<link rel="stylesheet" type="text/css" href="assets/admin-tools/admin-forms/css/admin-forms.css">
<!-- Feedback Form -->
<div class="admin-form theme-info" id="feedback1">
<div class="panel panel-info heading-border">
<div class="panel-heading">
<span class="panel-title"><i class="fa fa-rocket"></i>Your feedback</span>
</div>
<!-- end .form-header section -->
<form method="post" action="/" id="form-feedback">
<div class="panel-body p25">
<div class="section row">
<div class="col-md-6">
<label for="firstname" class="field prepend-icon">
<input type="text" name="firstname" id="firstname" class="gui-input" placeholder="First name...">
<label for="firstname" class="field-icon"><i class="fa fa-user"></i>
</label>
</label>
</div>
<!-- end section -->
<div class="col-md-6">
<label for="lastname" class="field prepend-icon">
<input type="text" name="lastname" id="lastname" class="gui-input" placeholder="Last name...">
<label for="lastname" class="field-icon"><i class="fa fa-user"></i>
</label>
</label>
</div>
<!-- end section -->
</div>
<!-- end section row section -->
<div class="section">
<label for="company" class="field prepend-icon">
<input type="text" name="company" id="company" class="gui-input" placeholder="Company">
<label for="company" class="field-icon"><i class="fa fa-building-o"></i>
</label>
</label>
</div>
<!-- end section -->
<div class="section">
<label for="email" class="field prepend-icon">
<input type="email" name="email" id="email" class="gui-input" placeholder="Email address">
<label for="email" class="field-icon"><i class="fa fa-envelope"></i>
</label>
</label>
</div>
<!-- end section -->
<div class="section">
<label for="mobile" class="field prepend-icon">
<input type="tel" name="mobile" id="mobile" class="gui-input" placeholder="Moble contact">
<label for="mobile" class="field-icon"><i class="fa fa-phone-square"></i>
</label>
</label>
</div>
<!-- end section -->
<div class="section">
<label class="field select">
<select id="gender" name="gender">
<option value="">Select department...</option>
<option value="admin">Administration</option>
<option value="sales">Marketing & Sales</option>
<option value="tech">Technical</option>
<option value="other">Other</option>
</select>
<i class="arrow double"></i>
</label>
</div>
<!-- end section -->
<div class="section">
<label for="comment" class="field prepend-icon">
<textarea class="gui-textarea" id="comment" name="comment" placeholder="Feedback message"></textarea>
<label for="comment" class="field-icon"><i class="fa fa-comments"></i>
</label>
<span class="input-footer">
<strong>Hint:</strong>Please enter between 80 - 300 characters.</span>
</label>
</div>
<!-- end section -->
<div class="spacer mb20"></div>
<div class="section">
<span class="rating block">
<span class="lbl-text">Rate our products</span>
<input class="rating-input" id="five-stars" type="radio" name="product-rate">
<label class="rating-star" for="five-stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="four-stars" type="radio" name="product-rate">
<label class="rating-star" for="four-stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="three-stars" type="radio" name="product-rate" checked>
<label class="rating-star" for="three-stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="two-stars" type="radio" name="product-rate">
<label class="rating-star" for="two-stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="one-star" type="radio" name="product-rate">
<label class="rating-star" for="one-star"><i class="fa fa-star"></i>
</label>
</span>
<span class="rating block">
<span class="lbl-text">Rate support team</span>
<input class="rating-input" id="5stars" type="radio" name="support-rate">
<label class="rating-star" for="5stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="4stars" type="radio" name="support-rate">
<label class="rating-star" for="4stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="3stars" type="radio" name="support-rate">
<label class="rating-star" for="3stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="2stars" type="radio" name="support-rate" checked>
<label class="rating-star" for="2stars"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="1star" type="radio" name="support-rate">
<label class="rating-star" for="1star"><i class="fa fa-star"></i>
</label>
</span>
<span class="rating block">
<span class="lbl-text">Rate our response</span>
<input class="rating-input" id="5s" type="radio" name="response-rate">
<label class="rating-star" for="5s"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="4s" type="radio" name="response-rate">
<label class="rating-star" for="4s"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="3s" type="radio" name="response-rate">
<label class="rating-star" for="3s"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="2s" type="radio" name="response-rate">
<label class="rating-star" for="2s"><i class="fa fa-star"></i>
</label>
<input class="rating-input" id="1s" type="radio" name="response-rate" checked>
<label class="rating-star" for="1s"><i class="fa fa-star"></i>
</label>
</span>
</div>
<!-- end section -->
<div class="spacer mb25"></div>
<div class="mb20">
<label class="field-label">Which areas require further improvement?</label>
</div>
<div class="section row">
<div class="col-md-6">
<label class="option block mb10">
<input type="checkbox" name="response">
<span class="checkbox"></span>Response time</label>
<label class="option block mb10">
<input type="checkbox" name="support">
<span class="checkbox"></span>Customer support</label>
<label class="option block">
<input type="checkbox" name="updates">
<span class="checkbox"></span>Product updates</label>
</div>
<!-- end section -->
<div class="col-md-6">
<label class="option block mb10">
<input type="checkbox" name="invoicing">
<span class="checkbox"></span>Timely invoicing</label>
<label class="option block mb10">
<input type="checkbox" name="social">
<span class="checkbox"></span>Social features</label>
<label class="option block">
<input type="checkbox" name="reports">
<span class="checkbox"></span>Reports & analytics</label>
</div>
<!-- end section -->
</div>
<!-- end .section row section -->
</div>
<!-- end .form-body section -->
<div class="panel-footer">
<button type="submit" class="button btn-primary">Submit Feedback</button>
</div>
<!-- end .form-footer section -->
</form>
</div>
<!-- end .panel -->
</div>
<!-- end: .admin-form -->