silahkan mengisi formulir Request For Service dibawah ini. Team kami akan segera menghubungi Anda.</p>
</div>
<?= form_open();?>
<div class="form-warp">
<div id="formRfs">
<div class="form-rfs">
<label>Nama *</label>
<input type="text" name="nama2" required="required"/>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Email *</label>
<input type="email" name="email2" style="display: block" required="required"/>
</div>
<div class="form-rfs">
<label>Handphone *</label>
<input type="text" name="hp2" style="display: block" required="required"/>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Nama Perusahaan</label>
<input type="text" name="perusahaan2" style="display: block;" />
</div>
<div class="form-rfs">
<label>No. Tel. Perusahaan</label>
<input type="text" name="telp2" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Alamat Perusahaan</label>
<textarea rows="5" name="alamat2"></textarea>
</div>
</div>
<div id="formRfs">
<div id="rfqContact">
<div class="form-rfs">
<label>Merk Tabung</label>
<input class="form-control" type="text" name="merk2" style="display: block;" />
</div>
<div class="form-rfs">
<label>Ukuran Tabung</label>
<input class="form-control" type="text" name="ukuran2" style="display: block;" />
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Media Tabung</label>
<select class="form-control" name="media2">
<option value="Powder">Powder</option>
<option value="CO2">CO2</option>
<option value="Foam">Foam</option>
<option value="Halotron">Halotron</option>
<option value="FM200">FM200</option>
<option value="Inergen">Inergen</option>
</select>
</div>
<div class="form-rfs">
<label>Tanggal Refilling terakhir</label>
<input class="form-control" type="date" name="tanggal2" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Jumlah tabung yang akan direfill</label>
<input class="form-control" type="text" name="jumlah2" style="display: block;" />
</div>
<div class="form-rfs">
<label>Permintaan Khusus /keterangan lain</label>
<textarea class="form-control" rows="5" name="permintaan2" style="width: 100%"></textarea>
</div>
</div>
</div>
<div id="btnRfs">
<button type="submit" name="submit" value="request2">Send RFS <i class="far fa-paper-plane"></i></button>
</div>
<?= form_close(); ?>
</div>
<button class="accordion">3. Konsultasi Design Fire Protection System</button>
<div class="panel">
<div class="contact-info">
<h3>Konsultasi Design Fire Protection System</h3>
<p>Silahkan mengisi formulir Request For Service dibawah ini. Team kami akan segera menghubungi Anda.</p>
</div>
<?= form_open();?>
<div class="form-warp">
<div id="formRfs">
<div class="form-rfs">
<label>Nama *</label>
<input type="text" name="nama3" required="required"/>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Email *</label>
<input type="email" name="email3" style="display: block" required="required"/>
</div>
<div class="form-rfs">
<label>Handphone *</label>
<input type="text" name="hp3" style="display: block" required="required"/>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Nama Perusahaan</label>
<input type="text" name="perusahaan3" style="display: block;" />
</div>
<div class="form-rfs">
<label>No. Tel. Perusahaan</label>
<input type="text" name="telp3" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Alamat Perusahaan</label>
<textarea rows="5" name="alamat3"></textarea>
</div>
</div>
<div id="formRfs">
<div id="rfqContact">
<div class="form-rfs">
<label>Lokasi Project</label>
<input type="text" name="lokasi3" style="display: block;" />
</div>
<div class="form-rfs">
<label>Option</label>
<select name="option3">
<option value="Pemasangan Baru">Pemasangan Baru</option>
<option value="Penambahan (extention)">Penambahan (extention)</option>
</select>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Product yang dibutuhkan</label>
<select name="produk3">
<option value="">FIRE ALARM SYSTEM</option>
<option value="">FIRE SUPPRESSION SYSTEM</option>
<option value="">FIRE FIGHTING SYSTEM</option>
<option value="">OTHER</option>
</select>
</div>
<div class="form-rfs">
<label>Product Detail</label>
<select name="detail3">
<option value="Conventional">Conventional</option>
<option value="Semi addressable">Semi addressable</option>
<option value="Addressable">Addressable</option>
</select>
</div>
</div>
<div class="form-rfs">
<label>Deskripsi Project</label>
<input type="text" name="deskripsi3" style="display: block;" />
</div>
<div class="form-rfs">
<label>Permintaan Khusus / keterangan lain</label>
<textarea class="form-control" rows="5" name="permintaan3" ></textarea>
</div>
</div>
</div>
<div id="btnRfs">
<button type="submit" name="submit" value="request3">Send RFS <i class="far fa-paper-plane"></i></button>
</div>
<?= form_close();?>
</div>
