"Bootstrap Contact Form"
Bootstrap 3.0.0 Snippet by ggofis

<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/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="anailetisim container-fluid"> <div class="container"> <div class="row"> <div class="col-md-6"> <div class="iletisimform"> <div class="mbottom"> <h2> İletişim Bilgilerinizi Bırakın </h2> <p> Soru, görüş ve önerileriniz için bilgilerinizi bırakın biz sizi arayalım. </p> </div> <form role="form" action="/tr/iletisim/" method="post"><div class="form-group"> <div class="row"> <div class="col-md-6"> <input type="text" class="form-control input-lg" placeholder="Adınız" required="" name="isim" id="isim" value=""> </div> <div class="col-md-6"> <input type="text" class="form-control input-lg" placeholder="Soyadınız" required="" name="soyisim" id="soyisim" value=""> </div> </div> </div><div class="form-group"> <div class="row"> <div class="col-md-6"> <input type="email" name="email" placeholder="E-Posta Adresiniz" required="" class="form-control input-lg" id="email" value=""> </div> <div class="col-md-6"> <input type="tel" name="tel" placeholder="Telefon" required="" class="form-control input-lg" id="tel" value=""> </div> </div> </div><div class="form-group"> <div class="row"> <div class="col-md-12"> <textarea name="mesaj" class="form-control" rows="8" cols="80" placeholder="Mesajınız"></textarea> </div> </div> </div><button type="submit" class="btn btn-gonder2 btn-lg" name="gonder">FORMU GÖNDER</button></form> </div> </div> <div class="col-md-1 text-center aralik1 hidden-xs"> <img class="img-responsive" src="http://erkankaratas.com.tr/wp-content/themes/drerkan/resimler/aralik1.png" alt=""> </div> <div class="col-md-5 iletisimbilgi"> <h2> İletişim Bilgilerimiz </h2> <table class="mtop"> <tbody><tr> <td><strong> Adres: </strong></td> <td>İnönü Üniversitesi Tıp Fakültesi, Turgut Özal Tıp Merkezi, Kulak Burun Boğaz Anabilim Dalı, Elazığ Yolu 11. km, 44280 Malatya, TÜRKİYE </td> </tr> <tr> <td><strong> Telefon: </strong></td> <td>+90 422 341 06 60- 4602<br>+90 422 444 19 96 - 4602</td> </tr> <tr> <td><strong>Fax: </strong></td> <td>+90 422 341 39 28</td> </tr> <tr> <td><strong>E-Mail: </strong></td> <td>erkan.karatas@inonu.edu.tr<br>drerkankaratas@gmail.com</td> </tr> </tbody></table> </div> </div> </div> </div> <div class="container-fluid"> <div class="row"> <iframe src="https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d799145.858158566!2d37.63311325804977!3d38.51847076974884!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x407636bd3c77fee3%3A0xb4f07b511f605ac1!2sMalatya!5e0!3m2!1str!2str!4v1480479127130" width="100%" height="300" frameborder="0" style="border:0" allowfullscreen=""></iframe> </div> </div>
/*ANA ILETISIM*/ .anailetisim {background: #95cb0e;border-top: 6px solid #87b50d;padding: 70px 0 0px 0;color:#fff;} .anailetisim h2 {font:300 30px 'Raleway',sans-serif;} .anailetisim .iletisimform input{color:#795548;font:300 16px 'Raleway',sans-serif;padding:12px 18px;border-radius: 8px;} .anailetisim .iletisimform select {background: #fff url('../resimler/selectbg.png') right 4px center no-repeat;color:#ccc;font:300 16px 'Raleway',sans-serif;padding:12px 18px;border-radius: 8px;-webkit-appearance: inherit;} .anailetisim .iletisimbilgi table td {vertical-align:top; color:#fff; font-weight:300; padding:0 12px 40px 12px; }

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