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"Service Request"
Bootstrap 3.3.0 Snippet by
mail2sundarg
3.3.0
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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 class="container"> <div class="row vertical-offset-100"> <div class="col-md-4 col-md-offset-4"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title">User Service Request</h3> </div> <div class="panel-body"> <form accept-charset="UTF-8" role="form"> <fieldset> <div class="form-group"> <select class="form-control" name="housetype"> <option>Single family home</option> <option>Condo or Townhouse</option> <option>Other</option> </select> </div> <div class="form-group"> <input class="form-control" placeholder="Address" name="email" type="text"> </div> <div class="form-group"> <input class="form-control" placeholder="Zip Code" name="email" type="text"> </div> <div class="form-group"> <input class="form-control" placeholder="E-mail" name="email" type="text"> </div> <input class="btn btn-lg btn-success btn-block" type="submit" value="Send me my free solar report"> </fieldset> </form> </div> </div> </div> </div> </div>
body{ background-color: #444; } .vertical-offset-100{ padding-top:100px; }
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Quote request form template - responsive web design
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