Request Form

Product Details
Your request have been saved. Our executive will get in touch shortly.

Product:
Quantity:

Customer Details

Name:
Date Of Birth:
Place Of Birth:
Time Of Birth:
Email ID:
Phone:
Reason for purchase:	</td> </tr> </div> </table> </form> </div> <div class="formbot"><input type="button" value="Request Quote" class="formbtn" id="submit" /></div> </div> <script> $('#submit').click(function(){ $prd=$('#product').val(); $qty=$('#qty').val(); //$desc=$('#desc').val(); $name=$('#name').val(); $dob=$('#dob').val(); $pob=$('#pob').val(); $tob=$('#tob').val(); $ph=$('#ph').val(); $email=$('#email').val(); $reason=$('#reason').val(); dataURL="product="+$prd+"&quantity="+$qty+"&name="+$name+"&dob="+$dob+"&pob="+$pob+"&tob="+$tob+"&ph="+$ph+"&email="+$email+"&reason="+$reason; $.ajax({ type: "POST", url: "request.php", data: dataURL, success: function(msg){ $('#mess').show(); //please put these two line after success/failure return; if (msg == "success") $('#mess div').html('Your request have been saved. Our executive will get in touch shortly.'); else $('#mess div').html('Failed.'); $('#tohide').hide(); } }); }) </script>