dv-orderlinks/form2.html at master · DevlessTeam/dv-orderlinks · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
	<meta charset="UTF-8">
	<title>Kuza Forms - Sell Anywhere, Grow your Business</title>
	<link rel="stylesheet" href="css/custom/style.css">
	<link rel="stylesheet" href="css/responsive/responsive.css">
	<link rel="stylesheet" href="css/helper.css">
	<link rel="stylesheet" href="css/custom.css">
</head>
<body>
	<div class="container">
		<div class="row">
			<form action="" method="POST" role="form">
				<div id="leftPage" class="col-lg-7 pd-tb-mini pd-r-50">
					<h3 class="mr-b-20">Customer information</h3>
					<div class="row">
						<div class="form-group col-md-6">
							<label for="" class="control-label">First Name</label>
							<input type="text" class="form-control" id="" placeholder="Enter your First Name">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">Last Name</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Last Name">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">Email Address</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Email Address">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">Phone #</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Phone #">
						</div>
					</div>
					<hr>
					<h3 class="mr-b-20">Address / Shipping Information</h3>

					<div class="row">
						<div class="form-group col-md-12">
							<label for="" class="control-label">Company Name</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Company Name">
						</div>
						<div class="form-group col-md-12">
							<label for="" class="control-label">Address</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Address">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">City / Town</label>
							<input type="text" class="form-control" id="" placeholder="Enter your City / Town">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">Region</label>
							<input type="text" class="form-control" id="" placeholder="Enter your Region">
						</div>
					</div>
				</div>
				<div id="rightPage" class="col-lg-5">
					<h3 class="mr-b-20">Booking Information</h3>
					<div class="row">
						<div class="form-group col-md-8">
							<label for="" class="control-label">Purpose</label>
							<input type="text" class="form-control" id="" placeholder="Purpose of Booking">
						</div>
						<div class="form-group col-md-4">
							<label for="" class="control-label">People #</label>
							<input type="number" class="form-control" id="" placeholder="# People">
						</div>
						<div class="form-group col-md-6">
							<label for="" class="control-label">Event Date</label>
							<input type="date" class="form-control" id="" placeholder="Event Date">
						</div>
						<div class="form-group col-md-3">
							<label for="" class="control-label">Start Time</label>
							<input type="time" class="form-control" id="">
						</div>
						<div class="form-group col-md-3">
							<label for="" class="control-label">End Time</label>
							<input type="time" class="form-control" id="">
						</div>
					</div>
					<h4 class="mr-tb-20">Select Venue</h4>
					<div class="row">
						<div class="form-group">
							<div class="col-md-6 mr-b-10">
								<label class="radio-inline"><input type="radio" name="venue" checked>Roof Top: Ghc 2,000 (8hrs)</label>
							</div>
							<div class="col-md-6 mr-b-10">
								<label class="radio-inline"><input type="radio" name="venue">Roof Top: Ghc 1,000 (4hrs)</label>
							</div>
							<div class="col-md-6 mr-b-10">
								<label class="radio-inline"><input type="radio" name="venue">Lecture Hall: Ghc 800 (8hrs)</label>
							</div>
							<div class="col-md-6 mr-b-10">
								<label class="radio-inline"><input type="radio" name="venue">Lecture Hall: Ghc 500 (4hrs)</label>
							</div>
						</div>
					</div>
					<hr class="mr-tb-20">
					<div class="row">
						<div class="form-group col-md-12 mr-t-20 text-center">
							<button type="submit" class="btn btn-lg btn-primary">Book Venue</button>
						</div>
					</div>

					<div class="bg-gray1 pd-30 mr-t-20 rd-5">
						<strong>NB:</strong>This is a sample design of the data collection service. Each section of the form can be modified or customized to your requirements of your business.
					</div>
				</div>
			</form>

		</div>
	</div>
</body>
</html>