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根据关闭选择下拉菜单提交具有不同输入值的表单

[英]Submitting form with different input values based off select drop down

 原文  2017-07-20 15:52:18  9   1    javascript/ php/ jquery/ html/ forms

问题描述

大家好，我目前在我的代码方面遇到问题，需要帮助，并且在大多数情况下都可以解决，但是我需要一两个问题。

下面的代码就是这样，它从1个输入字段和2个select下拉列表开始。 第二个下拉列表确定需要显示哪些其他输入字段。 一旦发生这种情况，用户将填写字段并提交表格。 然后转到php文件以处理值，验证等，称为newformprocess.php。

该下拉列表可与JavaScript一起使用，以确定要显示的内容和隐藏的内容。 因此，在作为索引页的newform.html中，有三个不同的部分，每个部分都带有“ Display：none;”。 隐藏或显示的代码（取决于下拉菜单）。 所有这些都很好，所有这些都是我认为是问题的下一部分，但无法弄清楚。

发生什么事是我在代码中进行的几次验证，即使在所有字段中都填入内容，它仍然向我抛出错误，提示我填写所有字段，但是我已经全部填写了。 第二个问题是，如果我取出所有验证并仅保留一个验证，它将起作用，但是，当我单击提交并在收到电子邮件时发送表单时，我会丢失很多输入字段，这意味着用户键入的内容我没有得到并非所有的输入字段都能得到用户键入的内容。

newform.php下面的索引页。 

<!DOCTYPE html>
<html>
  <head>
    <meta charset="UTF-8">
    <title>Offer Submission Form</title>
    <link rel="stylesheet" type="text/css" href="css/mystyle.css">
    <link href="https://fonts.googleapis.com/css?family=Lato" rel="stylesheet">
    <script src="http://ajax.googleapis.com/ajax/libs/jquery/2.0.0/jquery.min.js"></script>
    <script type="text/javascript" src="js/newForm.js"></script>
  </head>

<body>
 <div class="form-style-10">

  <div class="inner-wrap">

   <form action="newformprocess.php" method="post">

    <label>Dealership Name:<em class="required-star">*</em></label><input id="dealerName" name="dealerName" type="text" placeholder="Dealership Name" style="background-color: white;"/>

    <label>Which Marketing Medium?<em class="required-star">*</em></label><select id="market" type="select" name="marketing">
        <option id="market1" value="Facebook">Facebook</option>
        <option id="market2" value="Website Banner">Website Banner</option>
        <option id="market3" value="Radio">Radio</option>
        <option id="market4" value="TV">TV</option>
        <option id="market5" value="Email">Email</option>
        <option id="market6" value="Direct Mail">Direct Mail</option>
        <option id="market7" value="All Channels">All Channels</option>
    </select>


        <label>Offer Type?</label><select id="offertype" type="select" name="offerType">
            <option id="option_1" value="New">New Purchase</option>
            <option id="option_2" value="Leased">New Lease</option>
            <option id="option_3" value="Used">Used Purchase</option>
        </select>


