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根據關閉選擇下拉菜單提交具有不同輸入值的表單

[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

問題描述

大家好，我目前在我的代碼方面遇到問題，需要幫助，並且在大多數情況下都可以解決，但是我需要一兩個問題。

下面的代碼就是這樣，它從1個輸入字段和2個select下拉列表開始。 第二個下拉列表確定需要顯示哪些其他輸入字段。 一旦發生這種情況，用戶將填寫字段並提交表格。 然后轉到php文件以處理值，驗證等，稱為newformprocess.php。

該下拉列表可與JavaScript一起使用，以確定要顯示的內容和隱藏的內容。 因此，在作為索引頁的newform.html中，有三個不同的部分，每個部分都帶有“ Display：none;”。 隱藏或顯示的代碼（取決於下拉菜單）。 所有這些都很好，所有這些都是我認為是問題的下一部分，但無法弄清楚。

發生什么事是我在代碼中進行的幾次驗證，即使在所有字段中都填入內容，它仍然向我拋出錯誤，提示我填寫所有字段，但是我已經全部填寫了。 第二個問題是，如果我取出所有驗證並僅保留一個驗證，它將起作用，但是，當我單擊提交並在收到電子郵件時發送表單時，我會丟失很多輸入字段，這意味着用戶鍵入的內容我沒有得到並非所有的輸入字段都能得到用戶鍵入的內容。

newform.php下面的索引頁。 

<!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發送表單的位置。 

<?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，用於處理包含輸入字段的表單的div元素的隱藏或顯示。** 

$(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();
        }           
    }

    });
});

同樣，我遇到的問題如下。 如果我在上面的newformprocess.php文件中添加了所有驗證以確保輸入不為空，則會彈出一個警報彈出窗口以填寫所有字段，但是，我在所有添加的字段中都填寫了所有內容。 第二個問題是，如果我刪除所有驗證並僅使用一個驗證，則不會收到彈出式警報，而不會發送表單，但是，當我收到電子郵件時，大多數表單輸入值都是空的，就像用戶將其空白並事實並非如此，因為我是用戶，我需要填寫字段。對任何幫助您的人都非常感謝。

電子郵件的外觀即使我填寫了所有字段，也會發生這種情況。 如您所見，我得到了一些價值，但不是全部，這是從下拉列表中購買的。 當我從下拉列表中選擇“租賃”時，電子郵件具有更多的值，那么它在下面進行了配置，但仍然缺少一些。 當我在下拉列表中選擇“ Used”並提交時，我會得到所有值，因此“ Used”可以正常工作。 它的其他兩個。 

 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 個解決方案

解決方案1
 0  2017-07-21 16:50:03

我需要為可能遇到相同問題的任何人做的事情是，當我僅使用一種形式，並且在輸入元素中使用具有相同名稱=“ VALUE”的所有那些輸入時，它將覆蓋其他形式，並在我的電子郵件中顯示空白。

因此，對於每個隱藏或顯示的div，我將它們全部以自己的形式放置，這對我來說就像魔術一樣。 這是我使用三個下拉選項中的兩個所做的預覽... 

<!--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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