<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<div class="container">
<div class="row">
<form action="" method="post" class="smart-green">
<h1>Support Ticket
<span>Please fill all the texts in the fields.</span>
</h1>
<label>
<span>Your Name :</span>
<input id="name" type="text" name="name" placeholder="Your Full Name" />
</label>
<label>
<span>Your Email :</span>
<input id="email" type="email" name="email" placeholder="Valid Email Address" />
</label>
<label>
<span>Your Phone :</span>
<input id="Phone" type="email" name="Phone" placeholder="Valid Phone Number" />
</label>
<label>
<span>Subject :</span><input id="Subject" type="text" name="Subject" placeholder="Your Full Subject" />
</label>
<label>
<span>Message :</span>
<textarea id="message" name="message" placeholder="Your Message to Us"></textarea>
</label>
<label>
<span> </span>
<input type="button" class="button" value="Send" />
</label>
</form>
</div>
</div>
/*######## Smart Green ########*/
.smart-green {
margin-left:auto;
margin-right:auto;
max-width: 500px;
background: #F8F8F8;
padding: 30px 30px 20px 30px;
font: 12px Arial, Helvetica, sans-serif;
color: #666;
border-radius: 5px;
-webkit-border-radius: 5px;
-moz-border-radius: 5px;
}
.smart-green h1 {
font: 24px "Trebuchet MS", Arial, Helvetica, sans-serif;
padding: 20px 0px 20px 40px;
display: block;
margin: -30px -30px 10px -30px;
color: #FFF;
background: #9DC45F;
text-shadow: 1px 1px 1px #949494;
border-radius: 5px 5px 0px 0px;
-webkit-border-radius: 5px 5px 0px 0px;
-moz-border-radius: 5px 5px 0px 0px;
border-bottom:1px solid #89AF4C;
}
.smart-green h1>span {
display: block;
font-size: 11px;
color: #FFF;
}
.smart-green label {
display: block;
margin: 0px 0px 5px;
}
.smart-green label>span {
float: left;
margin-top: 10px;
color: #5E5E5E;
}
.smart-green input[type="text"], .smart-green input[type="email"], .smart-green textarea, .smart-green select {
color: #555;
height: 30px;
line-height:15px;
width: 100%;
padding: 0px 0px 0px 10px;
margin-top: 2px;
border: 1px solid #E5E5E5;
background: #FBFBFB;
outline: 0;
-webkit-box-shadow: inset 1px 1px 2px rgba(238, 238, 238, 0.2);
box-shadow: inset 1px 1px 2px rgba(238, 238, 238, 0.2);
font: normal 14px/14px Arial, Helvetica, sans-serif;
}
.smart-green textarea{
height:100px;
padding-top: 10px;
}
.smart-green select {
background: url('down-arrow.png') no-repeat right, -moz-linear-gradient(top, #FBFBFB 0%, #E9E9E9 100%);
background: url('down-arrow.png') no-repeat right, -webkit-gradient(linear, left top, left bottom, color-stop(0%,#FBFBFB), color-stop(100%,#E9E9E9));
appearance:none;
-webkit-appearance:none;
-moz-appearance: none;
text-indent: 0.01px;
text-overflow: '';
width:100%;
height:30px;
}
.smart-green .button {
background-color: #9DC45F;
border-radius: 5px;
-webkit-border-radius: 5px;
-moz-border-border-radius: 5px;
border: none;
padding: 10px 25px 10px 25px;
color: #FFF;
text-shadow: 1px 1px 1px #949494;
}
.smart-green .button:hover {
background-color:#80A24A;
}
