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Mini Shell

Mini Shell

Direktori : /home/eirtvhdf/designbeasts.com/
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Current File : //home/eirtvhdf/designbeasts.com/consultancy_form.php

        <form action="get.php" method="POST" autocomplete="off">
        

          <div class="row">
                                      <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedright">
                <input type="text" autocomplete="off" class="form-control" placeholder="Full Name" name="name" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Full Name'"  required="required"/>
              </div>
              <input type="hidden" name="_token" value="tuLQpLVyIffWjHIVf9St12ep2ujfD8u6CGNZ9cGH">
              <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedleft">
                <input type="email" autocomplete="off" class="form-control" placeholder="Email" name="email" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Email'"  required="required"/>
              </div>
              <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedright">
                <input type="number" min="1" autocomplete="off" class="form-control" placeholder="Phone Number" name="number" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Phone Number'" required="required" />
              </div>
              <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedleft">
                <input type="text" autocomplete="off" class="form-control" placeholder="Country" name="country" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Country'"   required="required"/>
              </div>
                        <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedright">
              <select class="cs-select cs-skin-elastic services" name="interest" id="interest" required>
                  <option value="" disabled >I am Interested in</option>
                  <option value="Logo Design">Logo Design  </option>
                  <option value="Brand Development ">Brand Development </option>
                  <option value="Web Design & Development ">Web Design & Development </option>
                  <option value="App Design & Development">App Design & Development </option>
                  <option value="Back-End Development">Back-End Development </option>
                  <option value="Digital Marketing ">Digital Marketing </option>
                  <option value="Marketing Collaterals">Marketing Collaterals </option>
                  <option value="Motion Graphics">Motion Graphics </option>
                  <option value="Website Management">Website Management </option>
                  <option value="Domain Registration">Domain Registration </option>
                  <option value="Creative Copywriting">Creative Copywriting </option>
                  <option value="2D & 3D Illustration">2D & 3D Illustration </option>
              </select>
            </div>
            <div class="col-xs-12 col-sm-6 col-md-6 margin-bottom-20 field-mergedleft">
                          <select class="cs-select cs-skin-elastic services" name="budget" id="budget" required>
                <option value="" disabled >Forecasted-Budget</option>
                <option value="Less than $1000">Less than $1000</option>
                <option value="$1000 to $2000">$1000 to $2000</option>
                <option value="$2000 to $5000">$2000 to $5000</option>
                <option value="$5000 to $10,000">$5000 to $10,000 </option>
                <option value="$20,000 to $30,000">$20,000 to $30,000</option>
                <option value="$35,000 to $50,000">$35,000 to $50,000</option>
                <option value="$50,000 and above">$50,000 and above</option>
              </select>
              
            </div>
            <div class="col-xs-12 col-sm-12 col-md-12 margin-bottom-20">
              <textarea class="form-control" name="description" placeholder="Talk about your project" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Project Description'" required></textarea>
            </div>
            
            <div class="col-md-12 col-xs-12 margin-bottom-20 field-mergedleft mid-body">
              <div class="clearfix">
                
                <!--<div class="col-lg-12">
                  



                <div class="company_profile pull-right">
                  <label class="control control--checkbox">
                  include Company Profile
                  <input type="checkbox" checked="checked"/>
                  <div class="control__indicator"></div>
                  </label>
                </div>



                <div class="company_profile fill-help pull-left">
                  <label class="control control--checkbox">
                  Please Fill all the field
                 
                  
                  </label>
                </div>

                </div>-->

              </div>
              <div class="text-center">
                <input class="btn-fill btn-quote" type="submit" id="quoteSubmit" name="quote" value="CONTACT OUR TEAM" />
              </div>
            </div>
          </div>
          <input type="hidden" name="page" value="index-2.php" />
        </form>

Zerion Mini Shell 1.0