<?php
require_once('header.php');
echo $page_content;
echo <<<EOJ
<div class="subscriptionenquirycanvas">
    <div class="container">
        <div class="hideonmobile">
            <div>
			    <a href="{$baseurl}"><img src="{$imageurl}logo.png" alt="{$websitename}" title="{$websitename}" style="height:30px !important;" /></a>
            </div>
            <div style="display: flex;flex-direction: column;">
                <b style="font-size: 18px;">{$websitename}</b>
                <span style="font-size: 13px;">Phone: +91-8178042476</span>
            </div>
        </div>
        <div class="buttongroup">
            <a href="https://www.akinik.com/subscription-enquiry/medicine-journal-subscription" target="_blank" class="enqbtn">Subscription Enquiry</a>
            <a href="https://wa.me/918178042476?text=Hi, I have a query regarding medicine journal subscription." target="_blank" class="enqbtn wab">
                <svg xmlns="http://www.w3.org/2000/svg" aria-label="WhatsApp" role="img" viewBox="0 0 512 512" width="18px" height="18px" fill="#000000"><g id="SVGRepo_bgCarrier" stroke-width="0"></g><g id="SVGRepo_tracerCarrier" stroke-linecap="round" stroke-linejoin="round"></g><g id="SVGRepo_iconCarrier"><rect width="512" height="512" rx="15%" fill="#25d366"></rect><path fill="#25d366" stroke="#ffffff" stroke-width="26" d="M123 393l14-65a138 138 0 1150 47z"></path><path fill="#ffffff" d="M308 273c-3-2-6-3-9 1l-12 16c-3 2-5 3-9 1-15-8-36-17-54-47-1-4 1-6 3-8l9-14c2-2 1-4 0-6l-12-29c-3-8-6-7-9-7h-8c-2 0-6 1-10 5-22 22-13 53 3 73 3 4 23 40 66 59 32 14 39 12 48 10 11-1 22-10 27-19 1-3 6-16 2-18"></path></g></svg>
                Chat
            </a>
        </div>
    </div>
</div>
EOJ;

$countries = '';
$stmt = $mysqli->prepare("SELECT nicename, phonecode FROM country WHERE phonecode != '0' ORDER BY nicename");
$stmt->execute();
$stmt->store_result();
$stmt->bind_result($nicename, $phonecode);
while ($stmt->fetch()) :
    $countries .= '<option value="' . $nicename . '" data-phonecode="+' . $phonecode . '" ' . ($phonecode == '91' ? 'selected' : '') . '>' . $nicename . '</option>';
endwhile;
$stmt->close();
echo <<<EOJ
<div class="subenqform">
    <div class="centered">
        <div class="formcard">
            <div class="formcardhead">
                <h5>Request For Subscription Enquiry</h5>
                <b>Please provide your contact details.</b>
                <button type="button" onclick="$('.subenqform').hide(0).find('form').reset();"><span class="material-icons">close</span></button>
            </div>
            <div style="padding: 12px 6px;">
                <form action="{$baseurl}{$pagename}" method="post" name="enquiryform" class="" enctype="multipart/form-data" onsubmit="return p(this)">
                <input type="hidden" name="token" value="{$en->encrypt('[PHPSESSID]=[GEN_TOKEN]')}" autocomplete="off" readonly />
                <input type="hidden" name="focus" value="{$en->encrypt('[PLACE_SUBENQUIRY]')}" autocomplete="off" readonly />
                <input type="hidden" name="{$token_id}" value="{$token_value}" autocomplete="off" readonly />
                    <input type="hidden" name="zipcode" value="" readonly />
                    <input type="hidden" name="recaptcha_response" id="recaptchaResponse">
                    <div class="form-row form-row-2">
                        <div class="form-col">
                            <label>Full Name</label>
                            <input type="text" name="name" autocomplete="off" class="field" />
                        </div>
                        <div class="form-col">
                            <label>Email</label>
                            <input type="text" name="email" autocomplete="off" class="field" />
                        </div>
                    </div>
                    <div class="form-row form-row-2">
                        <div class="form-col">
                            <label>Country</label>
                            <select name="country" class="field browser-default" onchange="phonecode.value = this.value ? event.target.options[event.target.selectedIndex].dataset.phonecode : '';">
                                <option value="" selected="selected">Select country</option>
                                {$countries}
                            </select>
                        </div>
                        <div class="form-col">
                            <label>Mobile Number</label>
                            <div style="display:flex;clear:both">
                                <input type="text" name="phonecode" id="phonecode" value="+91" class="field" style="width:50px;padding:0;text-align:center;background:#eee;outline:none;font-size:13px;" readonly />
                                <input type="text" name="phone" autocomplete="off" class="field phone" />
                            </div>
                        </div>
                    </div>
                    <div class="form-row">
                        <div class="form-col">
                            <label>Message</label>
                            <textarea name="message" rows="5" cols="5" autocomplete="off" class="field field-text" style="height: 80px;"></textarea>
                        </div>
                    </div>
                    <div class="form-row">
                        <div class="form-col" style="text-align: center;">
                            <button type="submit" class="enquirybutton">Submit Enquiry</button>
                            <div class="sloader">Please Wait...</div>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>
<div class="customtoast" style="position: fixed;top: 0;bottom: 0;left: 0;right: 0;z-index: 9999;width: 480px;height:50px;padding: 10px;margin: auto;border-radius: 4px;color: #fff;box-shadow: 0 2px 5px rgba(0,0,0,0.35);padding: 13px 12px;font-size: 14px;display:none;font-family: 'Roboto', sans-serif !important;"></div>
EOJ;
?>
<script id="googlerecaptcha" src="https://www.google.com/recaptcha/api.js?render=6Lfrk5QpAAAAAPeBXy9aMpivieJAsNJA5Oq2A_sP"></script>
<script>
grecaptcha.ready(function() {
    grecaptcha.execute(Object.fromEntries(new URL(googlerecaptcha.src).searchParams).render, {action: 'contact'}).then(function(token) {
        document.getElementById('recaptchaResponse').value = token;
    });
});
</script>
<?php
require_once('footer.php');
?>