<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE = edge">
<meta name="viewport" content="width = device-width, initial-scale = 1">
<title>Bootstrap 101 Template</title>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css" integrity="sha384-BVYiiSIFeK1dGmJRAkycuHAHRg32OmUcww7on3RYdg4Va+PmSTsz/K68vbdEjh4u" crossorigin="anonymous">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap-theme.min.css" integrity="sha384-rHyoN1iRsVXV4nD0JutlnGaslCJuC7uwjduW9SVrLvRYooPp2bWYgmgJQIXwl/Sp" crossorigin="anonymous">
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script>
<script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
<![endif]-->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.12.4/jquery.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js" integrity="sha384-Tc5IQib027qvyjSMfHjOMaLkfuWVxZxUPnCJA7l2mCWNIpG9mGCD8wGNIcPD7Txa" crossorigin="anonymous"></script>
<style>
#success_message {
display: none;
}
</style>
<script>
$(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');
});
});
</script>
</head>
<body>
<div class="container">
<form class="well form-horizontal" action=" " method="post" id="contact_form">
<fieldset>
<!-- Form Name -->
<legend>Contact Us Today!</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><!-- /.container -->
</body>
</html>