    <!--This div section is for when client select puchased as their new opiton....--->
    <div id="purchased" style="display:none;">
        <label>Start Date:<em class="required-star">*</em></label><input id="pur_startDate" name="startDate" type="text" placeholder="01/01/2012" style="background-color: white;"/>
        <label>End Date:<em class="required-star">*</em></label><input id="pur_endDate" name="endDate" type="text" placeholder="05/07/2015" style="background-color: white;"/>
        <label>Year:<em class="required-star">*</em></label><input id="pur_vehicleYear" name="yearOfVehicle" type="text" placeholder="Vehicle Year" style="background-color: white;"/>
        <label>Make:<em class="required-star">*</em></label><input id="pur_make" name="makeOfVehicle" type="text" placeholder="Make" style="background-color: white;"/>
        <label>Model:<em class="required-star">*</em></label><input id="pur_model" name="modelOfVehicle" type="text" placeholder="Model" style="background-color: white;"/>
        <label>Trim:<em class="required-star">*</em></label><input id="pur_trim" name="trimOfVehicle" type="text" placeholder="Trim of Vehicle" style="background-color: white;"/>
        <label>Model #:<em class="required-star">*</em></label><input id="pur_input_5" name="modelNumber" type="text" placeholder="14325" style="background-color: white;"/>
        <label>Stock #:<em class="required-star">*</em></label><input id="pur_input_5" name="stockNumber" type="text" placeholder="1234" style="background-color: white;"/>
        <label>MSRP:<em class="required-star">*</em></label><input id="pur_input_5" name="msrpNumber" type="text" placeholder="15995" style="background-color: white;"/>
        <label>Selling Price:<em class="required-star">*</em></label><input id="pur_input_5" name="sellingPrice" type="text" placeholder="12895" style="background-color: white;"/>
        <label>Down Payment:<em class="required-star">*</em></label><input id="pur_input_5" name="downPayment" type="text" placeholder="1000" style="background-color: white;"/>
        <label>$XXX/ Monthly Payment:<em class="required-star">*</em></label><input id="pur_input_5" name="monthlyPayment" type="text" placeholder="$198" style="background-color: white;"/>
        <label>Last 6 of VIN:<em class="required-star">*</em></label><input id="pur_input_5" name="lastVin" type="text" placeholder="123456" style="background-color: white;"/>
        <label>Rebate:</label><input id="pur_input_5" name="rebateInfo" type="text" placeholder="Rebate on Vehicle" style="background-color: white;"/>
        <label>APR:<em class="required-star">*</em></label><input id="pur_input_5" name="aprAmount" type="text" placeholder="ARP on Vehicle" style="background-color: white;"/>
        <label>Term:<em class="required-star">*</em></label><input id="pur_input_5" name="termOfVehicle" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
        <label>Other Notes(Rebate Info, Special Details etc):</label> <textarea id="pur_textArea" name="msg" placeholder="Notes" style="background-color: white;" rows=2></textarea>
    </div>

    <!--This div section is for when client select leased as their new opiton....--->
    <div id="leased" style="display:none;">
        <label>Start Date:<em class="required-star">*</em></label><input id="lsd_startDate" name="startDate" type="text" placeholder="01/01/2012" style="background-color: white;"/>
        <label>End Date:<em class="required-star">*</em></label><input id="lsd_endDate" name="endDate" type="text" placeholder="05/07/2015" style="background-color: white;"/>
        <label>Year:<em class="required-star">*</em></label><input id="lsd_vehicleYear" name="yearOfVehicle" type="text" placeholder="Vehicle Year" style="background-color: white;"/>
        <label>Make:<em class="required-star">*</em></label><input id="lsd_make" name="makeOfVehicle" type="text" placeholder="Make" style="background-color: white;"/>
        <label>Model:<em class="required-star">*</em></label><input id="lsd_model" name="modelOfVehicle" type="text" placeholder="Model" style="background-color: white;"/>
        <label>Trim:<em class="required-star">*</em></label><input id="lsd_trim" name="trimOfVehicle" type="text" placeholder="Trim of Vehicle" style="background-color: white;"/>
        <label>Model #:<em class="required-star">*</em></label><input id="lsd_model#" name="modelNumber" type="text" placeholder="14325" style="background-color: white;"/>
        <label>Stock #:<em class="required-star">*</em></label><input id="lsd_stock#" name="stockNumber" type="text" placeholder="1234" style="background-color: white;"/>
        <label>MSRP:<em class="required-star">*</em></label><input id="lsd_msrp" name="msrpNumber" type="text" placeholder="$15,995" style="background-color: white;"/>
        <label>Selling Price:<em class="required-star">*</em></label><input id="lsd_selling_price" name="sellingPrice" type="text" placeholder="12895" style="background-color: white;"/>
        <label>Down Payment:<em class="required-star">*</em></label><input id="lsd_down_payment" name="downPayment" type="text" placeholder="1000" style="background-color: white;"/>
        <label>$XXX/ Monthly Payment:<em class="required-star">*</em></label><input id="lsd_monthly_payment" name="monthlyPayment" type="text" placeholder="198" style="background-color: white;"/>
        <label>Last 6 of VIN:<em class="required-star">*</em></label><input id="lsd_vin" name="lastVin" type="text" placeholder="123456" style="background-color: white;"/>
        <label>Rebate:</label><input id="lsd_rebate" name="rebateInfo" type="text" placeholder="Rebate on Vehicle" style="background-color: white;"/>
        <label>Term:<em class="required-star">*</em></label><input id="lsd_term" name="termOfVehicle" type="text" placeholder="ARP on Vehicle" style="background-color: white;"/>
        <label>Residual Value:<em class="required-star">*</em></label><input id="lsd_residual_value" name="residualValue" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
        <label>Miles Per Year:<em class="required-star">*</em></label><input id="lsd_miles_year" name="milesPerYear" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
        <label>Other Notes(Rebate Info, Special Details etc):</label> <textarea id="lsd_textArea" name="msg" placeholder="Notes" style="background-color: white;" rows=2></textarea>
    </div>

