<body>
<!-- START FORM BODY -->
<div id="container">
<header>
<img src="https://auctionking.com/assets/charity/logo/YourLogoHere.png">
<h1>CONTACT FORM</h1>
</header>
<form>
<fieldset>
<legend>Fields marked with * are required</legend>
<br/>
<!-- START DIV part-1 PERSONAL INFORMATION -->
<div id="part-1">
<h2>Personal Information (required)</h2>
<label for="first-name">First Name</label>
<input type="text" name="first-name" id="first-name" required>
<br/>
<label for="last-name">Last Name</label>
<input type="text" name="last-name" id="last-name" required>
<br/>
<label for="birthdate">Birth Date</label>
<input type="date" name="birthdate" min="1917-01-01" id="birthdate" required>
<br/>
<label for="age">Age</label>
<input type="number" name="age" min="0" max="100" id="age" required>
<br/>
<label for="gender">Gender</label>
<br/>
<input type="radio" name="gender" value="female" id="gender" required>Female
<br/>
<input type="radio" name="gender" value="male" required>Male
<br/>
<input type="radio" name="gender" value="other" required>Other
<br/><br/>
<label for="country">Select your country</label>
<br/>
<select name="country" id="country" required>
<!-- https://www.freeformatter.com/iso-country-list-html-select.html -->
<option value="" label="Select a country" selected="selected">Select a country … </option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State of</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
<!-- END DIV part-1 PERSONAL INFORMATION -->
<br/>
<!-- START DIV part-2 ACCOUNT INFORMATION -->
<div id="part-2">
<h2>Account Information (required)</h2>
<label for="email">Your e-mail</label>
<input type="email" name="email" placeholder="account@email.com" id="email" required>
<label for="password">Password</label>
<input type="password" name="password" id="password" required>
</div>
<!-- END DIV part-2 ACCOUNT INFORMATION -->
<!-- START DIV part-3 OTHER INFORMATION -->
<div id="part-3">
<h2>Other Information (optional)</h2>
<label for="rating">How satisfied are you with our website?</label>
<br/>
<input type="radio" name="rating" id="rating" value="Very satisfied" tabindex="-1">Very satisfied
<br/>
<input type="radio" name="rating" value="Satisfied" tabindex="-1">Satisfied
<br/>
<input type="radio" name="rating" value="Dissatisfied" tabindex="-1">Dissatisfied
<br/><br/>
<label for="message">What can we do to improve our website?</label>
<br/>
<textarea rows="5" cols="50" id="message" tabindex="-1"></textarea>
</div>
<!-- END DIV part-3 ACCOUNT INFORMATION -->
<br/><br/>
<input type="submit" id="submitButton" name="submitButton" value="Send-message">
<input type="reset" id="resetButton" value="Reset all info" tabindex="-1">
</fieldset>
</form>
</div>
<!-- END FORM BODY -->
</body>
</html>
* {
-webkit-box-sizing: border-box;
-moz-box-sizing: border-box;
box-sizing: border-box;
}
body {
margin: 0;
padding: 0;
background: url("https://healthcorp.com.au/public/wp-content/uploads/2015/10/bg-grey-shapes.png");
background-size: cover;
font-family: 'Roboto Slab', serif;
}
#tema {
background: orange;
text-align: left;
padding: 10px 5px;
text-align: center;
position: fixed;
top: 25px;
left: 5px;
font-size: 15px;
border-radius: .5%;
}
audio {
background: orange;
height: 50px;
width: 100%;
}
header img {
margin-top: 20px;
height: 100px;
width: 100px;
}
#container {
background: #FFF;
width: 70%;
margin: 25px auto;
border: 1px solid;
border-radius: .5%;
}
header {
background: #9645c1;
text-align: center;
padding: 1%;
color: white;
}
form {
margin: 5%;
width: 70%;
}
fieldset {
border: 0px;
}
input[type="text"],
input[type="date"],
input[type="number"],
#country,
input[type="email"],
input[type="password"],
textarea {
border: 1px solid #9645c1;
display: block;
margin: 10px auto;
padding: 2%;
width: 100%;
}
input[type="radio"] {
margin-top: 1.5%;
}
#submitButton {
background: #c1beba;
padding: 15px 10px;
float: left;
cursor: pointer;
margin-right: 15px;
}
#submitButton:hover {
filter: brightness(115%);
}
#resetButton {
background: #e24f2b;
padding: 15px 10px;
color: white;
float: right;
cursor: pointer;
}
#resetButton:hover {
filter: brightness(115%);
}
#part-1 label:after {
content: " *";
color: red;
}
#part-2 label:after {
content: " *";
color: red;
}
textarea {
resize: none;
}
/*Media Query */
@media all and (min-width: 0px) and (max-width: 320px) {
h1 {
font-size: 22px;
}
h2 {
font-size: 20px;
}
#container {
width: 90%;
margin-top: 20%;
}
#tema {
width: 100%;
left: .5px;
top: 0;
}
#resetButton {
float: left;
}
}
@media all and (min-width: 321px) and (max-width: 480px) {
h1 {
font-size: 22px;
}
h2 {
font-size: 20px;
}
#container {
width: 90%;
margin-top: 13%;
}
#tema {
width: 100%;
left: .5px;
top: 0;
}
#resetButton {
float: left;
}
}
@media all and (min-width: 481px) and (max-width: 568px) {
h1 {
font-size: 22px;
}
h2 {
font-size: 20px;
}
#container {
width: 90%;
margin-top: 10%;
}
#tema {
width: 100%;
left: .5px;
top: 0;
}
}
@media all and (min-width: 569px) and (max-width: 768px) {
h1 {
font-size: 22px;
}
h2 {
font-size: 20px;
}
#container {
width: 90%;
margin-top: 7%;
}
#tema {
width: 100%;
left: .5px;
top: 0;
}
}
External CSS
This Pen doesn't use any external CSS resources.
External JavaScript
This Pen doesn't use any external JavaScript resources.