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<!DOCTYPE html> |
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<html lang="en" dir="rtl"> |
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<head> |
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<meta charset="UTF-8"> |
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<meta name="viewport" content="width=device-width, initial-scale=1.0"> |
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<title>Data Collection Form</title> |
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<script src="https://cdn.tailwindcss.com"></script> |
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<script src="https://unpkg.com/feather-icons"></script> |
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<script src="https://cdn.jsdelivr.net/npm/feather-icons/dist/feather.min.js"></script> |
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<style> |
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@import url('https://fonts.googleapis.com/css2?family=Tajawal:wght@400;500;700&display=swap'); |
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body { |
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font-family: 'Tajawal', sans-serif; |
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} |
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.form-input { |
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transition: all 0.3s ease; |
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} |
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.form-input:focus { |
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box-shadow: 0 0 0 3px rgba(99, 102, 241, 0.3); |
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} |
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</style> |
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</head> |
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<body class="bg-gray-50 min-h-screen"> |
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<div class="max-w-md mx-auto p-6"> |
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<div class="bg-white rounded-xl shadow-lg overflow-hidden mb-8 transition-all duration-300 hover:shadow-xl"> |
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<div class="bg-gradient-to-r from-indigo-500 to-purple-600 p-6 text-white"> |
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<div class="flex items-center justify-between"> |
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<div> |
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<h1 class="text-2xl font-bold">نموذج جمع البيانات</h1> |
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<p class="opacity-90">أدخل معلوماتك وسيتم إرسالها إلى البريد الإلكتروني</p> |
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</div> |
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<i data-feather="mail" class="w-10 h-10"></i> |
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</div> |
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</div> |
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<form id="dataForm" class="p-6 space-y-4"> |
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<div> |
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<label for="name" class="block text-sm font-medium text-gray-700 mb-1">الاسم الكامل</label> |
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<input type="text" id="name" name="name" required |
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class="form-input w-full px-4 py-2 border border-gray-300 rounded-lg focus:border-indigo-500 focus:ring-1 focus:ring-indigo-500 text-right"> |
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</div> |
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<div> |
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<label for="email" class="block text-sm font-medium text-gray-700 mb-1">البريد الإلكتروني</label> |
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<input type="email" id="email" name="email" required |
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class="form-input w-full px-4 py-2 border border-gray-300 rounded-lg focus:border-indigo-500 focus:ring-1 focus:ring-indigo-500 text-right"> |
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</div> |
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<div> |
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<label for="phone" class="block text-sm font-medium text-gray-700 mb-1">رقم الهاتف</label> |
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<input type="tel" id="phone" name="phone" |
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class="form-input w-full px-4 py-2 border border-gray-300 rounded-lg focus:border-indigo-500 focus:ring-1 focus:ring-indigo-500 text-right"> |
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</div> |
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<div> |
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<label for="message" class="block text-sm font-medium text-gray-700 mb-1">الرسالة</label> |
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<textarea id="message" name="message" rows="4" |
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class="form-input w-full px-4 py-2 border border-gray-300 rounded-lg focus:border-indigo-500 focus:ring-1 focus:ring-indigo-500 text-right"></textarea> |
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</div> |
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<div class="flex items-center justify-between pt-2"> |
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<button type="submit" class="bg-indigo-600 hover:bg-indigo-700 text-white px-6 py-2 rounded-lg font-medium transition-colors duration-300 flex items-center"> |
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<span>إرسال</span> |
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<i data-feather="send" class="mr-2 w-4 h-4"></i> |
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</button> |
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</div> |
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</form> |
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</div> |
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<div id="successMessage" class="hidden bg-green-100 border border-green-400 text-green-700 px-4 py-3 rounded-lg relative"> |
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<span class="absolute top-0 bottom-0 right-0 px-4 py-3"> |
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<i data-feather="check-circle" class="h-6 w-6 text-green-500"></i> |
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</span> |
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<div class="pr-8"> |
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<strong class="font-bold">تم الإرسال بنجاح!</strong> |
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<span class="block sm:inline">سيتم إرسال البيانات إلى [email protected]</span> |
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</div> |
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</div> |
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</div> |
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<script> |
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feather.replace(); |
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document.getElementById('dataForm').addEventListener('submit', function(e) { |
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e.preventDefault(); |
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setTimeout(() => { |
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document.getElementById('successMessage').classList.remove('hidden'); |
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document.getElementById('dataForm').reset(); |
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setTimeout(() => { |
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document.getElementById('successMessage').classList.add('hidden'); |
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}, 5000); |
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}, 1000); |
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}); |
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</script> |
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</body> |
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</html> |
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