Fiyat Teklifi Formu

Kod demoya eklenip kontrol edilecek!

http://www.biyomedikalakademi.com/tr/m/laringoskoplar/standart-laringoskop.html

<form action="/tr/form/4/4" method="post">
<div class="row">
<h2>Fiyat Teklifi</h2>

<div class="col-lg-12"><input class="form-control" name="form_1" placeholder="Adınız - Soyadınız" required="" type="text" /></div>

<div class="col-lg-12"><input class="form-control" name="form_2" placeholder="Telefon" required="" type="tel" /></div>

<div class="col-lg-12"><input class="form-control" name="mail" placeholder="E-posta Adresiniz" required="" type="email" /></div>

<div class="col-lg-12"><input class="form-control" name="form_3" placeholder="Adet" required="" type="text" /></div>

<div class="col-lg-12"><textarea class="form-control" name="form_4" placeholder="Açıklama" required=""></textarea></div>

<div class="col-lg-12"><input class="form-control" name="security1" type="hidden" value="5" /> <input class="form-control" name="security2" placeholder="2+3=?" type="text" value="" /></div>

<div class="col-lg-12"><button class="form-control btn btn-primary text-center" name="submit" type="submit">GÖNDER</button></div>
</div>
</form>