    <!-- IF users picks USED it will go to this section of the form...-->
    <div id="used" style="display:none;">
        <label>Start Date:<em class="required-star">*</em></label><input id="fin_startDate" name="startDate" type="text" placeholder="01/01/2012" style="background-color: white;"/>
        <label>End Date:<em class="required-star">*</em></label><input id="fin_endDate" name="endDate" type="text" placeholder="05/07/2015" style="background-color: white;"/>
        <label>Year:<em class="required-star">*</em></label><input id="fin_vehicleYear" name="yearOfVehicle" type="text" placeholder="Vehicle Year" style="background-color: white;"/>
        <label>Make:<em class="required-star">*</em></label><input id="fin_make" name="makeOfVehicle" type="text" placeholder="Make" style="background-color: white;"/>
        <label>Model:<em class="required-star">*</em></label><input id="fin_model" name="modelOfVehicle" type="text" placeholder="Model" style="background-color: white;"/>
        <label>Trim:</label><input id="fin_trim" name="trimOfVehicle" type="text" placeholder="Trim of Vehicle" style="background-color: white;"/>
        <label>Stock #:<em class="required-star">*</em></label><input id="fin_input_5" name="stockNumber" type="text" placeholder="1234" style="background-color: white;"/>
        <label>Selling Price:<em class="required-star">*</em></label><input id="fin_input_5" name="sellingPrice" type="text" placeholder="12895" style="background-color: white;"/>
        <label>Down Payment:<em class="required-star">*</em></label><input id="fin_input_5" name="downPayment" type="text" placeholder="1000" style="background-color: white;"/>
        <label>APR:<em class="required-star">*</em></label><input id="fin_input_5" name="aprAmount" type="text" placeholder="ARP on Vehicle" style="background-color: white;"/>
        <label>Term:<em class="required-star">*</em></label><input id="used_term" name="termOfVehicle" type="text" placeholder="" style="background-color: white;"/>
        <label>Other Notes(Rebate Info, Special Details etc):</label><textarea id="fin_textArea" name="msg" placeholder="Notes" style="background-color: white;" rows=2></textarea>
    </div>

        <div class="button-section"><br />
            <input type="submit" name="submit" value="Submit Offer" />
        </div>


</form> 
</body>
  </div>
</div>
</html>

newformprocess.php发送表单的位置。 

<?php 

//THIS SECTION IS FOR WHEN THE PURCHASED SECTION OF THE FORM IS FILLED OUT..........////        
        if(isset($_POST["submit"]))
        {

            // Checking For Blank Fields....
            if($_POST['dealerName']=="" || $_POST['startDate']=="" || $_POST['endDate']=="" || $_POST['yearOfVehicle']=="" || $_POST['makeOfVehicle']=="" || $_POST['modelOfVehicle']=="" || 
               $_POST['stockNumber']=="" || $_POST['sellingPrice']=="" || $_POST['downPayment']=="" || $_POST['termOfVehicle']=="")
                { 
?>
                    <script type="text/javascript">
                        alert("Please complete the text marked with an *."); //java script telling user to fill in all required fields..
                    </script>
<?php
                }


        //THIS IS THE INFO THAT WILL BE SENT TO INDIVIDUALS IN THE EMAIL SECTION BELOW AS LONG AS ALL THE REQUIRED FIELDS ARE FILLED IN.....//////              
        else{

            $offer = $_POST["offerType"];
            $typeOfPurchase = $_POST["typeOfPurchase"];
            $marketing = $_POST["marketing"];
            $dealerName = $_POST["dealerName"];
            $startDate = $_POST["startDate"];
            $endDate = $_POST["endDate"];
            $vehicleYear = $_POST["yearOfVehicle"];
            $vehicleMake = $_POST["makeOfVehicle"];
            $vehicleModel = $_POST["modelOfVehicle"];
            $vehicleTrim = $_POST["trimOfVehicle"];
            $modelNumber = $_POST["modelNumber"];
            $stockNumber = $_POST["stockNumber"];
            $msrp = $_POST["msrpNumber"];
            $sellingPrice = $_POST["sellingPrice"];
            $downPayment = $_POST["downPayment"];
            $monthlyPayment = $_POST["monthlyPayment"];
            $lastVin = $_POST["lastVin"];
            $aprAmount = $_POST["aprAmount"];
            $vehicleTerm = $_POST["termOfVehicle"];
            $rebate = $_POST["rebateInfo"];
            $residualValue = $_POST["residualValue"];
            $yearPerMiles = $_POST["milesPerYear"];
            $message = $_POST["msg"];


