<!
DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Axcel Gases Order Form</title>
<style>
body {
font-family: Arial, sans-serif;
background-color: #f0f2f5;
display: flex;
justify-content: center;
align-items: center;
height: 100vh;
margin: 0;
color: #333;
}
.container {
background-color: #ffffff;
padding: 40px;
border-radius: 10px;
box-shadow: 0 4px 15px rgba(0, 0, 0, 0.1);
width: 90%;
max-width: 500px;
box-sizing: border-box;
}
h2 {
text-align: center;
color: #004085;
margin-bottom: 25px;
}
label {
display: block;
margin-bottom: 8px;
font-weight: bold;
color: #555;
}
input[type="text"],
input[type="email"],
input[type="number"],
textarea {
width: 100%;
padding: 12px;
margin-bottom: 20px;
border: 1px solid #ccc;
border-radius: 5px;
box-sizing: border-box;
font-size: 16px;
}
button {
width: 100%;
padding: 15px;
border: none;
background-color: #007bff;
color: white;
border-radius: 5px;
cursor: pointer;
font-size: 18px;
font-weight: bold;
transition: background-color 0.3s ease;
}
button:hover {
background-color: #0056b3;
}
#statusMessage {
margin-top: 20px;
text-align: center;
font-weight: bold;
}
</style>
</head>
<body>
<div class="container">
<h2>Axcel Gases Cylinder Order</h2>
<form id="orderForm">
<label for="fullName">Full Name</label>
<input type="text" id="fullName" name="user_name" required>
<label for="email">Email Address</label>
<input type="email" id="email" name="user_email" required>
<label for="cylinderName">Cylinder Name</label>
<input type="text" id="cylinderName" name="cylinder_name" placeholder="e.g.,
Oxygen, Nitrogen, Argon" required>
<label for="quantity">Quantity</label>
<input type="number" id="quantity" name="quantity" min="1" required>
<label for="message">Message / Address</label>
<textarea id="message" name="message" rows="4" placeholder="Enter your delivery
address and any special instructions..."></textarea>
<button type="submit">Submit Order</button>
</form>
<div id="statusMessage"></div>
</div>
<script type="text/javascript"
src="[Link]
<script type="text/javascript">
// Replace with your EmailJS Public Key
[Link]({
publicKey: "YOUR_EMAILJS_PUBLIC_KEY",
});
[Link]('orderForm').addEventListener('submit', function(event) {
[Link](); // Stop the form from submitting normally
const statusMessage = [Link]('statusMessage');
[Link] = 'Sending...';
[Link] = '#007bff';
// Replace with your EmailJS Service ID and Template ID
[Link]('YOUR_EMAILJS_SERVICE_ID',
'YOUR_EMAILJS_TEMPLATE_ID', this)
.then(function() {
[Link]('SUCCESS!');
[Link] = 'Order submitted successfully!';
[Link] = 'green';
[Link]('orderForm').reset(); // Reset the form
}, function(error) {
[Link]('FAILED...', error);
[Link] = 'Failed to submit order. Please try again.';
[Link] = 'red';
});
});
</script>
</body>
</html>