<?php
$page="enquiry";
$title="Lifespan Contact Us | lifespan.industries. call Us:  +919100982138 ";
$des="Lifespan’s manufacturing unit consists of packaging, capsule,tablets, Powder &amp; Granules,Diskettes,Personal Care,Gels &amp; Paste manufacturing in Hyderabad.";
 include('header.php');
 //session_start(); ?>
	<section id="slider3">
		<img src="assets/images/conatct.jpg" alt="gallery" class="img-responsive">
			<?php if(isset($_SESSION['enquiry_msg']) && $_SESSION['enquiry_msg']!=''){ ?>
			<div><?php echo $_SESSION['enquiry_msg']; ?></div>
			<?php $_SESSION['enquiry_msg']=''; 
			unset($_SESSION['enquiry_msg']); 
			} ?>
		<h1 class=" t4 wow fadeInRight" data-wow-duration="1s" data-wow-delay="1s">Enquiry</h1>
	</section>
	<div class="container">
		<div class="row">
			<div class="col-md-8 col-xs-11">
                            <form class="form-horizontal  contact-form"  method="post" action="sendemail_enquiry_1.php" id="enquiry_frm" >
					<h5>COMPANY DETAILS</h5>   
					<div class="form-group">
						<div class="col-sm-3">
						  Company Name *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="company_name" required="required" placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Year of Establishment *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="year_of_establishment" required="required" placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Company Turnover
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="company_turnover"  placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Company Address *
						</div>
						<div class="col-sm-9">
							<textarea class="form-control" placeholder="" required="required" name="company_address" rows="3"></textarea>
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Company Website
						</div>
						<div class="col-sm-9">
						   <input type="text" class="form-control" name="company_website" placeholder="">
						</div>
					</div>
					
					<h5>CONTACT PERSONS DETAILS</h5>
					<div class="form-group">
						<div class="col-sm-3">
						 Contact Person Name *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="personal_name" required="required" placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Contact Person Designation *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="personal_designation" required="required" placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						  Contact Number *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="personal_contact_number" required="required" placeholder="">
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-3">
						 How did you come to know about Lifespan?
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="personal_how_come" placeholder="">
						</div>
					</div>
					
					<h5>PRODUCT DETAILS</h5>
					<div class="form-group">
						<div class="col-sm-3">
						 Product Name *
						</div>
						<div class="col-sm-9">
						  <input type="text" class="form-control" name="product_name" required="required" placeholder="">
						</div>
					</div>
					
					<div class="form-group">
						<div class="col-sm-3">
						 Product Type
						</div>
						<div class="col-sm-9">
                            <input type="checkbox" name="product_type[]" value="Tablets" > Tablets<br>
                                <input type="checkbox" name="product_type[]" value="Capsules" > Capsules<br>
                                <input type="checkbox" name="product_type[]" value="Powders"> Powders<br>
                                <input type="checkbox" name="product_type[]" value="Granules" > Granules<br>
                                <input type="checkbox" name="product_type[]" value="Liquids" > Liquids<br>
                                <input type="checkbox" name="product_type[]" value="Diskettes" > Diskettes<br>
                                <input type="checkbox" name="product_type[]" value="Paste" > Paste<br>
						</div>
					</div>
                                        <div id="add_rows">
                                           
                                        </div>
					
					<div class="form-group">
						<div class="col-sm-3">
						  Any Other Specifications/queries
						</div>
						<div class="col-sm-9">
							<textarea class="form-control" placeholder=""  name="other_query" rows="3"></textarea>
						</div>
					</div>
					
					<div class="form-group">
						<div class="col-sm-12 text-center">
							
						  <button type="submit" name="submit" class="btn main-btn hvr-sweep-to-right small-btn">Send</button>
						</div>
					</div>
				</form>
			</div>
			<!--div class="col-md-6">
				  <div class=""><i class="fa fa-home"></i> Address</div>
				   <p>Plot No:49, Phase lll, Bio Tech Park, near SEZ Karkapatla
Siddipet District, Telangana - 502279 </p>
			<div class=""><i class="fa fa-envelope"></i> Email</div>
		<p>info@lifespan.industries</p>
		<div class=""><i class="fa fa-phone"></i> Mobile</div>
		<p>+91 9312099999</p>

