"contact "
Bootstrap 3.3.0 Snippet by thalit__a

<div class="container"> <div class="row"> <div class="col-md-8"> <h2>Something Else here</h2> <form action="http://kernel.handyform.com.br" method="post"><!-- Não apague ou altere esta linha--> <input type="hidden" name="titulo" value="Obrigado"> <!-- Titulo do Email que será enviado ao visitante exemplo: Obrigado--> <input type="hidden" name="nomedest" value="Thalita"> <!-- Digite o seu nome --> <input type="hidden" name="emaildest" value="oliveirarthalita@gmailcom"> <!-- Seu Email ;D --> <input type="hidden" name="ok" value="http://www.handyform.com.br/url"><!-- Url de retorno exemplo: http://seusite.com/ok.html.html--> <table width="37%" border="0"> <div class="well well-sm"> <form> <div class="row"> <div class="col-md-6"> <div class="form-group"> <label for="name"> Name</label> <input type="text" class="form-control" id="name" placeholder="Enter name" required="required" /> </div> <div class="form-group"> <label for="email"> Email Address</label> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-envelope"></span> </span> <input type="email" class="form-control" id="email" placeholder="Enter email" required="required" /></div> </div> <div class="form-group"> <label for="subject"> Subject</label> <select id="subject" name="subject" class="form-control" required="required"> <option value="na" selected="">Choose One:</option> <option value="service">General Customer Service</option> <option value="suggestions">Suggestions</option> <option value="product">Product Support</option> </select> </div> </div> <div class="col-md-6"> <div class="form-group"> <label for="name"> Message</label> <textarea name="message" id="message" class="form-control" rows="9" cols="25" required="required" placeholder="Message"></textarea> </div> </div> <div class="col-md-12"> <button type="submit" class="btn btn-primary pull-right" id="btnContactUs"> Send Message</button> </div> </div> </form> </div> </div> <div class="container"> <div class="row"> <div class="col-md-4"> <h2>Google Map here</h2> <iframe src="https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d2646.2531389455903!2d-89.23024619999998!3d48.4516724!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x4d5923dbfe697737%3A0xc9d925c9bc9573fa!2s116+Bruce+St%2C+Thunder+Bay%2C+ON+P7A+5W6!5e0!3m2!1sen!2sca!4v1424272264157" width="600" height="450" frameborder="0" style="border:0"></iframe> </div></div></div> <a href="http://validator.w3.org/check?uri=http%3A%2F%2Fbootsnipp.com%2Fiframe%2Fb2BWe" class="pull-right" target="_blank"> <small>HTML</small><sup>5</sup> </a> </p>

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