<?php

session_start();

$name = '';
$email = '';
$message = '';

$fecha='';
$luz='';
$hora='';
$estiempo='';


if (isset($_SESSION['return_data'])) {
    
    $formOK = $_SESSION['return_data']['formOK'];
    $entries = $_SESSION['return_data']['entries'];
    $errors = $_SESSION['return_data']['errors'];
    unset($_SESSION['return_data']);
    
    if (!$formOK) {
        foreach ($entries as $key => $value) {
            ${$key} = $value;
        }
        $submitmessage = 'No se pude enviar el mensaje. ';
        $responsetype = 'failure';
    }
    else {
        $submitmessage = 'Su mensaje ha sido enviado.';
        $responsetype = 'success';
    }
}
?>


<!DOCTYPE html>
<html lang="es">
<head>
<meta charset="utf-8">
<title>Ampara</title>
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<meta name="description" content="" />
<meta name="author" content="http://bootstraptaste.com" />
<!-- css -->
<link href="css/bootstrap.min.css" rel="stylesheet" />
<link href="css/fancybox/jquery.fancybox.css" rel="stylesheet">
<link href="img/shadowbox.css" rel="stylesheet" />
<link href="css/flexslider.css" rel="stylesheet" />
<link href="css/style.css" rel="stylesheet" />
<script type="text/javascript" src="img/shadowbox.js"></script>
<script type="text/javascript">
    Shadowbox.init();
</script>   


<!-- Theme skin -->
<link href="skins/default.css" rel="stylesheet" />

<!-- HTML5 shim, for IE6-8 support of HTML5 elements -->
<!--[if lt IE 9]>
      <script src="http://html5shim.googlecode.com/svn/trunk/html5.js"></script>
    <![endif]-->
<style type="text/css"> 
        /* Form 
        form ol { list-style: none; padding: 0; }        
        label { display: block; width: 100%; font-weight: 700; margin-top: 1em; }
        #submit-container { overflow: hidden; }
        #send { padding: 0.25em; float: left; }
        #loading { width: 32px; height: 32px; display: none; margin-left: 0.75em; float: left; background: url(img/ajax-loader.gif); }
        .instruction { font-style: italic; }        
        .star { color: red; }
        input.error, textarea.error { -webkit-box-shadow: 0px 0px 2px 0px #fa301e; -moz-box-shadow: 0px 0px 2px 0px #fa301e; box-shadow: 0px 0px 2px 0px #fa301e; }
        label.error { color: red; display: inline; margin-left: 0.5em; }*/
       
        /* Submit Message */
        .failure { color: red; background: pink }
        .success { color: green; background: lightgreen; }
        .success, .failure { padding: 1em; font-style: italic; }
        #submit-message { margin-top: 2em; clear: both; }        
        #textos{font-family: Verdana, sans-serif;
		color:#333232;
		font-size:0.9em;
		}
		#textos input {padding:3px; font-size:0.9em;}
		
        /* Utility */
        .hidden { display: none !important; visibility: hidden; }
    </style>

</head>
<body>
<div id="wrapper">
	<!-- start header -->
	
	<!-- end header -->
	<section id="inner-headline">
	<div class="container">
		<div class="row">
			<div class="col-lg-12">
				<ul class="breadcrumb">
					<li><a href="index.php"><i class="fa fa-home"></i></a><i class="icon-angle-right"></i></li>
					<li class="active">Denuncia de Siniestro</li>
				</ul>
			</div>
		</div>
	</div>
	</section>
	<section id="content">
	
<div class="container">
<div class="row">
<div class="col-lg-9">
<h4>Comunicate con nosotros</h4>
<form  action="process2.php" method="post"  >


            <p><span class="<?php echo (isset($formOK) ? $responsetype : 'hidden'); ?>">
<?php if(isset($formOK)) { echo $submitmessage; } ?>
</span></p>
<p>&nbsp; </p>
<div class="row">
<div class="col-lg-3 field">
<label for="name">Nombre *</label>
        <br>
<input type="textos" name="name"   value="" required="required"/>


</div>
<div class="col-lg-3 field">
 <label for="email"> 
       
        
        <strong>Email *</strong>
</label>
        <br>
        <input type="textos" name="email" value="" required="required"/>
</div></div>
<div class="align-left">

<p>1 - Fecha de Siniestro</p>
<p>
Fecha*: (dd/mm/aa) <input  name="fecha" required="required" id="phone" value="" size="10"/> | Hora*: <input name="hora" required="required" id="phone" value="" size="7"/> | <label>
<input type="radio" name="luz" value="dia" id="luz_0">
Día</label> &nbsp;&nbsp;
<label>
<input type="radio" name="luz" value="noche" id="luz_1">
Noche</label>
| Estado del Tiempo*: <select class="select" name="estiempo" value="" required="required"> <option value="" selected="Elejir">Elegir</option>
<option value="lluvia">Lluvia</option>
<option value="seco">Seco</option>
<option value="niebla">Niebla</option>
<option value="nieve">Nieve</option>
<option value="granizo">Granizo</option>
</select>

<p>
<p>
<p>
<p>































<!--<input type="text" name="email" placeholder="* Enter your email address" data-rule="email" data-msg="Please enter a valid email" />
<div class="validation">
</div>-->



<label for="message">Mensaje
                <br>
</label>
            
<p> <textarea name="message" cols="32" rows="4" id="message"  type="textos"/></textarea>
        <label class="error"></label>
                                        
                <!--<p class="instruction"><span class="star" style="color:#A80A0D">&#42; Requerido</span></p>-->

<!--<textarea rows="8" name="message" class="input-block-level" placeholder="* Your message here..." data-rule="required" data-msg="Please write something"></textarea>
<div class="validation">
</div>-->
<p>&nbsp;</p>
<p>
 <input class="button" type="submit" name="send" value="Enviar" id="send"/ style="font-size:1.2em; padding:6px; color:#0230AB">
                <span id="loading"></span> 
<!--<button class="btn btn-theme margintop10 pull-left" type="submit">ENVIAR</button>-->
<span class="pull-right margintop20">* Requerido</span>
</p>
</div>
</form>
</div>
</div>
        
<div class="row">
</section>
	
<a href="#" class="scrollup"><i class="fa fa-angle-up active"></i></a>

   <a href="img/boedo-g.jpg" rel="shadowbox[gru2]" title="Sucursal Boedo"></a>
   <a href="img/san-justo-g.jpg" rel="shadowbox[gru2]" title="Sucursal San Justo"></a>
   <a href="img/v-del-parque-g.jpg" rel="shadowbox[gru2]" title="Sucursal Villa del Parque"></a>
   <a href="img/lugano-g.jpg" rel="shadowbox[gru2]" title="Sucursal Lugano"></a>
   <a href="img/san-martin-g.jpg" rel="shadowbox[gru2]" title="Sucursal San Martín"></a>
   <a href="img/Palomar-g.jpg" rel="shadowbox[gru2]" title="Sucursal Ciudad Jardín"></a>
   <!-- javascript
    ================================================== -->
<!-- Placed at the end of the document so the pages load faster -->
<script src="js/jquery.js"></script>
<script src="js/jquery.easing.1.3.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/jquery.fancybox.pack.js"></script>
<script src="js/jquery.fancybox-media.js"></script>
<script src="js/google-code-prettify/prettify.js"></script>
<script src="js/portfolio/jquery.quicksand.js"></script>
<script src="js/portfolio/setting.js"></script>
<script src="js/jquery.flexslider.js"></script>
<script src="js/animate.js"></script>
<script src="js/custom.js"></script>
<script src="js/validate.js"></script>
</body>
</html>