<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/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="container"> <div class="row"> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <div class="form-group"> <legend>Product Request</legend> <label class="col-md-4 control-label" for="product">Product</label> <div class="col-md-6"> <select id="cproduct" name="product" class="form-control"> <option value="startup">streamdrill: Startup</option> <option value="business">streamdrill: Business</option> <option value="enterprise">streamdrill: Enterprise</option> <option value="ultimate">streamdrill: Ultimate</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="name">Name</label> <div class="col-md-6"> <input id="name" name="name" type="text" placeholder="Max Muster" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="email">Email Address</label> <div class="col-md-6"> <input id="email" name="email" type="text" placeholder="max@muster.com" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="company">Company</label> <div class="col-md-6"> <input id="company" name="company" type="text" placeholder="Muster Inc." class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="street">Street Adress</label> <div class="col-md-6"> <input id="street" name="street" type="text" placeholder="123 Main Street" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="post">Post/ZIP Code</label> <div class="col-md-6"> <input id="post" name="post" type="text" placeholder="123456" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="city">City</label> <div class="col-md-6"> <input id="city" name="city" type="text" placeholder="Springfield" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="country">Country</label> <div class="col-md-6"> <select id="country" name="country" class="form-control" required=""> <option value=""></option> <option value="AR">Argentina</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BR">Brazil</option> <option value="BG">Bulgaria</option> <option value="CA">Canada</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CO">Colombia</option> <option value="CR">Costa Rica</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CY">Cyprus</option> <option value="CZ">Czech Republic</option> <option value="DK">Denmark</option> <option value="DO">Dominican Republic</option> <option value="EG">Egypt</option> <option value="EE">Estonia</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="HK">Hong Kong S.A.R., China</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="KZ">Kazakhstan</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Laos</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MK">Macedonia</option> <option value="MY">Malaysia</option> <option value="MT">Malta</option> <option value="MX">Mexico</option> <option value="MD">Moldova</option> <option value="MC">Monaco</option> <option value="ME">Montenegro</option> <option value="MA">Morocco</option> <option value="NL">Netherlands</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="KP">North Korea</option> <option value="NO">Norway</option> <option value="PK">Pakistan</option> <option value="PS">Palestinian Territory</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="RO">Romania</option> <option value="RU">Russia</option> <option value="SA">Saudi Arabia</option> <option value="RS">Serbia</option> <option value="SG">Singapore</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="ZA">South Africa</option> <option value="KR">South Korea</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="TW">Taiwan</option> <option value="TH">Thailand</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="US">USA</option> <option value="UZ">Uzbekistan</option> <option value="VN">Vietnam</option> </select> </div> </div> <div class="form-group"> <label class="col-md-4 control-label" for="singlebutton"></label> <div class="col-md-4"> <button id="submit" name="submit" class="btn btn-primary">Send Request</button> </div> </div> </fieldset> </form> </div> </div>