<button class="accordion">4. Konsultasi Design Electronic Security System</button>
<div class="panel">
<div class="contact-info">
<h3>Konsultasi Design Electronic Security System</h3>
<p>Silahkan mengisi formulir Request For Service dibawah ini. Team kami akan segera menghubungi Anda.</p>
</div>
<?= form_open();?>
<div class="form-warp">
<div id="formRfs">
<div class="form-rfs">
<label>Nama *</label>
<input type="text" name="nama4" required="required"/>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Email *</label>
<input type="email" name="email4" style="display: block" required="required"/>
</div>
<div class="form-rfs">
<label>Handphone *</label>
<input type="text" name="hp4" style="display: block" required="required"/>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Nama Perusahaan</label>
<input type="text" name="perusahaan4" style="display: block;" />
</div>
<div class="form-rfs">
<label>No. Tel. Perusahaan</label>
<input type="text" name="telp4" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Alamat Perusahaan</label>
<textarea rows="5" name="alamat4"></textarea>
</div>
</div>
<div id="formRfs">
<div id="rfqContact">
<div class="form-rfs">
<label>Lokasi Project</label>
<input type="text" name="lokasi4" style="display: block;width: 100%" />
</div>
<div class="form-rfs">
<label>Option</label>
<select name="option4">
<option value="Pemasangan Baru">Pemasangan Baru</option>
<option value="Penambahan (extention)">Penambahan (extention)</option>
</select>
</div>
</div>
<div class="form-rfs">
<label>Product yang dibutuhkan</label>
<select class="form-control" name="produk4">
<option value="CCTV SYSTEM">CCTV SYSTEM</option>
<option value="ACCESS CONTROL SYSTEM">ACCESS CONTROL SYSTEM</option>
<option value="INTRUDER ALARM SYSTEM">INTRUDER ALARM SYSTEM</option>
<option value="KEY LOCK MANAGEMENT SYSTEM">KEY LOCK MANAGEMENT SYSTEM</option>
<option value="OUTDOOR PERIMETER HIGH SECURITY PRODUCT">OUTDOOR PERIMETER HIGH SECURITY PRODUCT</option>
<option value="MECHATRONICS( Secuirty door , window etc.)">MECHATRONICS( Secuirty door , window etc.)</option>
<option value="ANTI TERROR PRODUCT (X-RAY, WTMD, etc.)">ANTI TERROR PRODUCT (X-RAY, WTMD, etc.)</option>
<option value="BUILDING AUTOMATION SYSTEM">BUILDING AUTOMATION SYSTEM</option>
<option value="ENTRANCE CONTROL SYSTEM">ENTRANCE CONTROL SYSTEM</option>
<option value="TRIPOD TURNSTILES">TRIPOD TURNSTILES</option>
<option value="SPEEDSTILES (Pedestrian Gate)">SPEEDSTILES (Pedestrian Gate)</option>
<option value="FULLHEIGHT TURNSTILES">FULLHEIGHT TURNSTILES</option>
<option value="MASS TRANSPORTATION GATE">MASS TRANSPORTATION GATE</option>
<option value="OTHER">OTHER</option>
</select>
</div>
<div class="form-rfs">
<label>Deskripsi Project</label>
<input class="form-control" type="text" name="deskripsi4" style="display: block;width: 100%" />
</div>
<div class="form-rfs">
<label>Permintaan Khusus / keterangan lain</label>
<textarea class="form-control" rows="5" name="perusahaan4" style="width: 100%"></textarea>
</div>
</div>
</div>
<div id="btnRfs">
<button type="submit" name="submit" value="request4">Send RFS <i class="far fa-paper-plane"></i></button>
</div>
<?= form_close();?>
</div>
<button class="accordion">5. Other</button>
<div class="panel">
<div class="contact-info">
<h3>Other <i class="flaticon-1-send pull-right"></i></h3>
<p>Silahkan mengisi formulir Request For Service dibawah ini. Team kami akan segera menghubungi Anda.</p>
</div>
<?= form_open();?>
<div class="form-warp">
<div id="formRfs">
<div class="form-rfs">
<label>Nama *</label>
<input type="text" name="nama5" required="required"/>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Email *</label>
<input type="email" name="email5" style="display: block" required="required"/>
</div>
<div class="form-rfs">
<label>Handphone *</label>
<input type="text" name="hp5" style="display: block" required="required"/>
</div>
</div>
<div id="rfqContact">
<div class="form-rfs">
<label>Nama Perusahaan</label>
<input type="text" name="perusahaan5" style="display: block;" />
</div>
<div class="form-rfs">
<label>No. Tel. Perusahaan</label>
<input type="text" name="telp5" style="display: block;" />
</div>
</div>
<div class="form-rfs">
<label>Alamat Perusahaan</label>
<textarea rows="5" name="alamat5"></textarea>
</div>
</div>
<div id="formRfs">
<div class="form-rfs">
<label>Deskripsi /Penjelasan</label>
<input type="text" name="deskripsi5" style="display: block;" />
</div>
<div class="form-rfs">
<label>Permintaan Khusus / keterangan lain</label>
<textarea rows="5" name="permintaan5"></textarea>
</div>
</div>
</div>
<div id="btnRfs">
<button type="submit" name="submit" value="request5">Send RFS <i class="far fa-paper-plane"></i></button>
</div>
<?= form_close();?>
</div>
</div>