{% extends 'application_portal/base.html' %}

{% block title %}Contact Form{% endblock %}

{% block content %}
<div class="container-fluid">
        <div class="row-fluid">
            <div class="span3">
                <div class="well sidebar-nav"> 
                <li class="nav-header">Important links</li>
                <ul class="nav nav-list">
                    <li><a href="/ladm/search/">View Parcel map</a> </li>
                    <li><a href="/ladm/apply/">Submit applications</a> </li>
                </ul>     
            </div>                
            </div>
            <div class="span9">  
                  <h2>Contact Form</h2>
                  <p>To send us a message fill out the below form.</p>
                  
                {% if errors %}
                    <ul>
                        {% for error in errors %}
                        <li>{{ error }}</li>
                        {% endfor %}
                    </ul>
                {% endif %}
              
                <form action="/ladm/contact/" method="post">
                    {% csrf_token %}
                    
                    <div class="fieldWrapper">
                        <label>Subject:</label>
                        <input type="text" name="subject">
                    </div> 
                    <br>
                    <div class="fieldWrapper">
                        <label>Your e-mail (optional):</label>
                        <input type="text" name="email">
                    </div> 
                    <br>
                    <div class="fieldWrapper">
                        <label>Message: </label>
                        <textarea name="message" class="input-block-level" rows="10" cols="100"></textarea>
                    </div> 
                    <br>
                    <input type="submit" name="submit" class="btn btn-primary" value="Submit">
                </form>

            </div>
        </div>
    </div>

{% endblock %}