<div id="contact" class="contact-sec">
		<div class="container">
			<div class="row">
				<div class="col-lg-12">
					<h3>Contact Us</h3>
				</div>
			
				<div class="col-lg-12">
					
					 <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="+91(845)555-1212" 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">Your Subject</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="subject" class="form-control selectpicker" >
	  <option value=" " >Select Subject</option>
	  <option>User Registration</option>
	  <option>Business info Register</option>
	  <option >Support</option>
	  <option >Others</option>
	  
	</select>
  </div>
</div>
</div>


<!-- Text area -->
  
<div class="form-group">
  <label class="col-md-4 control-label">Your Message</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="Your Message"></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>
				
			</div>
		</div>
	</div>
	
	