            $message = wordwrap($message, 70);
            $msrpAmount = number_format($msrp, 2, '.', ',');
            $sellPrice = number_format($sellingPrice, 2, '.', ',');
            $dwnPayment = number_format($downPayment, 2, '.', ',');
            $monthPayment = number_format($monthlyPayment, 2, '.', ',');
            $apr = number_format($aprAmount, 2, '.', ',');
            $rebateAmount = number_format($rebate, 2, '.', ',');
            $miles = number_format($yearPerMiles);
            $residual = number_format($residualValue, 2, '.', ',');

            $form_content = 
            "What Type of Offer: $offer
            If your purhcase was new what was your type of purchase: $typeOfPurchase
            Which Marketing Medium: $marketing
            Dealership Name: $dealerName
            Start Date: $startDate
            End Date: $endDate
            Year of Vehicle: $vehicleYear
            Make of Vehicle: $vehicleMake
            Model of Vehicle: $vehicleModel
            Trim of Vehicle: $vehicleTrim
            Model #: $modelNumber 
            Stock #: $stockNumber
            MSRP:$$msrpAmount
            Vehicle Selling Price:$$sellPrice
            Down Payment on Vehicle:$ $dwnPayment
            '$'XXX/ Monthly Payment:$ $monthPayment
            Last 6 of VIN: $lastVin
            Vehicle Rebate:$$rebateAmount
            Residual Value:$$residual
            Vehicle APR:$$apr
            Miles Per Year: $miles
            Other Notes (Rebate Info, Special Details etc): $message";

            $email_subject = "Online Offer Submission Form";

            //THIS IS THE ARRAY THAT WILL HOLD EVERYONE THAT WILL GET THE EMAIL....//////
            $arrEmail = array('Jonathan <jonathan@mywebsite.com>');


                foreach($arrEmail as $key => $email_to)
                mail($email_to, $email_subject, $form_content);

            header('location: http://www.website.com/thank-you-for-contacting-dealer-world/');
        }
        }
?>

** JavaScript文件，用于处理包含输入字段的表单的div元素的隐藏或显示。** 

$(document).ready(function() {
$select = $("#offertype");
$("#offertype").on("change",function(){

    if($(this).val() == "New"){
        if($("#purchased").is(":hidden")){
            $("#purchased").show();
            $("#leased").hide();
            $("#used").hide();
        }           
    }

    if($(this).val() == "Leased"){
        if($("#leased").is(":hidden")){
            $("#leased").show();
            $("#purchased").hide();
            $("#used").hide();
        }           
    }

    if($(this).val() == "Used"){
        if($("#used").is(":hidden")){
            $("#used").show();
            $("#purchased").hide();
            $("#leased").hide();
        }           
    }

    });
});

同样，我遇到的问题如下。 如果我在上面的newformprocess.php文件中添加了所有验证以确保输入不为空，则会弹出一个警报弹出窗口以填写所有字段，但是，我在所有添加的字段中都填写了所有内容。 第二个问题是，如果我删除所有验证并仅使用一个验证，则不会收到弹出式警报，而不会发送表单，但是，当我收到电子邮件时，大多数表单输入值都是空的，就像用户将其空白并事实并非如此，因为我是用户，我需要填写字段。对任何帮助您的人都非常感谢。

电子邮件的外观即使我填写了所有字段，也会发生这种情况。 如您所见，我得到了一些价值，但不是全部，这是从下拉列表中购买的。 当我从下拉列表中选择“租赁”时，电子邮件具有更多的值，那么它在下面进行了配置，但仍然缺少一些。 当我在下拉列表中选择“ Used”并提交时，我会得到所有值，因此“ Used”可以正常工作。 它的其他两个。 

