Elisha Stevens

Contact Us Form

Contact Form

Developed with HTML, styled with Bootstrap, and embedded into webpage.

Currently not able to receive any information submitted, but working on changing this soon.

Contact Us

Questions, Comments, Concerns?

Fill out the form below, and we'll get back to you within 1-2 business days.

How would you prefer to be contacted?

MY CODE

<!DOCTYPE html>
<html lang="en">
    <head>
        <meta charset="utf-8">
        <meta name="viewport" content="initial-scale=1, width=device-width">
        <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.1.3/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-1BmE4kWBq78iYhFldvKuhfTAU6auU8tT94WrHftjDbrCEXSU1oBoqyl2QvZ6jIW3" crossorigin="anonymous">
        <title>Contact Us</title>
    </head>
    <body>
        <div class="container-fluid">
            <div class="text-center">
                <h1>Questions, Comments, Concerns?</h1>
                <p>Fill out the form below, and we'll get back to you within 1-2 business days.</p>
            </div>
            <form>
                <div class="mb-3">
                    <label class="form-label" for="name">Name</label>
                    <input type="text" id="name" class="form-control" required>
                </div>
                <div class="mb-3">
                    <label class="form-label" for="email">Email Address</label>
                    <input type="email" id="email" class="form-control" required>
                </div>
                <div class="mb-3">
                    <label class="form-label" for="number">Phone Number</label>
                    <input type="number" id="number" class="form-control" required>
                </div>
                <div class="mb-3">
                    <label class="form-label" for="message">Message</label>
                    <textarea id="message" rows="5" class="form-control" required></textarea>
                </div>
                <div class="mb-3">
                    <p>How would you prefer to be contacted?</p>
                    <div class="form-check">
                        <input class="form-check-input" type="radio" name="radio" id="phone">
                        <label class="form-check-label" for="phone">Phone</label>
                    </div>
                    <div class="form-check">
                        <input class="form-check-input" type="radio" name="radio" id="email">
                        <label class="form-check-label" for="email">Email</label>
                    </div>
                </div>
                <div class="text-center">
                    <button type="submit" class="btn btn-outline-primary">Submit</button>
                </div>
            </form>
        </div>
    </body>
</html>