/home/kkco/public_html/home__2939f42/include/brosur_unpab.php
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" /><form id="emf-form" target="_self" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/89bfaSvM0cjCc6">
<table style="text-align:left;" width="100%" cellpadding="2" cellspacing="0" border="0" bgcolor="#FFFFFF">
<tr valign="top" ><td id="td_element_label_0" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nama Lengkap</b></font>
<span style="color:red;"><small>*</small></span>
<input id="element_0" name="element_0" value="" size="30"
class="form-control validate[required]" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr><tr valign="top" ><td id="td_element_label_1" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Email</b></font>
<span style="color:red;"><small>*</small></span>
<input id="element_1" name="element_1"
class="form-control validate[required,custom[email]]"
value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr><tr valign="top" ><td id="td_element_label_2" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Nomor HP</b></font>
<span style="color:red;"><small>*</small></span>
<input id="element_2" name="element_2"
class="form-control validate[required,custom[onlyNumber]]"
value="" size="30" type="text" /><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr><tr valign="top" ><td id="td_element_label_3" style="" align="left"><font face="Verdana" size="2" color="#000000"><b>Alamat Lengkap</b></font>
<span style="color:red;"><small></small></span>
<textarea id="element_3" name="element_3" cols="45" rows="3"
class="form-control validate[optional] "></textarea><div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr><tr><td colspan="2" align="left">
<input name="element_counts" value="4" type="hidden" />
<input name="embed" value="forms" type="hidden" /><input class="btn btn-success btn-block" value="KIRIM" type="submit" />
</td></tr></table></form>