elements
components
Other Stuff
Form Contact
<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>