<link href="//netdna.bootstrapcdn.com/bootstrap/3.1.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.1.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="panel panel-default">
<div class="panel-heading">
<h3 class="panel-title">Leave us a message</h3>
</div>
<div class="panel-body">
<form>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="name">Name:</label>
<input type="text" class="form-control" id="name" placeholder="Name">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="surname">Surname:</label>
<input type="text" class="form-control" id="surname" placeholder="Surname">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="email">Email:</label>
<input type="email" class="form-control" id="email" placeholder="Email">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="phone">Phone (optional):</label>
<input type="tel" class="form-control" id="phone" placeholder="Phone">
</div>
