Submit a Help Request

<%= frm::form ( action => 'mailto:support@back2front.ca', -check => [ "Contact Name" => [ "*" ], "Email Address" => [ "email" ], "Phone Number" => [ "phone" ], [ 'Phone Number', 'Email Address' ] => sub{ 'At least one of Phone Number or Email Address must be entered to allow us to respond to requests.' if ! param ( 'Phone Number' ) and ! param ( 'Email Address' ) }, "Request Details" => [ sub{ 'Please enter the details of your inquiry.' if ! frm::check ( $_ => '*' ) }, '*' ], frm::check('captcha') ] ) %>
<%= frm::step_text ( form => "Please fill out the form below with any inquiry you" . " might have.", receipt => "Your request has been submitted." . " You will be contacted shortly." ) %>
Contact Name: * <%= frm::input ( type => 'text', -label => undef, name => "Contact Name", size => 30 ) %>
Company: <%= frm::input ( type => 'text', -label => undef, name => "Company", size => 30 ) %>
Email Address: <%= frm::input ( type => 'text', -label => undef, name => "Email Address", size => 30 ) %>
Phone Number: <%= frm::input ( type => 'text', -label => undef, name => "Phone Number", size => 30 ) %>

Details of your inquiry: *
<%= frm::input ( type => 'textarea', -label => undef, name => "Request Details", rows => 8, columns => 50 ) %>
 
<%= frm::input ( type => 'captcha' ) %>
<%= frm::input ( type => 'submit', label => frm::page ( 0 => "Submit Request", 1 => "Reset" ) ) %>