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<!DOCTYPE html> <html> <head> <title>Car Booking 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, textarea, p { padding: 0; margin: 0; outline: none; font-family: Roboto, Arial, sans-serif; font-size: 14px; color: #666; line-height: 22px; } h1 { position: absolute; margin: 0; font-size: 36px; color: #fff; z-index: 2; } .testbox { display: flex; justify-content: center; align-items: center; height: inherit; padding: 20px; } form { width: 100%; padding: 20px; border-radius: 6px; background: #fff; box-shadow: 0 0 20px 0 #333; } .banner { position: relative; height: 210px; background-image: url("/uploads/media/default/0001/02/328c356e9bba5add698e405d0059aa4207d8f1f6.jpeg"); background-size: cover; display: flex; justify-content: center; align-items: center; text-align: center; } .banner::after { content: ""; background-color: rgba(0, 0, 0, 0.4); position: absolute; width: 100%; height: 100%; } input, textarea, select { margin-bottom: 10px; border: 1px solid #ccc; border-radius: 3px; } input { width: calc(100% - 10px); padding: 5px; } select { width: 100%; padding: 7px 0; background: transparent; } textarea { width: calc(100% - 12px); padding: 5px; } .item:hover p, .item:hover i, .question:hover p, .question label:hover, input:hover::placeholder { color: #333; } .item input:hover, .item select:hover, .item textarea:hover { border: 1px solid transparent; box-shadow: 0 0 6px 0 #333; color: #333; } .item { position: relative; margin: 10px 0; } input[type="date"]::-webkit-inner-spin-button { display: none; } .item i, input[type="date"]::-webkit-calendar-picker-indicator { position: absolute; font-size: 20px; color: #a9a9a9; } .item i { right: 1%; top: 30px; z-index: 1; } [type="date"]::-webkit-calendar-picker-indicator { right: 0; z-index: 2; opacity: 0; cursor: pointer; } input[type="time"]::-webkit-inner-spin-button { margin: 2px 22px 0 0; } input[type=radio], input.other { display: none; } label.radio { position: relative; display: inline-block; margin: 5px 20px 10px 0; cursor: pointer; } .question span { margin-left: 30px; } label.radio:before { content: ""; position: absolute; top: 2px; left: 0; width: 15px; height: 15px; border-radius: 50%; border: 2px solid #ccc; } #radio_5:checked ~ input.other { display: block; } input[type=radio]:checked + label.radio:before { border: 2px solid #444; background: #444; } label.radio:after { content: ""; position: absolute; top: 7px; left: 5px; width: 7px; height: 4px; border: 3px solid #fff; border-top: none; border-right: none; transform: rotate(-45deg); opacity: 0; } input[type=radio]:checked + label:after { opacity: 1; } .btn-block { margin-top: 10px; text-align: center; } button { width: 150px; padding: 10px; border: none; border-radius: 5px; background: #444; font-size: 16px; color: #fff; cursor: pointer; } button:hover { background: #666; } @media (min-width: 568px) { .name-item, .city-item { display: flex; flex-wrap: wrap; justify-content: space-between; } .name-item input, .city-item input { width: calc(50% - 20px); } .city-item select { width: calc(50% - 8px); } } </style> </head> <body> <div class="testbox"> <form action="/"> <div class="banner"> <h1>Car Booking Form</h1> </div> <div class="item"> <p>Name</p> <div class="name-item"> <input type="text" name="name" placeholder="First" /> <input type="text" name="name" placeholder="Last" /> </div> </div> <div class="item"> <p>Email</p> <input type="text" name="name"/> </div> <div class="item"> <p>Phone</p> <input type="text" name="name"/> </div> <div class="item"> <p>Number of Passengers</p> <input type="text" name="name"/> </div> <div class="item"> <p>Contact Address</p> <input type="text" name="name" placeholder="Street address" /> <input type="text" name="name" placeholder="Street address line 2" /> <div class="city-item"> <input type="text" name="name" placeholder="City" /> <input type="text" name="name" placeholder="Region" /> <input type="text" name="name" placeholder="Postal / Zip code" /> <select> <option value="">Country</option> <option value="1">Russia</option> <option value="2">Germany</option> <option value="3">France</option> <option value="4">Armenia</option> <option value="5">USA</option> </select> </div> </div> <div class="question"> <p>Vehicle</p> <div class="question-answer"> <div> <input type="radio" value="none" id="radio_1" name="vehicle" /> <label for="radio_1" class="radio"><span>Limousine (8-12 person)</span></label> </div> <div> <input type="radio" value="none" id="radio_2" name="vehicle" /> <label for="radio_2" class="radio"><span>SUV (6-7 person)</span></label> </div> <div> <input type="radio" value="none" id="radio_3" name="vehicle" /> <label for="radio_3" class="radio"><span>Van (12-15 person)</span></label> </div> <div> <input type="radio" value="none" id="radio_4" name="vehicle" /> <label for="radio_4" class="radio"><span>Bus (50+ person)</span></label> </div> <div> <input type="radio" value="none" id="radio_5" name="vehicle" /> <label for="radio_5" class="radio other"><span>other:</span></label> <input class="other" type="text" name="name" /> </div> </div> </div> <div class="item"> <p>Pick Up Date</p> <input type="date" name="bdate" /> <i class="fas fa-calendar-alt"></i> </div> <div class="item"> <p>Pick Up Time</p> <input type="time" name="name" /> <i class="fas fa-clock"></i> </div> <div class="item"> <p>If pick up from the airport, please enter airport name</p> <input type="text" name="name"/> </div> <div class="item"> <p>Flight Number</p> <input type="text" name="name"/> </div> <div class="item"> <p>Pick Up Point</p> <input type="text" name="name" placeholder="Street address" /> <input type="text" name="name" placeholder="Street address line 2" /> <div class="city-item"> <input type="text" name="name" placeholder="City" /> <input type="text" name="name" placeholder="Region" /> <input type="text" name="name" placeholder="Postal / Zip code" /> <select> <option value="">Country</option> <option value="1">Russia</option> <option value="2">Germany</option> <option value="3">France</option> <option value="4">Armenia</option> <option value="5">USA</option> </select> </div> </div> <div class="item"> <p>Destination</p> <input type="text" name="name" placeholder="Street address" /> <input type="text" name="name" placeholder="Street address line 2" /> <div class="city-item"> <input type="text" name="name" placeholder="City" /> <input type="text" name="name" placeholder="Region" /> <input type="text" name="name" placeholder="Postal / Zip code" /> <select> <option value="">Country</option> <option value="1">Russia</option> <option value="2">Germany</option> <option value="3">France</option> <option value="4">Armenia</option> <option value="5">USA</option> </select> </div> </div> <div class="item"> <p>Notes</p> <textarea rows="3"></textarea> </div> <div class="btn-block"> <button type="submit" href="/">SEND</button> </div> </form> </div> </body> </html>