Request a quote
Request a quote
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<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Tech Support & Maintenance Form</title>
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<style>
.form-group { margin-bottom: 15px; }
label { font-weight: bold; }
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</head>
<body>
<div class="container mt-5">
<h1 class="mb-4">Request a Service</h1>
<form action="send_email.php" method="post">
<div class="form-group">
<label for="name">Name:</label>
<input type="text" class="form-control" id="name" name="name" required>
</div>
<div class="form-group">
<label for="email">Email:</label>
<input type="email" class="form-control" id="email" name="email" required>
</div>
<div class="form-group">
<label for="phone">Phone:</label>
<input type="tel" class="form-control" id="phone" name="phone" pattern="[0-9]{10}" required>
<small class="form-text text-muted">Please enter a valid 10-digit phone number.</small>
</div>
<div class="form-group">
<label for="company">Company Name:</label>
<input type="text" class="form-control" id="company" name="company">
</div>
<div class="form-group">
<label for="cloud-solutions">Cloud Solutions (AWS/Azure):</label>
<select class="form-control" id="cloud-solutions" name="cloud_solutions[]" multiple>
<option value="Infrastructure Setup">Infrastructure Setup</option>
<option value="Cloud Migration">Cloud Migration</option>
<option value="Managed Services">Managed Services</option>
</select>
</div>
<div class="form-group">
<label for="cybersecurity-audits">Cybersecurity Audits:</label>
<select class="form-control" id="cybersecurity-audits" name="cybersecurity_audits[]" multiple>
<option value="Vulnerability Assessment">Vulnerability Assessment</option>
<option value="Penetration Testing">Penetration Testing</option>
<option value="Security Compliance">Security Compliance</option>
</select>
</div>
<div class="form-group">
<label for="network-management">Network Management:</label>
<select class="form-control" id="network-management" name="network_management[]" multiple>
<option value="Network Design & Setup">Network Design & Setup</option>
<option value="Monitoring & Maintenance">Monitoring & Maintenance</option>
<option value="Troubleshooting & Support">Troubleshooting & Support</option>
</select>
</div>
<div class="form-group">
<label for="tech-support-maintenance">Tech Support & Maintenance:</label>
<select class="form-control" id="tech-support-maintenance" name="tech_support_maintenance[]" multiple>
<optgroup label="PC Maintenance">
<option value="PC Tune-Up">PC Tune-Up</option>
<option value="Hardware Diagnostics">Hardware Diagnostics</option>
<option value="Software Updates">Software Updates</option>
</optgroup>
<optgroup label="Anti-virus Protection">
<option value="Virus Removal">Virus Removal</option>
<option value="System Scan">System Scan</option>
<option value="Real-time Protection">Real-time Protection</option>
</optgroup>
<optgroup label="PC Security">
<option value="Firewall Configuration">Firewall Configuration</option>
<option value="Security Updates">Security Updates</option>
<option value="Data Encryption">Data Encryption</option>
</optgroup>
<optgroup label="Software Installation & Updates">
<option value="Operating System Installation">Operating System Installation</option>
<option value="Application Installation">Application Installation</option>
<option value="Patch Management">Patch Management</option>
</optgroup>
<optgroup label="System Monitoring & Performance Tuning">
<option value="Performance Optimization">Performance Optimization</option>
<option value="Resource Management">Resource Management</option>
<option value="Real-time Monitoring">Real-time Monitoring</option>
</optgroup>
<optgroup label="Backup & Disaster Recovery">
<option value="Data Backup Solutions">Data Backup Solutions</option>
<option value="Disaster Recovery Planning">Disaster Recovery Planning</option>
<option value="Data Restoration">Data Restoration</option>
</optgroup>
<optgroup label="IT Consultation & Troubleshooting">
<option value="Technical Support">Technical Support</option>
<option value="IT Strategy Planning">IT Strategy Planning</option>
<option value="Issue Resolution">Issue Resolution</option>
</optgroup>
</select>
</div>
<div class="form-group">
<label for="web-development">Web Development:</label>
<select class="form-control" id="web-development" name="web_development[]" multiple>
<option value="Custom Web Apps">Custom Web Apps</option>
<option value="E-Commerce Solutions">E-Commerce Solutions</option>
<option value="CMS Development (WordPress, Shopify)">CMS Development (WordPress, Shopify)</option>
<option value="API Integration">API Integration</option>
</select>
</div>
<div class="form-group">
<label for="additional-details">Additional Details:</label>
<textarea class="form-control" id="additional-details" name="additional_details" rows="3"></textarea>
</div>
<div class="form-group">
<label for="contact-method">Preferred Contact Method:</label>
<select class="form-control" id="contact-method" name="contact_method" required>
<option value="Email">Email</option>
<option value="Phone">Phone</option>
<option value="Either">Either</option>
</select>
</div>
<button type="submit" class="btn btn-primary">Submit</button>
</form>
</div>
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