63 lines
3.8 KiB
JavaScript
63 lines
3.8 KiB
JavaScript
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export default function Form3() {
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return (
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<>
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<section className="form-section mr_bottom_minus_250 position-relative z_1">
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<div className="container">
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<div className="row align-items-center">
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<div className="col-lg-6 col-md-12">
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<div className="contact_form_box_all style_one bg_14 bg_op_4 mr_right_40 z_1" style={{ backgroundImage: 'url(assets/images/form-shape-1.png)' }}>
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<div className="section_title color_white type_one">
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<h4 className="sm_title"> Check Your Favorite Insurance</h4>
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<div className="title_whole">
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<h2 className="title"> Get Started Favorite
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Insurance</h2>
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</div>
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</div>
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<div className="contact_form_shortcode">
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<form method="post" action="#">
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<div className="forms-field-name mr_bottom_20">
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<input type="text" name="name" placeholder="First Name" required />
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</div>
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<div className="forms-field-name mr_bottom_20">
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<input type="text" name="sname" placeholder="Second Name" required />
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</div>
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<div className="forms-field-email mr_bottom_20">
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<input type="text" name="email" placeholder="Email" spellCheck="false" required />
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</div>
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<div className="forms-field-Dropdown mr_bottom_40">
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<select name="select">
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<option value className="placeholder" disabled >Insurance Type</option>
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<option value="Life Insurance">Life Insurance</option>
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<option value="Health Insurance">Health Insurance
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</option>
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<option value="House Insurance">House Insurance</option>
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<option value="Travel Insurance">Travel Insurance
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</option>
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</select>
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</div>
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<div className="forms-field-number-slider mr_bottom_40">
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<input type="range" name="range" min={0} max={7000} step={1} style={{ width: "100%" }} />
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<div className="slider-hint mr_top_5" data-hint="Selected Value: {value}">
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Selected Value: <b>4500</b>
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</div>
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</div>
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<button type="submit">Get a Guote</button>
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</form>
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</div>
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</div>
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</div>
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<div className="col-lg-6 col-md-12 mr_left_minus_100">
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<div className="image_box_only type_nine">
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<img src="/assets/images/form-image-1.jpg" className="img-fluid" alt="img" />
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</div>
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</div>
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</div>
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</div>
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</section>
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</>
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)
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}
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