 What Type of Offer:New
                    Which Marketing Medium: Email
                    Dealership Name: test 1
                    Start Date:
                    End Date:
                    Year of Vehicle:
                    Make of Vehicle:
                    Model of Vehicle:
                    Trim of Vehicle:
                    Model #:
                    Stock #:
                    MSRP:$
                    Vehicle Selling Price:$
                    Down Payment on Vehicle:$
                    '$'XXX/ Monthly Payment:$
                    Last 6 of VIN:
                    Vehicle Rebate:$
                    Residual Value:$
                    Term:
                    Vehicle APR:$
                    Miles Per Year:
                    Other Notes (Rebate Info, Special Details etc):

1 个解决方案

解决方案1
 0  2017-07-21 16:50:03

我需要为可能遇到相同问题的任何人做的事情是，当我仅使用一种形式，并且在输入元素中使用具有相同名称=“ VALUE”的所有那些输入时，它将覆盖其他形式，并在我的电子邮件中显示空白。

因此，对于每个隐藏或显示的div，我将它们全部以自己的形式放置，这对我来说就像魔术一样。 这是我使用三个下拉选项中的两个所做的预览... 

<!--This div section is for when client select puchased as their new opiton....--->
<div id="purchased" style="display:none;">
    <form action="" method="post">
        <label>Dealership Name:<em class="required-star">*</em></label><input id="dealerName" name="dealerName" type="text" placeholder="Dealership Name" style="background-color: white;"/>
        <label>Which Marketing Medium?<em class="required-star">*</em></label><select id="market" type="select" name="marketing">
            <option id="pick1" selected="selected" value="">Select One</option>
            <option id="market1" value="Facebook">Facebook</option>
            <option id="market2" value="Website Banner">Website Banner</option>
            <option id="market3" value="Radio">Radio</option>
            <option id="market4" value="TV">TV</option>
            <option id="market5" value="Email">Email</option>
            <option id="market6" value="Direct Mail">Direct Mail</option>
            <option id="market7" value="All Channels">All Channels</option>
        </select>
            <label>Start Date:<em class="required-star">*</em></label><input id="pur_startDate" name="startDate" type="text" placeholder="01/01/2012" style="background-color: white;"/>
            <label>End Date:<em class="required-star">*</em></label><input id="pur_endDate" name="endDate" type="text" placeholder="05/07/2015" style="background-color: white;"/>
            <label>Year:<em class="required-star">*</em></label><input id="pur_vehicleYear" name="yearOfVehicle" type="text" placeholder="Vehicle Year" style="background-color: white;"/>
            <label>Make:<em class="required-star">*</em></label><input id="pur_make" name="makeOfVehicle" type="text" placeholder="Make" style="background-color: white;"/>
            <label>Model:<em class="required-star">*</em></label><input id="pur_model" name="modelOfVehicle" type="text" placeholder="Model" style="background-color: white;"/>
            <label>Trim:<em class="required-star">*</em></label><input id="pur_trim" name="trimOfVehicle" type="text" placeholder="Trim of Vehicle" style="background-color: white;"/>
            <label>Model #:<em class="required-star">*</em></label><input id="pur_input_5" name="modelNumber" type="text" placeholder="14325" style="background-color: white;"/>
            <label>Stock #:<em class="required-star">*</em></label><input id="pur_input_5" name="stockNumber" type="text" placeholder="1234" style="background-color: white;"/>
            <label>MSRP:<em class="required-star">*</em></label><input id="pur_input_5" name="msrpNumber" type="text" placeholder="15995" style="background-color: white;"/>
            <label>Selling Price:<em class="required-star">*</em></label><input id="pur_input_5" name="sellingPrice" type="text" placeholder="12895" style="background-color: white;"/>
            <label>Down Payment:<em class="required-star">*</em></label><input id="pur_input_5" name="downPayment" type="text" placeholder="1000" style="background-color: white;"/>
            <label>$XXX/ Monthly Payment:<em class="required-star">*</em></label><input id="pur_input_5" name="monthlyPayment" type="text" placeholder="$198" style="background-color: white;"/>
            <label>Last 6 of VIN:<em class="required-star">*</em></label><input id="pur_input_5" name="lastVin" type="text" placeholder="123456" style="background-color: white;"/>
            <label>Rebate:</label><input id="pur_input_5" name="rebateInfo" type="text" placeholder="Rebate on Vehicle" style="background-color: white;"/>
            <label>APR:<em class="required-star">*</em></label><input id="pur_input_5" name="aprAmount" type="text" placeholder="ARP on Vehicle" style="background-color: white;"/>
            <label>Term:<em class="required-star">*</em></label><input id="pur_input_5" name="termOfVehicle" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
            <label>Other Notes(Rebate Info, Special Details etc):</label> <textarea id="pur_textArea" name="msg" placeholder="Notes" style="background-color: white;" rows=2></textarea>
                <div class="button-section"><br />
                    <input type="submit" name="submit" value="Submit Offer" />
                </div>  
    </form>
</div>

