formExample/index.html at master · damic88/formExample · GitHub

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<!doctype html>
<html lang="en">
<head>
    <title>Form</title>

    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
    <meta name="description" content="Novomedici" />
    <meta name="keywords" content="novomedici" />
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
    <link href="http://fonts.googleapis.com/css?family=Raleway:300,400,600" rel="stylesheet" type="text/css">
    <link rel="stylesheet" href="css/main.css">
</head>
<body>
    <div class="wrapper">
        <div class="contentCostumerForm">
	        <div class="costumerForm">
	        	<h3>Contact Us</h3>
	        	<form action="#" method="post">
	        		<div class="name field1">
	        			<div class="label"><label>First Name</label></div>
		      	  		<div class="input"><input type="text" name="name"></div>

	        		</div>
	        		<div class="lastname field2">
	        		    <div class="label"><label>Last Name</label></div>
		      	  		<div class="input"><input type="text" name="password"></div>
	        		</div>
	        		<div class="email field1">
	        			<div class="label"><label>Email	</label></div>
		      	  		<div class="input"><input type="text" name="name"></div>

	        		</div>
	        		<div class="phonenumber field2">
	        		    <div class="label"><label>Phone Number</label></div>
		      	  		<div class="input"><input type="text" name="password"></div>
	        		</div>
	        		<div class="question">
	        			<div class="label"><label>Question/Comment</label>
						<textarea name="question">
						</textarea>
	        		</div>
					<div class="submitContent">
						<p>Please allow up to 48 hours for a response to your inquiry</p>
						<div class="button"><a href="#"><img src="images/submitButton.png" class="img-responsive"></a></div>
					</div>
	        	</form>
	        </div>
		</div>
    </div>

    <script>window.jQuery || document.write('<script src="js/vendor/jquery-1.8.1.min.js"><\/script>')</script>
</body>
</html>