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HTML

CSS

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HTML

              
                <div class="container bg1">
  <legend class="h1 text-center bg1">Contact Us</legend>
  <div class="container wrapper">
    <form class="form-horizontal" role="form" method="post" action="">

      <div class="form-group">
        <label class="control-label col-sm-2" for="name"><span class="required">*</span>Name:</label>
        <div class="col-sm-10 inputGroupContainer">
          <div class="input-group">
            <span class="input-group-addon"><i class="glyphicon glyphicon-user"></i></span>
            <input name="name" type="text" required class="form-control" id="name" placeholder="Your full name" title="name">
          </div>
        </div>
      </div>

      <!--Email Address-->

      <div class="form-group">
        <label class="control-label col-sm-2" for="Email"><span class="required">*</span>Email Address:</label>
        <div class="col-sm-10 inputGroupContainer">
          <div class="input-group"> <span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
            <input name="Email" type="email" required class="form-control" id="email" placeholder="your@email.com.au" title="Email">
          </div>
        </div>
      </div>

      <!--Phone Optional-->
      <div class="form-group">
        <label class="control-label col-sm-2" for="Phone">Phone #:</label>
        <div class="col-sm-10 inputGroupContainer">
          <div class="input-group">
            <span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
            <input name="Phone" type="email" class="form-control" id="phone" placeholder="Optional" title="Phone no."></span>
          </div>
        </div>
      </div>
      <!--Text Area-->
      <div class="form-group">
        <label class="control-label col-sm-2" for="message"><span class="required">*</span>Message:</label>
        <div class="col-sm-10 inputGroupContainer">
          <div class="input-group">
            <span class="input-group-addon"><i class="glyphicon glyphicon-pencil"></i></span>

            <textarea class="form-control" name="message" rows="4" placeholder="Type your message here."></textarea>
          </div>
        </div>
      </div>

      <!-- Human validation-->
      <div class="form-group">
        <label for="human" class="col-sm-2 control-label"><span class="required">*</span> Human Test:</label>
        <div class="col-sm-10 inputGroupContainer">
          <h3 class="human">6 + 6 = ?</h3>
          <input type="text" class="form-control" id="human" name="human" placeholder="Your Answer">
          <span class="required small"></span>
        </div>
      </div>

      <!--SEND Button-->

      <div class="form-group">
        <label class="col-sm-2 control-label"></label>
        <div class="col-sm-10">
          <button type="submit" class="btn btn-warning">Send <span class="glyphicon glyphicon-send"></span>
          </button>
        </div>
      </div>

    </form>
  </div>
              
            
!

CSS

              
                .container legend {
	margin-top: 35px;
	margin-left: auto;
	margin-right: auto;
	color: #EB771F;
}

body {
	background-color: #e7e7e7;
}

.bg1 {
  background-color: #E8FBDA;
}

.navbar-header .navbar-brand .img-responsive {
	width: 100px;
	height: auto;
	margin-left: 25px;
}

.container .navbar-header .navbar-brand {
	height: 90px;
}

.container.nav #defaultNavbar1 .nav.navbar-nav.navbar-right {
	margin-top: 25px;
}

nav .container {
	background-color: #262626;
}

div.copyright {
	color: #f2f2f2;
}

footer {
	height: 50px;
	width: 100%;
	align-content: center;
	font-size: 10px;
	font-family:Segoe, "Segoe UI", "DejaVu Sans", "Trebuchet MS", Verdana, sans-serif;
	padding-top: 20px;
	padding-bottom: auto;
	background-color: #2F2F2F;
}

.form-horizontal {
	width: 85%;
	margin: 0 auto 0 auto;
	padding: 10px;
}
	
              
            
!

JS

              
                
              
            
!
999px

Console