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<!DOCTYPE html> <html> <head> <title>Restaurant Reservation 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; line-height: 42px; font-size: 42px; 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 25px 0 #d6e0f5; } .banner { position: relative; height: 300px; background-image: url("/uploads/media/default/0001/02/53019e0a8aae1c494bf9489d3f1db33cd0dd49a1.jpeg"); background-size: cover; display: flex; justify-content: center; align-items: center; text-align: center; } .banner::after { content: ""; background-color: rgba(0, 0, 0, 0.3); position: absolute; width: 100%; height: 100%; } input, select, textarea { margin-bottom: 10px; border: 1px solid #ccc; border-radius: 3px; } input { width: calc(100% - 10px); padding: 5px; } input[type="date"] { padding: 4px 5px; } select { width: 100%; padding: 7px 0; background: transparent; } textarea { width: calc(100% - 12px); padding: 5px; } .item input:hover, .item select:hover, .item textarea:hover { border: 1px solid transparent; box-shadow: 0 0 6px 0 #d6e0f5; color: #d6e0f5; } .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: 2%; top: 28px; z-index: 1; } [type="date"]::-webkit-calendar-picker-indicator { right: 1%; z-index: 2; opacity: 0; cursor: pointer; } .btn-block { margin-top: 10px; text-align: center; } button { width: 150px; padding: 10px; border: none; border-radius: 5px; background: #0087cc; font-size: 16px; color: #fff; cursor: pointer; } button:hover { background: #6eb8dd; } @media (min-width: 568px) { .name-item, .city-item { display: flex; flex-wrap: wrap; justify-content: space-between; } </style> </head> <body> <div class="testbox"> <form action="/"> <div class="banner"> <h1>Restaurant Reservation 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="email" name="email"/> </div> <div class="item"> <p>Phone</p> <input type="text" name="phone" placeholder="### ### ####"/> </div> <div class="item"> <p>Reservation Date</p> <input type="date" name="bdate" required/> <i class="fas fa-calendar-alt"></i> </div> <div class="item"> <p>Reservation Time</p> <input type="time" name="btime" required/> </div> <div class="item"> <p>How many people will you be with?</p> <input type="text" name="language"/> </div> <div class="item"> <p>Additional notes</p> <textarea rows="3"></textarea> </div> <div class="btn-block"> <button type="submit" href="/">Send</button> </div> </form> </div> </body> </html>