89 lines
4.6 KiB
PHP
89 lines
4.6 KiB
PHP
<div id="get-in-touch-page" class="popup-container">
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<span id="close-btn" class="close-btn"><i class="fa-solid fa-xmark text-18 text-black"></i></span>
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<div class="popup-container-inside ">
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<div class="row">
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<div class=" col-md-9 ">
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<div class="inside1">
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</div>
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</div>
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<div class=" col-md-3 ">
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<div class="inside2">
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</div>
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</div>
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<div class="inside-content">
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<div class="row">
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<div class=" col-md-7 " data-custom-animations="true"
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data-ca-options='{"animationTarget": ".btn, h2", "ease": "power4.out", "initValues":{"x": "-10px", "y": "10px", "opacity":0} , "animations":{"x": "0px", "y": "0px", "opacity":1}}'>
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<div
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class="w-full p-30 ml-5 bg-white rounded-10 module-title flex flex-col h-full relative bg-size bg-no-repeat bg-center-right transition-all mr-50 sm:mr-0">
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<div class=" pt-10">
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<h4 class="text-ter text-36">
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Get in <span class="text-brand">touch</span>
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</h4>
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<h5 class="font-medium text-16">Book your <span class="font-bold">FREE
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consultation </span>with Certified Counsellors</h5>
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</div>
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<form action="{{ route('counselor.store') }}" method="POST" id="counselor-form">
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@csrf
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<div class="flex justify-between items-center gap-5">
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<input class="w-full mb-10 rounded-6 py-10 text-14 px-10 border-bottom"
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type="text" name="name" id="name" placeholder=" Name" required>
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<input class="w-full mb-10 rounded-6 py-10 text-14 px-10 border-bottom"
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type="text" name="address" id="address" placeholder=" Address" required>
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</div>
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<div class="flex justify-between items-center ">
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<input class="w-60percent mb-10 rounded-6 py-10 text-14 px-10" type="email"
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name="email" id="email" placeholder="Your Email" required>
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<input class="w-30percent mb-10 rounded-6 py-10 text-14 px-10" type="number"
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inputmode="numeric" name="contact" id="contact" placeholder="Contact"
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required>
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</div>
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<input class="w-full mb-10 rounded-6 py-10 text-14 px-10" type="text"
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name="test_score" id="test_score"
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placeholder="Language Test Score (ilets overall: 7.0 )" required>
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<input class="w-full mb-20 rounded-6 py-10 text-14 px-10" type="text"
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name="qualification" id="qualification" placeholder="Recent Education Qualification"
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required>
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<input class="mb-20" type="checkbox" id=terms>
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<label class="text-14 mb-20" for="terms">I accept the terms & conditions</label>
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<button type="submit" id="counselor-submit-btn"
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class=" w-full py-10 bg-sec text-white rounded-10 text-16 border-0 button-hover">
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<i class="fa-solid fa-paper-plane text-white text-16 pr-5"></i>
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Send Message</button>
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</form>
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</div>
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</div>
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<div class=" col-md-5 map" data-custom-animations="true"
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data-ca-options='{"animationTarget": ".btn, h2", "ease": "power4.out", "initValues":{"x": "-10px", "y": "10px", "opacity":0} , "animations":{"x": "0px", "y": "0px", "opacity":1}}'>
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<iframe src="{{ setting('map') }}" width="100%" height="100%" style="border:0;"
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allowfullscreen="" loading="lazy" referrerpolicy="no-referrer-when-downgrade"></iframe>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-6">
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</div>
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</div>
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</div>
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</div>
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