https://beadoctor.com/

1<!DOCTYPE html>
2<html>
3<head>
4	<title>IFSC</title>
5	<meta charset="utf-8">
6	<link rel="stylesheet" type="text/css" href="pop-css/font-awesome.css">
7	<link rel="stylesheet" href="pop-css/bootstrap.css">
8</head>
9<body>
10<style type="text/css">
11#memberModal{    background: url(icon/bg.jpg); background-attachment: fixed; background-size: cover; background-repeat: no-repeat; background-position: 100% 100%;}
12.modal-body .form-control {position: relative;}
13.modal-body i {position: absolute;left: 15px;top: 15px;bottom: 15px;text-align: center;background: #000;color: #fff;line-height: 2.3em;z-index: 99;padding: 0px 15px;border-radius: 6px;border-top-right-radius: 0px;border-bottom-right-radius: 0px;}
14 .form-control {padding-left: 55px;}
15 .modal-content{background: #fff;padding: 30px;border-top-left-radius: 0px; border-top-right-radius: 0px;}
16 #memberModalLabel {font-family: 'open-sans', sans-serief;font-weight: bold;color: #000;font-size: 25px;line-height: 70px;}
17 .modal-header {border:none;}
18 .modal-footer {border:none;}
19 .modal-header .close {margin-top: -2px; border: 1px solid #000;padding: 10px;border-radius: 77%;
20 }
21 #btn-submit {background: #000;color: #fff;font-weight: bold;text-transform: uppercase;letter-spacing: 2px;border-radius: 0px;box-shadow: 4px 6px 10px rgba(0, 0, 0, 0.31); border:none;width: 142px;height: 42px;}
22 #btn-submit:after{background: #ff0000; display: block; width: 200px;height: 42px;}
23  ::-webkit-input-placeholder { /* Chrome/Opera/Safari */
24  color: #000 !important;
25}
26::-moz-placeholder { /* Firefox 19+ */
27  color: #000 !important;
28}
29:-ms-input-placeholder { /* IE 10+ */
30  color: #000 !important;
31}
32:-moz-placeholder { /* Firefox 18- */
33  color: #000 !important;
34}
35</style>
36<!-- pop-up -->
37<div class="modal fade" id="memberModal" tabindex="-1" role="dialog" aria-labelledby="memberModalLabel" aria-hidden="true" data-backdrop="static" data-keyboard="false">
38    <div class="modal-dialog">
39     <img src="icon/border-top.png" alt="..." class="img-responsive">
40        <div class="modal-content">
41            <div class="modal-header">
42                               <button onclick="window.location='http://www.beadoctor.com/default.html';" type="button" class="close" aria-label="Close"><span aria-hidden="true">&times;</span>
43                </button>
44                     <img src="icon/phn-icon.png" width="70px" class="img-responsive pull-left">
45                 <h4 class="modal-title text-center" id="memberModalLabel">Get A Quick Call!</h4>
46            </div>
47            <div class="modal-body">
48                                <form action="http://code.dvtpl.in/thanku.php" style="margin:0px" method="post" onSubmit="return ValidateForm(this);">

49<script language="javascript">var sa_email_id = '66699-77814';var sa_sent_text = 'Thank you for contacting us. We will get back to you soon.';</script>

49

50<script language="javascript" src="http://s1.smartaddon.com/sa_htmlform.js"></script>

50
51<div id="sa_contactdiv">
52
53

54<script type="text/javascript">
55function ValidateForm(frm) {
56
57if (frm.mobile.value == "" || frm.mobile.value == null) {alert('Mobile number is required.');frm.mobile.focus();return false;}
58
59
60if (frm.skip_CaptchaCode.value == "" || frm.skip_CaptchaCode.value == null) {alert('Enter web form code.');frm.skip_CaptchaCode.focus();return false;}
61return true; }
62function ReloadCaptchaImage(captchaImageId) {
63var obj = document.getElementById(captchaImageId);
64var src = obj.src;
65var date = new Date();
66var pos = src.indexOf('&rad=');
67if (pos >= 0) { src = src.substr(0, pos); }
68obj.src = src + '&rad=' + date.getTime();
69return false; }
70</script>

70

71<script>
72function isNumber(evt) {
73    evt = (evt) ? evt : window.event;
74    var charCode = (evt.which) ? evt.which : evt.keyCode;
75    if (charCode > 31 && (charCode < 48 || charCode > 57)) {
76        return false;
77    }
78    return true;
79}
80</script>

80
81                                    <i class="fa fa-mobile" style="bottom: 78px;"></i>
82                  <input type="text" name="mobile" class="form-control" pattern="[0-9]{10,10}" autocomplete="off"  maxlength="10" id="extra7" onKeyPress="return isNumber(event)" required maxlength="10" placeholder="Enter Your mobile number">
83                  <!-- Mention the Client Mail ID's on which information have to send -->
84                  <input type="hidden" name="name"  class="box-div" value="send enquiry"/>
85                  <input type="hidden" class="box-div" name="email" value="send enquiry" />
86                   <input type="hidden" class="box-div" name="msg" value="enquiry from pop up" />
87       <!-- Mention the Client Mail ID's on which information have to send -->
88        <input name="clientMailID" type="hidden" value="[email protected]"/>
89		
90        <!-- Website Name where to divert for conversion -->
91		<input name="website" type="hidden" value="beadoctor.com/thanku.html" />
92        <!-- Auto Incremented -->
93		<input name="loginID" type="hidden" value="1282" />
94        <!-- Company Name -->
95		<input name="companyName" type="hidden" value="IFSC" />
96             
97            </div>
98            <div class="modal-footer">
99                <input type="submit" class="btn btn-primary">
100            </div>
101   </form>
102            </div>
103            
104        </div>
105    </div>
106</div>
107 

107<script src="pop-js/jquery-3.1.1.min.js"></script>

107

108<script type="text/javascript" src="pop-js/bootstrap.js"></script>

108
109 

109<script type="text/javascript">
110		$(document).ready(function () {
111    $('#memberModal').modal('show');
112});
113	</script>

113
114 
115 </body>
116</html>