<!DOCTYPE html>
<html>
<head>
<title>Bank Customer Feedback Form</title>
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
<link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.5.0/css/all.css" integrity="sha384-B4dIYHKNBt8Bc12p+WXckhzcICo0wtJAoU8YZTY5qE0Id1GSseTk6S+L3BlXeVIU" crossorigin="anonymous">
<style>
html, body {
min-height: 100%;
}
body, div, form, input, select {
padding: 0;
margin: 0;
outline: none;
font-family: Roboto, Arial, sans-serif;
font-size: 14px;
color: #666;
line-height: 22px;
}
h1, h4 {
margin: 15px 0 4px;
font-weight: 400;
}
h4 {
margin: 20px 0 4px;
font-weight: 400;
}
span {
color: red;
}
.small {
font-size: 10px;
line-height: 18px;
}
.testbox {
display: flex;
justify-content: center;
align-items: center;
height: inherit;
padding: 3px;
}
form {
width: 100%;
padding: 20px;
background: #fff;
box-shadow: 0 2px 5px #ccc;
}
input {
width: calc(100% - 10px);
padding: 5px;
border: 1px solid #ccc;
border-radius: 3px;
vertical-align: middle;
}
input:hover, textarea:hover, select:hover {
outline: none;
border: 1px solid #095484;
background: #e6eef7;
}
.title-block select, .title-block input {
margin-bottom: 10px;
}
select {
padding: 7px 0;
border-radius: 3px;
border: 1px solid #ccc;
background: transparent;
}
select, table {
width: 100%;
}
option {
background: #fff;
}
.day-visited, .time-visited {
position: relative;
}
input[type="date"]::-webkit-inner-spin-button {
display: none;
}
input[type="time"]::-webkit-inner-spin-button {
margin: 2px 22px 0 0;
}
.day-visited i, .time-visited i, input[type="date"]::-webkit-calendar-picker-indicator {
position: absolute;
top: 8px;
font-size: 20px;
}
.day-visited i, .time-visited i {
right: 5px;
z-index: 1;
color: #a9a9a9;
}
[type="date"]::-webkit-calendar-picker-indicator {
right: 0;
z-index: 2;
opacity: 0;
}
.question-answer label {
display: block;
padding: 0 20px 10px 0;
}
.question-answer input {
width: auto;
margin-top: -2px;
}
th, td {
width: 18%;
padding: 15px 0;
border-bottom: 1px solid #ccc;
text-align: center;
vertical-align: unset;
line-height: 18px;
font-weight: 400;
word-break: break-all;
}
.first-col {
width: 25%;
text-align: left;
}
textarea {
width: calc(100% - 6px);
}
.btn-block {
margin-top: 20px;
text-align: center;
}
button {
width: 150px;
padding: 10px;
border: none;
-webkit-border-radius: 5px;
-moz-border-radius: 5px;
border-radius: 5px;
background-color: #095484;
font-size: 16px;
color: #fff;
cursor: pointer;
}
button:hover {
background-color: #0666a3;
}
@media (min-width: 568px) {
.title-block {
display: flex;
justify-content: space-between;
}
.title-block select {
width: 30%;
margin-bottom: 0;
}
.title-block input {
width: 31%;
margin-bottom: 0;
}
th, td {
word-break: keep-all;
}
}
</style>
</head>
<body>
<div class="testbox">
<form action="/">
<h1>Bank Customer Feedback Form</h1>
<h4>Type of Feedback<span>*</span></h4>
<select>
<option value=""></option>
<option value="">Enquiry</option>
<option value="2">Complaint</option>
<option value="3">Compliment</option>
<option value="4">Suggestion</option>
</select>
<h4>Feedback/Enquiry on<span>*</span></h4>
<select>
<option value=""></option>
<option value="1">Credit and Debit Cards</option>
<option value="2">Deposit</option>
<option value="3">Housing and Renovation Loan</option>
<option value="4">iBanking</option>
<option value="5">Treasures</option>
</select>
<h4>Name<span>*</span></h4>
<div class="title-block">
<select>
<option value="title" selected>Title</option>
<option value="ms">Ms</option>
<option value="miss">Miss</option>
<option value="mrs">Mrs</option>
<option value="mr">Mr</option>
</select>
<input class="name" type="text" name="name" placeholder="First" />
<input class="name" type="text" name="name" placeholder="Last" />
</div>
<h4>Email Address<span>*</span></h4>
<input type="text" name="name" />
<h4>Contact Number<span>*</span></h4>
<input type="text" name="name"/>
<h4>Name of Staff who served me</h4>
<input type="text" name="name"/>
<h4>Branch visited</h4>
<input type="text" name="name"/>
<h4>Feedback/Enquiry</h4>
<p class="small">Please do not indicate your account or credit card number and banking instruction in your comments. Thank you for your time and valuable feedback.</small>
<textarea rows="5"></textarea>
<div class="btn-block">
<button type="submit" href="/">Send Feedback</button>
</div>
</form>
</div>
</body>
</html>