<form id="bank-contact-form" action="test.php" method="get">
  <div class="form-body">

    <div class="row">
      <div class="col-sm-12 col-md-6 col-lg-6">

        <h4>Ihre Kontaktdaten</h4>
        <div class="form-group">

          <div class="radio inline">
            <label>
              <input type="radio" name="gender" id="" value="1" required>
              <span class="radio-icons">
                <i class="fa fa-circle-thin fa-2x unchecked"></i>
                <i class="fa fa-check-circle-o fa-2x checked"></i>
              </span>
              <span>Frau</span>
            </label>
          </div>

          <div class="radio inline">
            <label>
              <input type="radio" name="gender" id="" value="2">
              <span class="radio-icons">
                <i class="fa fa-circle-thin fa-2x unchecked"></i>
                <i class="fa fa-check-circle-o fa-2x checked"></i>
              </span>
              <span>Herr</span>
            </label>
          </div>
        </div>

        <div class="form-group ">
          <label for="exampleInputEmail1" class="control-label">Vorname</label>
          <input type="text" class="form-control " id="first-name" placeholder="" value="" name="first-name" data-name="" required>
        </div>

        <div class="form-group ">
          <label for="exampleInputEmail1" class="control-label">Name</label>
          <input type="text" class="form-control " id="last-name" placeholder="" value="" name="last-name" data-name="" required>
        </div>

        <div class="form-group ">
          <label for="exampleInputEmail1" class="control-label">E-Mail</label>
          <input type="email" class="form-control " id="email" placeholder="" value="" name="email" data-name="" required>
        </div>

        <div class="form-group ">
          <label for="exampleInputEmail1" class="control-label">Telefon</label>
          <input type="text" class="form-control " id="phone" placeholder="optional" value="" name="phone" data-name="">
        </div>

      </div>
      <div class="col-sm-12 col-md-6 col-lg-6">
        <h4>Ihre Anschrift</h4>

        <div class="form-group ">
          <label for="exampleInputEmail1" class="control-label">Straße, Hausnummer</label>
          <input type="text" class="form-control " id="street" placeholder="optional" value="" name="street" data-name="">
        </div>

        <div class="row">
          <div class="col col-sm-4">

            <div class="form-group ">
              <label for="exampleInputEmail1" class="control-label">PLZ</label>
              <input type="text" class="form-control " id="zip" placeholder="optional" value="" name="zip" data-name="" maxlength="5" size="5">
            </div>

          </div>

          <div class="col col-sm-8">

            <div class="form-group ">
              <label for="exampleInputEmail1" class="control-label">Ort</label>
              <input type="text" class="form-control " id="city" placeholder="optional" value="" name="city" data-name="" size="25">
            </div>

          </div>
        </div>

        <h5>Sind Sie bereits Kunde der </h5>
        <div class="form-group">

          <div class="radio inline">
            <label>
              <input type="radio" name="customer" id="" value="1">
              <span class="radio-icons">
                <i class="fa fa-circle-thin fa-2x unchecked"></i>
                <i class="fa fa-check-circle-o fa-2x checked"></i>
              </span>
              <span>Ja</span>
            </label>
          </div>

          <div class="radio inline">
            <label>
              <input type="radio" name="customer" id="" value="2">
              <span class="radio-icons">
                <i class="fa fa-circle-thin fa-2x unchecked"></i>
                <i class="fa fa-check-circle-o fa-2x checked"></i>
              </span>
              <span>Nein</span>
            </label>
          </div>
          <hr/>

          <div class="checkbox">
            <label>
              <input name="" id="" class="" type="checkbox" value="" data-name="">
              <span class="check-icons">
                <i class="fa fa-circle-thin fa-2x unchecked"></i>
                <i class="fa fa-check-circle-o fa-2x checked"></i>
              </span>
              <span>Ich möchte einen Beratungstermin vereinbaren</span>

            </label>
          </div>
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12 col-md-12 col-lg-12">
        <div class="form-group">
          <label class="control-label">Ihre Nachricht</label>
          <textarea id="message" placeholder="" class="form-control" rows="3" required name="message"></textarea>

        </div>

      </div>
      <div class="col-sm-12 col-md-12 col-lg-12">

        <div class="alert alert-danger hide">
          <strong>
						Fehler:
  </strong> Bitte füllen Sie Anrede, Vorname, Nachname und E-Mailadresse korrekt aus.
        </div>
      </div>
    </div>
  </div>
  <div class="form-success">
    <div class="row">
      <div class="col-sm-12 col-md-12 col-lg-12">

        <div class="alert alert-sucess hide">
          <strong>
        Alert title
  </strong> Additional notes taking place here
        </div>
      </div>
    </div>
  </div>
  <input class="form-control " id="hiddenBankID" value="" name="bank-id" data-name="" type="hidden">

</form>