<!--This div section is for when client select leased as their new opiton....--->
<div id="leased" style="display:none;">
   <form action="" method="post">
        <label>Dealership Name:<em class="required-star">*</em></label><input id="dealerName" name="dealerName" type="text" placeholder="Dealership Name" style="background-color: white;"/>
        <label>Which Marketing Medium?<em class="required-star">*</em></label><select id="market" type="select" name="marketing">
            <option id="pick1" selected="selected" value="">Select One</option>
            <option id="market1" value="Facebook">Facebook</option>
            <option id="market2" value="Website Banner">Website Banner</option>
            <option id="market3" value="Radio">Radio</option>
            <option id="market4" value="TV">TV</option>
            <option id="market5" value="Email">Email</option>
            <option id="market6" value="Direct Mail">Direct Mail</option>
            <option id="market7" value="All Channels">All Channels</option>
        </select>
            <label>Start Date:<em class="required-star">*</em></label><input id="lsd_startDate" name="startDate" type="text" placeholder="01/01/2012" style="background-color: white;"/>
            <label>End Date:<em class="required-star">*</em></label><input id="lsd_endDate" name="endDate" type="text" placeholder="05/07/2015" style="background-color: white;"/>
            <label>Year:<em class="required-star">*</em></label><input id="lsd_vehicleYear" name="yearOfVehicle" type="text" placeholder="Vehicle Year" style="background-color: white;"/>
            <label>Make:<em class="required-star">*</em></label><input id="lsd_make" name="makeOfVehicle" type="text" placeholder="Make" style="background-color: white;"/>
            <label>Model:<em class="required-star">*</em></label><input id="lsd_model" name="modelOfVehicle" type="text" placeholder="Model" style="background-color: white;"/>
            <label>Trim:<em class="required-star">*</em></label><input id="lsd_trim" name="trimOfVehicle" type="text" placeholder="Trim of Vehicle" style="background-color: white;"/>
            <label>Model #:<em class="required-star">*</em></label><input id="lsd_model#" name="modelNumber" type="text" placeholder="14325" style="background-color: white;"/>
            <label>Stock #:<em class="required-star">*</em></label><input id="lsd_stock#" name="stockNumber" type="text" placeholder="1234" style="background-color: white;"/>
            <label>MSRP:<em class="required-star">*</em></label><input id="lsd_msrp" name="msrpNumber" type="text" placeholder="$15,995" style="background-color: white;"/>
            <label>Selling Price:<em class="required-star">*</em></label><input id="lsd_selling_price" name="sellingPrice" type="text" placeholder="12895" style="background-color: white;"/>
            <label>Down Payment:<em class="required-star">*</em></label><input id="lsd_down_payment" name="downPayment" type="text" placeholder="1000" style="background-color: white;"/>
            <label>$XXX/ Monthly Payment:<em class="required-star">*</em></label><input id="lsd_monthly_payment" name="monthlyPayment" type="text" placeholder="198" style="background-color: white;"/>
            <label>Last 6 of VIN:<em class="required-star">*</em></label><input id="lsd_vin" name="lastVin" type="text" placeholder="123456" style="background-color: white;"/>
            <label>Rebate:</label><input id="lsd_rebate" name="rebateInfo" type="text" placeholder="Rebate on Vehicle" style="background-color: white;"/>
            <label>Term:<em class="required-star">*</em></label><input id="lsd_term" name="termOfVehicle" type="text" placeholder="ARP on Vehicle" style="background-color: white;"/>
            <label>Residual Value:<em class="required-star">*</em></label><input id="lsd_residual_value" name="residualValue" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
            <label>Miles Per Year:<em class="required-star">*</em></label><input id="lsd_miles_year" name="milesPerYear" type="text" placeholder="Residual Payment on Vehicle" style="background-color: white;"/>
            <label>Other Notes(Rebate Info, Special Details etc):</label> <textarea id="lsd_textArea" name="msg" placeholder="Notes" style="background-color: white;" rows=2></textarea>
        <div class="button-section"><br />
            <input type="submit" name="submit" value="Submit Offer" />
        </div>  
    </form> 
</div>

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