<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Title</title>
    <script src="https://code.jquery.com/jquery-3.3.1.min.js"
            integrity="sha256-FgpCb/KJQlLNfOu91ta32o/NMZxltwRo8QtmkMRdAu8=" crossorigin="anonymous"></script>

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    <script src="<?= $template ?>custom.js"></script>
    <script type="text/javascript" charset="utf-8">
        localStorage.setItem('path', '<?= $path ?>');
        localStorage.setItem('template', '<?= $template ?>');
    </script>
</head>
<body>


<div class="container text-center">
    <div class="row">
        <div class="col-12 mt-5">
            <h2 style="text-align: left;">RTB Ringba Call Transfer</h2>
            <form id="LeadForm" name="LeadForm" class="row g-3" method="post" action=""
                  onsubmit="GetResponse(); return false;">
                <div class="col-auto">
                    <label for="phone_number" class="visually-hidden">Phone Number</label>
                    <input type="number" maxlength="10" minlength="10" class="form-control" id="phone_number" name="phone_number"
                           placeholder="Phone Number">
                </div>
                <div class="col-auto">
                    <label for="zip_code" class="visually-hidden">Zip Code</label>
                    <input type="number" maxlength="5" minlength="5" class="form-control" id="zip_code" name="zip_code" placeholder="Zip Code">
                </div>
                <div class="col-auto">
                    <button type="button" class="btn btn-primary mb-3" onclick="GetResponse()">Submit</button>
                </div>
            </form>
        </div>
        <div class="col-6 mt-2 mb-5" align="left" id="formResponse">
            Please submit form with phone number and zip code...
        </div>

    </div>
</div>
<script>
    function GetResponse() {
        var phpdata = $("form#LeadForm").serialize();
        var response = AjaxRequest("form-submit", phpdata, 'formResponse');
        return false;
    }
</script>
</body>
</html>
