<?php 
	$title = "Contact exacqVision";
	
	$links = "
	<link rel='stylesheet' href='css/index.css' type='text/css' media='screen' />
	<link rel='stylesheet' href='/js/jquery.qtip.min.2.0.1.css' type='text/css'>";
	
	$recaptcha = true;
	
	$toaster = true;
	
	require_once("/var/www/PHPwebsite/olde_header.php");
	
	// include a list of states and countries and provinces
	require_once('/var/www/PHPwebsite/ExacqLibrary/CountriesAndStatesArrays.php');

	
	
	$titleString = "";
	$bg = "ui-header-bg-start";
	
	
		
		$titleString .= _("Contact Us");

		$pardotURL = "https://security.johnsoncontrols.com/l/922093/2021-08-17/86zw";
	
	
	echo "
	<div class='ui-header-container'>
		
		<div class='ui-header-text-container'>
			<div class='".$bg."'>
				<div class='ui-header-h1-container-full'><h1>".$titleString."</h1></div>
			</div>
		</div>
	</div>
	
	<div class='top-section'>
		<div class='top-description'>
			<div>".($subTitleString ?? "")."</div>
		</div>
	</div>";        
?>



<iframe class='ui-exacq-display-none' name='pardotIframe' pardotBaseUrl='<?php echo $pardotURL; ?>'></iframe>

<form method='POST' action='<?php echo $pardotURL; ?>' id='trialForm' name='trialForm' target='pardotIframe'>

	<div id='form-container' type='<?php echo $type ?? ""; ?>' product='<?php echo $product ?? ""; ?>'>
	
		<div class='datarow required'>
			<div class='name'><b>Required</b></div>
			<div class='input'></div>
		</div>
	
		<div class='datarow required'>
			<div class='name'>First Name</div>
			<div class='input'><input type='text' name='first_name'></div>
		</div>
		
		<div class='datarow required'>
			<div class='name'>Last Name</div>
			<div class='input'><input type='text' name='last_name'></div>
		</div>
		
		<div class='datarow required'>
			<div class='name'>Email</div>
			<div class='input'><input type='email' name='email' id='email'></div>
		</div>
		
		
		
		<div class='datarow required'>
			<div class='name'>Company Name</div>
			<div class='input'><input type='text' name='company'></div>
		</div>
		
		
		
		<div class='datarow required'>
			<div class='name'>Country</div>
			<div class='input'>
				<select class='check' name='country' id='country-select'>
					<?php
						foreach ($Countries as $key => $val) {
							if (@$_POST['country'] == $val)
								echo '<option value="'.$key.'" selected="selected" >'.$key.'</option>';
							else
								echo '<option value="'.$key.'">'.$key.'</option>';
						}
					?>
				</select>
			</div>
		</div>
		
		<div class='datarow'>
			<div class='name'>City</div>
			<div class='input'><input type='text' name='city'></div>
		</div>
		
		<div class='datarow required'>
			<div class='name'>Job Functions</div>
			<div class='input'>
				<select class='check' name='job-function' id='job-function-select'>
                                    <option value="" selected="selected"></option>
					<option value="Administration">Administration</option>
                                        <option value="Branch Manager">Branch Manager</option>
                                        <option value="Counter Sales">Counter Sales</option>
                                        <option value="Customer Service">Customer Service</option>
                                        <option value="Engineering">Engineering</option>
                                        <option value="Estimator">Estimator</option>
                                        <option value="Finance and Accounting">Finance and Accounting</option>
                                        <option value="Freight Forward">Freight Forward</option>
                                        <option value="Information Technology">Information Technology</option>
                                        <option value="Inside Sales">Inside Sales</option>
                                        <option value="Management">Management</option>
                                        <option value="Marketing">Marketing</option>
                                        <option value="Other">Other</option>
                                        <option value="Outside Sales">Outside Sales</option>
                                        <option value="Parts Sales">Parts Sales</option>
                                        <option value="President">President</option>
                                        <option value="Project Manager">Project Manager</option>
                                        <option value="Purchasing">Purchasing</option>
                                        <option value="Trade Compliance">Trade Compliance</option>
                                        <option value="Warehouse">Warehouse</option>                                        
				</select>
			</div>
		</div>

                <div class='datarow required'>
			<div class='name'>Business Phone</div>
			<div class='input'><input type='text' name='phone'></div>
		</div>
		
                <div class='datarow required'>
                <div class='name'>Products of Interest</div>
                <div class='input'>
                    <input type="checkbox" id="poi1" name="poi1" value="TRUE">
                    <label for="poi1">Video Surveillance</label><br>
                    <input type="checkbox" id="poi2" name="poi2" value="TRUE">
                    <label for="poi2">Video Storage</label><br>
                    <input type="checkbox" id="poi3" name="poi3" value="TRUE">
                    <label for="poi3">Integrated Access Control</label><br>
                    <input type="checkbox" id="poi4" name="poi4" value="TRUE">
                    <label for="poi4">Additional Cameras</label><br>
                </div>
                </div>
            
            <div class='datarow'>
                <div class='name'>Please identify the specific reason of your inquiry</div>
                <div class="input">
                    <textarea name="comments"></textarea>
                </div>
            </div>
            
            
            
            <div class='datarow_gdpr'>
                <div class=''><b>Email Consent</b><span>*</span></div>
                <br>
                <div class=''>
                    <input type="radio" id="email_constent1" name="email_constent" value="FALSE">
                    <label for="email_constent1">Yes, I wish to receive marketing emails about security solutions from Johnson Controls Security</label><br>
                    <br>
                    <input type="radio" id="email_constent2" name="email_constent" value="TRUE">
                    <label for="email_constent2">No, I do not wish to receive marketing emails about security solutions from Johnson Controls Security</label><br>
                </div>
            </div>
            <br>
            <div class='datarow_gdpr'>
                <div class=''><b>Privacy Notice</b><span>*</span></div>
                <br>
                <div class=''>
                    <input type="checkbox" id="privacy" name="privacy_notice" value="TRUE">
                    <label for="privacy">By completing the above form and checking this box you confirm that you have read, understood and accepted our Privacy terms as well as our Cookie terms. <a href="https://www.johnsoncontrols.com/privacy" target="_blank">Read our Privacy Policy</a></label><br>
                </div>
            </div>
		<br>
                
		
		<div class='datarow'>
			<div class='name'></div>
			<div class='confirm'>
				<!-- This is registered to nullsage@gmail.com -->
				<div class="g-recaptcha" data-sitekey="6LfpbQsTAAAAAFp99s5xVa-S1Yjn_5MXzy3333Mf"></div>
			</div>
		</div>
		
		<div class='datarow'>
			<div class='name'></div>
			<div class='confirm'>
				<button type='button' id='sendform'><?php echo _("Submit Contact Request"); ?></button>
			</div>
		</div>
	</div>
</form>
<div id='toaster'></div>
<div id='exacq-loading-box' class='ui-exacq-display-none'>
	<div class='image-container'>
		<img src='/resources/images/ajax-loader.gif'>
	</div>
	<div class='message'></div>
</div>
					
<?php 
	include("/var/www/PHPwebsite/footer.php"); 
?>
<script type='text/javascript' src='/js/jquery.qtip.min.2.0.1.js'></script>
<script type='text/javascript' src='js/index.js'></script>