"ORDER FORM"
Bootstrap 3.3.0 Snippet by ntd187

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<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 id="main-wrap">
<div class="container" style="width:640px!important;max-width:100%!important;">
<div id="wsite-content" class="wsite-selements wsite-not-footer">
<div class="wsite-image wsite-image-border-none " style="padding-top:10px;padding-bottom:10px;margin-left:0;margin-right:0;text-align:center"> <a href="https://docs.google.com/forms/d/1mHVKEsHU582GXpz4uti8alJsRFu67Gb643YX-1w0rik/viewform" target="_blank"><img src="https://googledrive.com/host/0BxpJzj8xk6bieWd5TV9RVktHZmc/order-online-btn-frontpage.jpg" alt="mua effortless english online" style="width:auto;max-width:100%"></a>
<div style="display:block;font-size:90%">Quý khách vui lòng điền đầy đủ thông tin bên dưới, các thông tin màu đỏ là bắt buộc:</div>
</div>
<div id="302604206391460689" align="left" style="width: 100%; overflow-y: hidden;" class="wcustomhtml">
<style type="text/css">
.required {
border-color: #FF9D9D;
}
.bg-primary {
background-color: #DB2828;
margin: 0 15px;
max-width: 942px;
}
.row h2 {
margin: 7px 0;
}
.help-block {
font-size: 0.8em;
}
.input-group-addon.primary {
color: rgb(255, 255, 255);
background-color: rgb(50, 118, 177);
border-color: rgb(40, 94, 142);
}
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@import url(http://netdna.bootstrapcdn.com/font-awesome/4.0.3/css/font-awesome.css);
.spinner input {
text-align: right;
}
.input-group-btn-vertical {
position: relative;
white-space: nowrap;
width: 2%;
vertical-align: middle;
display: table-cell;
}
.input-group-btn-vertical > .btn {
display: block;
float: none;
width: 100%;
max-width: 100%;
padding: 8px;
margin-left: -1px;
position: relative;
border-radius: 0;
}
.input-group-btn-vertical > .btn:first-child {
border-top-right-radius: 0;
}
.input-group-btn-vertical > .btn:last-child {
margin-top: -2px;
border-bottom-right-radius: 0;
}
.input-group-btn-vertical i {
position: absolute;
top: 0;
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