	
					</div-->
		</div>
	</div>
                <br><br>
<?php include('footer.php'); ?>
                
                <script>
    $(document).ready(function(){
        $('input[type="checkbox"]').click(function(){
            if($(this).is(":checked")){
                //alert("Checkbox is checked.");
               // alert($(this).val())
                app_prod_detail($(this).val())
            }
            else if($(this).is(":not(:checked)")){
               // alert("Checkbox is unchecked.");
               // alert($(this).val())
                 $('#added_row_'+$(this).val()).remove();
            }
        });
    });


    $("#enquiry_frm").submit(function(){
    var checked = $("#enquiry_frm input:checked").length > 0;
    if (!checked){
        alert("Please check at least one product type");
        return false;
    }
});


    function app_prod_detail(valu){
       // alert(valu);
        var data = '<div id="added_row_'+valu+'">'
                    +'<h5>'+valu.toUpperCase()+' DETAILS</h5>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'If any other please specify'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="text" class="form-control" name="if_other_product_type_'+valu+'"  placeholder="">'
                    +'</div>'
                    +'</div> '

                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'This Product will be applied under'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="radio" name="product_applied_under_'+valu+'" value="Ayush"> Ayush<br>'
                    +'<input type="radio" name="product_applied_under_'+valu+'" value="FSSAI"> FSSAI'

                    +'</div>'
                    +'</div>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'If any other please specify'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="text" class="form-control" name="if_other_product_applied_under_'+valu+'"  placeholder="">'
                    +'</div>'
                    +'</div>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Product Description *'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<textarea class="form-control" placeholder="" required="required" name="product_description_'+valu+'" rows="3"></textarea>'
                    +'</div>'
                    +'</div>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Benchmark Products in Market (If any)'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<textarea class="form-control" placeholder=""  name="benchmark_products_in_market_'+valu+'" rows="3"></textarea>'
                    +'</div>'
                    +'</div>'

                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Tentative Label Claim/ Ingredients List'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<textarea class="form-control" placeholder=""  name="tentative_label_claim_'+valu+'" rows="3"></textarea>'
                    +'</div>'
                    +'</div>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Desired Packaging Options'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="text" class="form-control" name="desired_packaging_options_'+valu+'"  placeholder="">'
                    +'</div>'
                    +'</div>'

                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Do you require Lifespan to provide Logistics'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="radio" name="product_logistics_provided_'+valu+'" value="Yes"> Yes'
                    +'<input type="radio" name="product_logistics_provided_'+valu+'" value="No"> No '
                    +'</div>'
                    +'</div>'

                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Tentative Budget'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="text" class="form-control" name="tentative_budget_'+valu+'" placeholder="">'
                    +'</div>'
                    +'</div>'
                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Tentative MOQ'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="text" class="form-control" name="tentative_moq_'+valu+'"  placeholder="">'
                    +'</div>'
                    +'</div>'

                    +'<div class="form-group">'
                    +'<div class="col-sm-3">'
                    +'Order quantities are for'
                    +'</div>'
                    +'<div class="col-sm-9">'
                    +'<input type="radio" name="order_quantities_are_for_'+valu+'" value="Monthly"> Monthly'
                    +'<input type="radio" name="order_quantities_are_for_'+valu+'" value="One Time"> One Time '
                    +'</div>'
                    +'</div>'
                    +'</div>';
            $('#add_rows').append(data);
            
           
    }
</script>
<style type="text/css">
	.two-column {
		box-shadow: 0px 0px 3px #656565;
		padding: 10px;
		margin-bottom: 12px;
		border-radius: 6px;
	}
	section#slider3 {padding-bottom: 20px;}
	input[type=radio], input[type=checkbox] {margin: 0 6px;}
	h5 {font-size: 25px; line-height: 35px; font-weight: 700;}
	
	@media only screen and (max-width: 767px) {
		h5 {font-size: 20px; line-height: 28px;}
	}
    </style>